HomeMy WebLinkAbout010-941-25-2223-SAN-1978-149 \ .
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�P L B 6 7 � State and County State Permit # 18907 __
� Permit Application County Permit # _8_'�149_ _
for Private Domestic Sewage Systems County Sawyer _
CST 8-245 -
"DENOTES STATE APPROVAL REQUIRED ��� - 941- 25-�o-
Date Approval Received from State if Required State Plan I.D. # �� � 3 __
_ /Q`7�7/�) �eC �rh� LH
A. OWNER OF PROPERTY ; .- _, �- �:,ii Maiting Address:
.
� ��y�) r �-- 13� � 1 S_ ��
B. OCA N: Y4 ///U '/d, Section ��_, T L� N, R_ J�
j�-�-
�(or) W Lot#/ � City_
Subdivision Name, nearest road, lake or landmark Blk# Village
Town sh i pi�b������'ff,�f��
�-�
C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance
Single family �__ Duplex No. of Bedrooms "'� No. of Persons
.�
D. TYPE OF APPLIANCES: Dishwasher --��5 �NO Food Waste Grinder �6� � N # of Bathrooms_—
Automatic Washer 1� YES �6-, Other (speci ) _
E. SEPTIC TANK CAPACITY Total gallons No. of tanks �
"Holding tank capacity Total gallons No. of tanks
New Installation Addition Replacement_ Prefab Concrete
*Poured in Piace Steel Other (specify) __
F. EFF�T DISPOSAL SYSTEM: Perc ation Rate 1) � 2) 3) Total Absorb Area sq. ft.
New Addition Replacement *Fill System
Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches____
Seepage Bed: Length��Width��_Depth �__Tile Depth�_No. of Lines �_
Seepage Pit: Inside diameter Liquid Depth_ Tile Size �
Percent slope of land Distance from critical slope _
/ •
I, the undersigned, do here certify that the information I have reported is in accord with Section H62.20,
Wisconsin Administrative Code, and that I tiave sized the effluent disposal system from the EH-115 prepared
by the Ce 'fi d Soil Tester,
NAME — � _C.S.T. # ��7� � and other information
obtaine rom � (owner/builder�.
Plumber's Si tur � p� # Phone # �������
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of pe and all distances in accord with
H 22 includin well). ---
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Do Not Write in Space Below - FOR DEPARTMENT USE ONLYS
Date of Application 9-15-78 Fees Paid: State 10.00County 15.00 Date Ser�tem�er 1978
Permit Issued/ (date) _Issuing Agent Name Ela?ne M Nehrling
Inspection Yes No Valid# Date Rec'd
1. county (white py) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON; WI 53701
� state (pink copy) ��;� 4. piumber (canary copy)
Revised Date f/1/76
�f C�3>' 7
' r .
Department of Zoning and Sanitation o
Sawyer County �
m
�s
Inspection Report
�
Owner Gary S . Inhoff n
K
Addres5 p,0. Box 153 Hayward , Wisconsin 54843 �'
Name of business a
x
Builder °,
ro
Address
Plumber LaVern Dennis
AddPess Winter Wisconsin 54896
H
0
Inspection �
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� Private ( ) Public Property Sanitary-instal °,
�� � Dv�elling Setback - lake
Violation Mobile Hm Setback - road
Garage Setback-lot line y
( ) Sanitary ( ) Zoning Privy 'S�
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Discussed with owner yes no x'
Discussed with builder yes no I
Jiscussed with plumber yes no �O
Disc�zssed with yes no
Date - � �{ — �gj
1
Signature of Officer � • �..-
TOWN O � HAYWA R C
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