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HomeMy WebLinkAbout004-839-08-5313-SAN-2023-143 v� SAWYER COUNTY ZONING & CONSERVAT�ON ADMINiSTRATION ' D 10610 Main Street, Suite 49 Z Hayward, Wisconsin 54843 : � (715) 634-8288 �,,� s_anitarian(n�sawyercountVgov.org � COUNTY SANITARY PERMIT APPLICATION w in accord with Chapter DSPS 383,Wis. Adm. Code and Sawyer County Private Sewage System Ordinance APPLICATiON iIVFORMATiON—TYPE OR PRINT Property Owmer's Name Property Legal Description `�o,.h�� � �"���` ��•��^C.f 5 GL '/4 '/<, Sec. g ,Twp.3 � N,Range $ � � Property Owner's Mailing Address Lot Number Block Number I � -1 I-I�;r I oorl p�-vG 2 City,State Zip Code Phone Number Subdivision Name or CSM Number N��soh �; gyo�.6 ( ) 3c/zi8 # �yso TYPE OF BUiLDING: (Check one) ❑ State Owned ❑ciry Nearest Road �e,.,�,5 r ❑ Public �1'or 2 Family Dwel►ing—No. of bedrooms ❑village �own of� �O�J�"rY Fire Number PUBLIC BUiLDTNG/LAND USE: [Explain d,�use/purpose fur d,ls Parcel Tax Number: (12 digit legacy number) pennit,(i.e.,campground,festival,recreation/entertainment ecent etc.)] � 0 0 �-� 3 �' -og -� 3 _ 3 Tl'PE OF PERMiT: Additional Information: ❑ POWTS Reconnection(SAN# - ) �POWTS Connection (SAN# "ZO - 2Slf) *Attach a Plot Plan with all required information per SPS 383.21 ❑POWTS Revision (SAN#_- ) ❑ POWTS Repair(SAN#_-_) *Soil Test Information (CST# 20 - Z�Z ) ❑ Other: * Gallons per day �SO RESPONSiBILITY STATEMENT: T,the undersigned, assume responsibility for the installation of the POWTS activity for which this permit is isstied. Plumbei's Name:(Print) Plumber's Si�nature MP/MPRSW No: Business Phone Number: � (�,� 5�4� )�C I�� [ �z (��Y� ss-� - sy�y Plumber's Address(Street,City State,Zip Code): 6g u M e�-��,1.� r� OFFICE USE ONLY: l�isapproved Review nate: 'ermit Fee: Date Issued: Issuing Agent Signature �Approved ❑Owner Given Reason for �I�� �� ��.� � '��� I�j ,y� �� - Denial �v COMMENTS: **Expires 2 years from date of issue** Expiration date: � I ��j � �..5� CONDiTiONS OF APPROVAL/REASONS FOR DISAPPROVAL: D D - f � � � � ����sL. -� � 1: ,�3 �� �UL 18 2023 �� �� � ���� � � ^ �k# ��S .��..�--••�-�--_ '�t,e...�_�—,.,_..�.---�-- SAWYER COUNTY NtNG ADtJI{N15TRATION Rev. 04/21/15 y 3 6�� NO R�FL1hD5 AFT'ER ISBUE OF PER1t�T �l� CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE. � SOIL EVALUATION o s��e:4°a ao� 60 80 � SYSTEM PAGE 2 OF SITE MAP PLOT PLAN /� PROJECT NAME: oesicN F�ow: '�1�� cao 1a' Attach design flow calculations for commercial plans. PROJECTADDF2E55� ��1�5 ^� Pipe Malenal/ASTM Standard(Tables 384.303 8 384.30-5) NSanitary Sewer S�� �j b / BM Symbd:� BM1 E�1-albn: ��U�6 FT Force Main'. / eM cesc�ptlo��. �Ol` �n�'1�- ��nN. ma�ica�e nonn� IMPORTANT: Slope G2tlierrt(%) Well Symbd(ifapplicable)'. � arawing an Show ground elevation contours ai sui[2ble intervals. of Tes�etl Arra'. on Ne aPProPa'�te liire. �,`�-}I t �,, 1� L G� „�� V'" ��,kc ��p�aSeG �a4" � � � .o aa� �o�� , —, ' ',�,��w�y �_ �, 1 � J �oh.5 1�z Dylan Schultz 7076N Stone Lake Rd Stone Lake,WI 54876 MPRS 15161 , I / Indusny Services Division ��y F 75 , \ S�3 v �� 1400 E Weshiagton Ave S�.�w�y f(� l./ P.O.Box 7162 gmihry pe�micximb�(m be filled ia 1 � �� �� Madisoq WI53707-7162 Z , �� �5-� �� - �oa '�2� q�o I Sanitary Permit App ication �T�uctiwN�bc G m eccoldmw w;m srs 7ss11a).wis.nam.coaa wbmiuion orm;s to`m w me ypmp�iue govanmmw wit ` is mryiied prior w abtammg a amitay pemi�Noee:ApplieaGm fmm+for ataro-oaned POVVI'S ve aubmiRed m projst Addrtee(if diff�t ehm mulin� i the Depc�mt of Safrry'md P'ofeaeiamel Serviw.Pvnond'mtrnmarton yw ymide may be used for sewudey T 2 ( � m�coadmee with Wa Aiv Lw s.15. 1 m Stam '���"'�"'� � "�' �I L A Ilcatlon Inform�tlon-Plqse Pr[nt All Informetioo � P�opmty Oana's Nme Pucei q �� D�.�.�..i�( y �.-��+-�. T�Ikes ooy_ 839-0�- 3 i ' Ropaty Owvc'c M�iling Mdrn� Property La�ion ►7 �,tr-i�. A ve c�.i.o� � �3 (.tiry.sme zip coae rn�e x�mbe v. v, s«son `6~ �vCtS<:.� �✓t .$�'{Oi/� (circleoneZ II.Type of Bnllding(check dl that�PP�Y) La q T�—N: R � E o<<nv�, �I or 2 Femily Dwnllin8-N�bc oCBed'ooms 3 a Subdiviaiw Nme Hlock q ❑PublidCa�merc'ut-7eeenribe Uae ❑City of ❑9t�eOwved-DesaiM1eUx CSMNumbc ❑Villegeof 3`�2i8 ��� �t�or C��.�.<<n�ti III.Type of Permik (Check wly one boz on Iine A. Complete line B H vpplidble) '�. xew sy.oem ❑ Rmlac�mt syrt� ❑ rrotnmHHdaing T�t xeplac�m[onir ❑omer hfoaisrmam w P.rie1mB SYcim{Wlain) B. ❑pq�t pmervA ❑pe�mit Revuion ❑Chimge of Pl�bc ❑P�it hms6c m Naw Lirt Pmvio�o Pmmit Nimmba md IM2 Lcuad Bdme F.+�intim Ownc IyV.T otPOWIS 9 mlCom anUDavfce: Chacic ell that a 1 I�Nan-Pfa�si¢ized In-Cno�d ❑P�maviaed Inl3mund ❑Atl3nde ❑Mawd>24 in.of suinble soil ❑:Nowd<?A m.of euCable eoii ❑xoiaroB r� ❑omQ n�w co�mn car�> ❑����c��> V.Dh rabneat Ara Intormatlon: Deug�F7w(� Deai�soil npplimion Rae(�def) i IhwR**���a��(� �v�aes Pmpowd(� sM�F1ev�¢m yso _ � � c� �,� �-s-z G �.v VL T�nit Info Cepecity in iotal p of ManufiGiac GWlom Gdlom Unib a y�' � u Ne.�Tdo Hriam6Tmlo • b 'a �S � » a� �o � s°P°`°f�B Tm` f�r — ItL�c^ � w�r'� r r �C �i ce�cQ VII.Ra nsibility Stfbment- ;fhe nad ad,�rome rapoodbllity Por Imhll�tlov o[tEe POR'I5�6own oo the�tlathed PI a N Pl�ba'�3i�imve IvIP/�R9 Nnmba Buemm Phome N�ber `�erry`�u�accavattng, LLC �� �-��,�.�� 7�S- `�9�- 2voq � Stone Lake,WI 54876Pc�� vm. o rnn.ot u�oo , � � � ed ❑Diwppmved Pamit Fa Dffie Lsued IssuiEg S' . ❑o..�ac�„mn��� s Oc�.'a 10�15 ZuZ� ' � IR Condttiom of Approc�VReawm for Dlappronl OfI ��GiI ��L N�ACfUNDSAFTER ISSUE OF PERMIT r, � !�;;r,�n-,� ,. Mwrooemvlekvd�mrerm.m0�.mmumnmmecemaonbonwvv.otlsm.. vin '1reYp_ me;_,� _,_, i..-:.. �C+1-- #- � IZ� , io��5� 2�2� � .'.!� ocr o s z�zo ;, ,__ SBD-6396(R.OS/14) i. ..:`i ; r� ::� .: :f;, ZONING AUMWIS7FATIOM cMEcrc eox�s�airne�E c►�c eaoc�s�avtir.�a� � S01L EVALUATION �� '' =40' � SYSTEM PAGE 2 OF SITE MAP ° �° B0 80 PLOT PLAN PRa�cr w1ME �a, o�ic�t F,.ow: �{SC� � AtE�h dasign tbw c�Cutetl�a tor oonuner�fei pfarw, �cr�no+�se: ���...� �� N a�n�i�asr�s�a�R�aea.�s a ssa.aas} �y�:-7c..t, Ko ,p t�c., tjn eMBym�oi: �i e�ff3evsnon: 1��4 F-r ie►i e..cnp�: 2�'� wk�i� {�i,ve. r..,�[� Scr�ca.; Form�a�r,: ry.Fa � at�e���rc�� N'"���(��1 O ��� show grAurxi elevatl�at sulbbte h�v�. ai tlie epproprlm�, -�-_..�.---"_' ..�----- L-./,f/�'�, L.. .C�. CJ � �'. _ ,��'..�`-�_ _ ' � -- _._..-- .—....__.___ - t 9a� � 2. q 7, c� � � 8. l ►� 9 7�c� 5 96�R � s K (o `�`�• �(S -�ol-- � �, � Ko�� e, �q_a� • l.�.ke. -- 7�i,o `� SYS�^ _ ��t.�t2 _ 93 ��q � . �o�� � � 3 - �Gc�roor�.. sysa-c.� � dt� �...� C.<<,,.�.p� 1-�w K v � . Jerry Ruid Excavating, LLC W208 County HWY A Stone Lake� WI 54878 � 3�' , ��{�9.6.� /ytP�PS �� ���