HomeMy WebLinkAbout018-837-21-3301-PVY-2023-001 SAWYER COUNTY ZONING&CONSERVATION ADMINISTRATION -L�
10610 Main Street,Suite 49 �
Hayward,Wisconsin 54843-0676 �.
(715�634-8288
www.sawvercountveov.ore w
NON-PLUMBING SANITARY PERMIT APPLICATION v�
In accordance with Chapter DSPS 391,W is.Adm.Code and �
Sawyer County Privau Sewage System Ordinance ��
C�
APPLICATION INFORMATION-TYPE OR PRINT PAGE: of �
�P�Y Owner Name P(opaty I.cgel Daeriplian
� 5�'la '���•���, S 2� .T 37 N,R 8 W
Propeny Owna's Maili�g Add�ess La Numbn Blodc Number
T'r (
City,State Zip Code Phonc Numbcr Su6dirision Name m CSM Number
` �y G ( .Z) ',� ."7
TYPE OF BUILDING:(Check one) State Owned Ciry Nearat Road ��
❑Public �1 or 2 Family Dwelling-No.of bedrooms ��'��0� �
— y�r�or�ppe ��' Fim Number# t( �
PUBLIC BUILDING/LAND USE:[Fxpainu�e usdpwp�sc faUris Peml Tax Number.(12 digit legacy number)
permh.li.c.,eampg�oind.fativd.�ecalioNenunainmenl event pc.11
Q��-.��Z-Z1-.�3.5�.1
TYPE OF PERMIT: TYPE OF NON-PLUMBING DEVICE/SYSTEMlfOILETNNIT:
❑Privy-Pit Toilet(CST# )
�Non•Plumbing(Privy,Toilet,Restroom,Etc.) �Privy-Vault Toilet(200 gal. min.capacity required)
(Vault size:Z'�gallons or cubic yards
❑Other. Vault Privy Type:�Concrete�Steel�olyethylene 0 Other
❑Composting Toilet System ❑Incinerating Toilet Device
❑Portable Restroom Unit ❑Other
RESPONSIBIL[TY STATEMENT:
I,lha undersigned,essumc rcsponsibility for thc installation of�he non-plumbing soni�ary system for which this pcmmi�is issued. 1 funha egra that
eny dwelling in conjunclion with Ihis permit N�ill�rot be provided with indoor plumbing and/or wa�a haokup. I will usc thc non-plumbing ryAem
indicnted as n meens of wagtc disposal,anJ I wiil carry wocer to md from the stnicluro. 1 undersland that bcfarc indoor plumbing and waler hook ups
arc insmOcd,thc proper S�e nnd Counry Pcrmits will bc applicd fw. I funha undcrstand that any dcviwions Crom the above will constimtc a
violutlan of Sawycr County Ordinanca und would subjcct me tu the penalties of the Ordinanas. By signing this applicetion,l am also grenting
pertnission lo thc mning depeAment pttsanncl to rnta my property et any mawnabk time for thc puryose of inspenion lo aswre compiiana with
the zoning and seniution�aws relative to thc iswance of�his permit.
Oxner's Nemc:(Prinq Owna's i mwe:
G
OFFICE US ONLY:
Disepprov�d Prnnic Fa: C5T N. Due Issued luui�wgeM Sip�Murc
�npp cd ❑Ou�rcrGivcnlnitid SI50.00 � ;�j�:;I�,< ZV�y��G:_;-I-�.t,'�v"
o Advcnc Dctamim�ion .� . . .�-.
COMMENTS: ���� � ,
i � -
L) ���1�_`�-;.-- •'
"Expires 2 years trom date of issue ��
•NO REFUNDS AFTER ISSUE OF PERMIT F'EB 10 2023 �
SHORELINE PROPERTY:�YES NO If"Yes,"Name of the bod of water: ER COU�iTY
CONDaI IONS OF APPROVAUREASONS FOR DISA�ROVAG:
V'r�Y���� �
� 1�;��3__
��I r11 '`I�r
�J.,1N�nJn 1)�1
Rev.04/29/16 �-c"t+,
NO R[FUNDS AFTER
ISSUC C�PEfiIJ:IT
NON-PLUMBING SANITARY PERMIT APPLICATION
PAGE:2 of 3
6— N��a^
Privy Plot Plao
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Please include the followiog iaformstion with distances on the above plot plan:
�North Arrow
�Nearest Road
�Site Address w�,�++�aj �rcr ���+��'ti�'�
p�Swctures
6�Well (�f� We11
cxPropeny Lines
a�Lake,River and/or Stream �eer�-�e-
�Wedands �.ferr�
Minimum Setback Requirements:
(•�10'from any slab constructed accessory building
�25'from any habitable building
45'from any property line
50'from any water supply well
75'from the ordinary high water mark of navigable waters
�130'from the centerline of state highways or 66'from right-of-way line,whichever is greater
Rev.0429/16