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HomeMy WebLinkAbout016-637-20-2202-LUP-1994-585 � . Application for Land Use Permit XX � . County of Sawyer o � The undersigned hereby makes application tor a Land Use Permit and agrees Uiat p all work shall Ue done in compliance wi[h the requirements of the Sawyer County � Zoning Ordinance and the laws and regulations of the State of Wisconsi.n. 'm � PRINT - USE BLACK INK OR PENCIL 3 �, � a �t/1/1l��,'.v A �.loy�ra, r� '�;�,,.} � � � Owner Builder � /3j I l3oK ;�.57 �%NcwSc.v /Sd � � Mai in��ress Mailing Address n FX���^'�� �r S't8 35 City, Stat2, Zip City, State, Zip r o Building Land Use Zone District ° � (1/) New ( ) Filling N n ( ) Addition ( ) Dredging Lot size ( ) Alteration ( ) Grading � , � --1 v � ( ) Moving On ( ) Acres ( ) ( ) ��' � New Construction :� Size a 6 ft wide ' wide ' wide S � ,3� ft long ' long ' long � 0 Floor area q 3 6 sq ft sq ft sq ft � � ,4 ( � 1 Total hgt � 7 to peak ' hgt ' hgt i� Stories 1 Nc. af Bedrooms � rear lot line ,��te o t (year round) or (seasonal) �' `T � r- Type of Bldg, Addition, Use "3 � a o ( ) Dwelling �• " (� Garage (1) (2)3' ar r• ( ) Storage Building � N I � r• ( ) Boathouse ° � ( ) Livingroom ' ( ) Bedroom 1 ( ) Kitchen-Dining � ( ) Porch (enclosed) (roofed) � ( ) Deck - open $5�� ( ) � rw ( ) �.o' Type of Construction � �`� �: y � � (� Frame ( ) Block �� 5"`��� ( ) Log ( ) Concrete � �� � P � � ( ) Pole ( ) Steel "�) � o ( ) ( ) Pole/Metal � v� � � � F\ � Construction Cost $ Sc�G ,cc °'� .:�, � G)' Vol �� Pg IyU-, of Deed ��-yr�� �r64 3G� � CS Vo1 � P ' �� H g T � ro � ,, � � Cer. Soil Test �_ � �� ; ����r n r � Sanitary Permit 7(�- 3�-7 4-2 _ L road -------------- z --------- � � 0 J/�c,.; �ri,� �p • z Issued _y�0 UC.G'�l-i hP� �9�1N Denied � � GZ. �fi1 t�i � 1r1-� -1'�r-,f�)LL, � Owner �Zoning A minis r� j�l��t{ .� 1 Jo��� 2�i � � . -� ' �' � vZOw v20W �20J C� J J � g' � g O � c � � �, z 0 �20� �ZO� �Z�W � 9J gJ 9J ' 1 � C , � � � J � D. z p . C� wzoW ti20� � ` , g� , 9- ' W � � o O < O — � . 20 �A c„ �O,w ;e en n -� n. lg�a �' � ox � � � 9 ;� -c �� -e � � � � :(� :n :'`; �i . '� r.: :: °^� •:i �: ��� �� � �a Z:7 .'- oi O iv �i `� P^ } ir. Cl i i CJ =i :� ^ M .(�z� �. Z� „� Q - C: � �- �W � N g•" `i ,� o '� n c �g ,� � '' .� . � � \ • Applicati_o� foi Land Use Permit: ' ' County of Sawyer o "fhe tm dersigned hereby makes application Lor. a Land Use Permit and agr.ees that 1� � .. all. work shall be done in compliance wilh the requirements ot. the Sawyer County o 'Loning Ordinance and the laws and regu]_ations of the State ot Wisconsin. � PRINT - USr I3LACK INK OR PENCIL � � � (��� � � �� �;y�.. � - ��`�z/ /� l✓� Y���,��� J� � � /�4 r - , Ocmer Builder :;. , � � on +` �ta'i i_ng � c�dress Mailing Address u G�. � �ity , State , Zip City, State , 7.ip r o Building Land Use Zone District � � ( ) New ( ) Filling -� m (�O Addition O Dredgi_ng Lot size v � ( ) Alteration ( ) Grading ( ) Moving On ( ) Acres `��. ����� �, ( ) ( ) New Construction �'_ Size `� ft wide _ ' wide ' wide " ,�� f t long ' long ' long _� Floor area �RC� sq ft sq ft sq ft ��'} rz�c � �.. Total hgt � to peak ' hgt ' hgt x' � Stor_ ies � —� No . of Bedrooms rear lot line _ _ ..___ _--r�e o 4J C (year round) or (seasonal) _ G� '� Type of Bldg , Addition, Use a o ( ) Dwelling �� rt ( ) Garage ( 1 ) (2) car �' � ( ) Storage I3uilding r• ( ) Boathouse °p (x) Livingroom Q I� ( ) Bedroom -3 3 �' � ( ) Kitchen-Dining �'� -�, � ( ) Porch (enclosed) (roofed) �'� -- ( ) Decic - open `�' r ( ) � � � r�r ( ) � � ya � '!� � �. ` � Type of Cons�ruction `_� � 2 . � (x) Frame ( ) Block - �- � v �'� ( ) Log ( ) Concrete �' :c� f �-= F�'' ( ) Pole ( ) Steel \ ��' �� �, � �.5� g ( ) ( ) Pole/Metal � ��S �,� � � .:.. � � � d v Construction Cost $ ��• ^ �n' r��s � �,4. � � y�• �„�'%' p`�I �1 S� C. Vol j �j� Pg ��((Z of Deed � '�� n � �4- -J; - �f��:� � � '� C S Vo i � i � � �-d y -���,`1-� -� � � � �' ` � � � Cer . S o i l Te s t dV � -10 �- ) �.s � ! ,, . U/1NSo r�/ ~ `; Sanitary Permit /V�fJ___ --------�- �L road �--------��-- z � �TT o . z � � Issued 30 December 1994 Denied �.. < � � � �; - Owner Zoning ministrator �� ' R , � � �"- ��-- "- APPLICATIDN �FOR SAtaYER GOUIlTY � . SANITARY PERMIT ' � ' � AppZication # Date ��9-�l� ^ fFee o $Z0� 00 received S - G� � � � �.�.,zz - ° �-����._ ' ,� � Jate County CZerk ������.� ��k� , . � �ip�Zzeution is herebr� made �for� a Sawyer Countz� Sanitary � Permit for wor�. to be done on the premises deseribed Fcerein. � f �.- i ;���r `� '� ' N 11 f: ..,r• ,.,r,`)...;. �o . �� _•--'�t���,��.:�.-- r-J ��/ ,� � . . ' 7n �����a e _ � � ; �un r,fr Ad�ess Te ephone The � �-�"'� _ o f the � rl �� Sec� 9'�` Trvn. ;"' �7 R, r. ! .> '�- �r m������ Lot � BZock Sub�division , v . "r'� �... _ �. t�:�'. ..,��..Fr,� �y ,�� ..,.�. ,�'� rL„R„' .l��l � �"�or� eont�mpl t �'�- " To` be�pez�formed � � �lumber of Bedrooms '�_, h'umber oJ" Bathrooms _�� ,., Dishz�asher r',1a� '` Gar"bage Grinder � p_� Automatic!'Washer t , l--�- �n SoiZ Description � : � - -. ... � -•. �: Septie Tank Size �� gaZ. ' � � Seepage Pit � zght Diameter • Seepage Trenc'n �_ i,ength � tdidth �_ Depth � . Septie Tank Permit # Percolation Test Form PL3 43 attached � (' I�s rJ0 ContempZated cornpletion ��date �� , �� c'.� � � . ' � � � _ _ , _, � Apptication Appro, ved ,- • .: Pe .rrnz`t #��� '�� , , ° . Sczni tarian._ .�, � �..�-c����� �.�"<��/.r'�,. � Or.�ner Agent �Jo z fi�a Dat�.' , , . Remarks . ,,;. _ : FinaZ -lns�pe�t' � . � ' • ��,.` ' , _,:� i ,.�;s, �;t ` „�_,� �,:' ;,, � �:: San�ta`ria�i -- / -- " Oraraer/!�gent Notified. (Date) Remarks � _ �_ ..._ �*'� Se�cd ori��nal��ana three �opies u�i�h . *** . " � fee af �`ZD. 00 to -County Clerk Y } .�.�_..._._—�._ --,.�-�._..� .^-�.. ._ 1� �.--,r- ,�. . , ..�. � .. . . . ' l �. . . . .. �! j � , , f � .. .. . ._� � .. . .. :. � � . � .. . 1 ' .�. n.. . � :(`� . .. , . � .. _ ' � \ ' '�� .�: . �.. '. .• , ... ., i .... . .:.. .... �"_ '�__' .. �.-.. .�� ..�...... "'_. . . ..... .. �. _.. . . . . ` .. .. .. . . ``� , . 1 I I�/��/� � ��.. �!//����L/ � � , �'1�. . . . � � . . . . 'i . .� . . . .. : .. . . _ � . ' . . . .. . . ..�•. � � �,. , . . :�, .. .. . . . , . . � . . , � - i 1 � f � j� j - ` -- ._ _ . .- _ .. �i �_; _ ` � ; , - � ( 1 _ . _ - -- . . _ ._ � ' _ , � , i � ,i � _. __ �._ _ _..-- __ _ _ .. _ : , � ' 1"� c � _ � � � ; � _ . - - -- __ _ - _ r - --�1 ---� . , , �1 � �� � ; -. . , , E`� . i .._. _ , .�< � - . � _ . _ ._ . .. . �� ;� . � � - ... . - �- . -. . .. . _ ___ _. _ ..__ __. . �� _ _ -- ._ . , � . . �-��� , , � . , ^,s�� �>i 1 ` ti'. � , _ � �•",. . � - �� • � ,�+ ..,,., - ,t . ,.. .. , ,., .: , .. . ::,.�.� ar', ��'" _ ;. ;" . `Q ._..._ ._ �:>... �.' ,. '_r�,.j.. .___s . , ��: _ 'a!'� / ' . . � ��5�.�. . ..�i1 ... :J ____„�/.y.�p .__...__. _ � -,i:�. ./,: •., `. tJ�' . �:;5 �'�dicate Lot sz�;e and shape, Zoeation of dwelling (�') � septic tank (ST), sep tic �ie Zd (SF) or seepage pi t. ,!SP)_ an�' dis�ance o f anu. � portion of septic s�stem from du;elling, r.�eZZ and p.ropert z� Zine . If property "Lies rait�iin �0 f�et of a Zake, river or a strEam so indicate an.d �hou� distance tl2ere,rom,. If_ anr� portion of t.he_ cor�templated eonstructtion w2ZZ Zie ti�ithir, 25 fee.t,'of :d�aeZZing, �ieLZ. - septic tank., septic fieZd or seepage pit o f abbut�ing vu�rier so indicate. Tlze under�signed agrees that aZl worl: perrormed and equipment instaZ_Zed_shaZZ be in accordance-.r�ith� t.'-:e Sanitary Coda of Saw�er County and aZZ applieable Zaw� and regulatio�zs of.`, tlz.e, a�ate; of_ .. Wisconsin and recommendations of the Sa�ver Count� San,i,turian... __ _ ; � i\>.t � . ;;,_} �t�_.1 _. ' �.:;�- --�---___ _ __ _ ___ .,., _. .. ! � �_ _____.___________._____ . _.._ _... __ ___. -D�ner;--�Q�ent Sian ure .. . �:�.�. �3�:t ^..?:Y C�`r �:;:�..�:� ' _.n'):� S:��v s�S�..;_ k�� . K� i • '�.'Y9��..� �ir?\:Ci�, J;t r.:� . l� �t :r �EO :f.'C ` 1 Form. Plb �7 Wisconsin State ' APFLICATION FOR PERMIT Division of Health f or _ PUR.CHASE OR INSTALLATION OF A SEPTIC TANK (Sec. 1l�1�.03, Wis. Stats.) A. OWN�.R OF P'ROPERTY Z'yPe or use BLACK ink. Name � Address Street, City, Zip Code , � ; l � " .�- B. LOCATI F PROPERTY WHERE SEPTIC TANK IS TO BE INSTALLED Check l. City Mail address County one: 2. Village 3. �Town � � � ; ,�� �� / � L-tL �Z Give license number held: C. INSTALLER Wisconsin Restricted -- Licenssd Sewer Plumber � Services N Address � J ' � `���r /� r� � D. S�ECIFICATIONS OF SEPTIC TANK �W TANK � REPLACEMENT Size in gallons: Check one 1. 50o g�.. 4. 1,50o g�. 7. t�,o0o g�. 2. �/ 75o g�. 5. — 2,o0o g�.. 8. — 5,o0o gal 3. 1,000 gal. 6. 3,000 gal. � 9• I�over 5,000 ga1. give�capacity Materials: l. Prefab concrete 2. Poured concrete 3. �eel E. TYPE OF CUPANCY 1. ingle family residence 3. Commercial establishment S. Other 2. Multiple family residence !�. Industrial establishment F. APPROXINIATE NUMBER OF PEftSONS SERVED DAILY � G. PERCOLATION TEST MADE 1 ;� Yes 2. _ No Date -- �'..5� -� �Cj d � • By whom �j (To be completed by County Clerk) Date application is filed and fee paid .S/-/� - i �J Permit issued date) - - Permit Number ���y�� County *� Clerk � , ��`���-c� Note: The application cannot be .consider for filing until all of the above questions are answered and the fee paid. County Clerk will forward application, the fee of $1.00, and Copy (b) of the Permit (yellow copy) to the Division of Health. Checks and money orders should be made payable to the Division of Health. P�.'� SSPTIC TANK PSAPQ? N0. � ���2— ' R � P 0 R T 0 N S 0 I L P t A C 0 L A T I 0 N T � S ? " ' A N D S 0 I L B 0 R I N G S ?0 - DIYISION a!' HEALTH � PWI'IDZNG StCTIOdJ P.O.Box 309, Hedison, Wis. 53701 Pursue�rt to H 62.20, Wis. Adminiat�tiv Cods p� PROPERTff ADDRESS /} � LOCATION (C ok Cit " Yillage 2oxu v "� . /F�.�����Y .��t.� TaKrtship f• N�TliR SUPPLY Fli�is Publio Utility Cooperstive Privats i(ell *,! .--....�� /' , ' SEbU�G� DISPOSAL INSTALI.ED BYt / — Address j11��� �+ . ��{��� Dats �_r .., �7n /y ` �-�� ��— SEP?IC TAT7K SIZt '/,��'�l erial �.-i Peroolation & Soil Borings Test Dat� �r_�d EFFLUENT DISP.t Tile Sizs � No. Lin. Ft. �_?r�oh Nidth '":_"t�� Depth of Til• /� � Saepage Bed: Ler�$th Width Depth of Til� —r�— Seepage Pite Outside Diamater I.iquid Depth TYPIi OF OUCUPANCYt R6SIDCNCSs Number of Bedrooms �,�,_ OTF�R: (apeoiPy) Number of Paraons � FOOD WASTB GRINDERt Yea No�Dishrrashor: Yea No �Auto�tio Clothes ifsahert Yes No� P E R C 0 L A T I 0 N T E S T Teat Depth Charaater ot Soil Haurs Mater Teat Time Dro in Water Level Inahes Minutea Nueiber Inohes ?hiolmess in Inahea Sinos Hole in Hol• Interval .Seoond to Next to Last To Fall lst Wetted Overn in Minutes Last Period Ifist Perio Period Ons Inch �uoaraple P- 0 36�� To Soil 10�� Cla 26� 25 ea or no 30 1 2 . 1 2 2 60 �' /� f /� � / , . '� /� r II �l J I / ri �� �� U li I� RECORD ➢ATA FROti MINIM[ki OF 3 HOLES Compute size oP absorption area in a000rd xith H 62.20 wis. Administrative Code. S 0 I L B Q R I N G S • Iiialmum 36�^Below Pro osed Abao tion S ste� Test Total Depth De th to Ground Water De th to BQdrook Nuaiber Inahes Observed Eetiasated Observed Estimated Chare,oter oP Soil with Thiaknaa� in Inohss Y�mple B- 0 72" 72" �C.1 Bl 'Co Soil 12'! C 18p Sarid 18„ Gravel 24„ l I �' r� �. � �. / P � i�� �J � ...T:. r,._ � l;;i U �!j i . r/ f!,• � � �% Q ��/ ,,�d ,�i '� �� s� RECOf� DATA FRO[�S MINIM[1M OF 3 TEST HOI.ES I� the undersigned, hereby oertiPy that the peraolation tests reported on this form xere made by me or under my auper- vision in sacord xith the prooedures and method apeoified in Chapter H 62.20 (13)� flisoonsin Administrativs Code� and that the data reaorded and loaation of test holea are oorreot to the best of eqr lmowladgs ar�d belief. NAMT �L�� ' TITi.Y �Y�"�� Typa or Print � a REGISTRATION N0. o� MASTER PLUMBEft LICSNSE N0. ADARESS DATE _ ,�`�^�i� �- �D SIGNATUI� � 4 ' � �l� .. r' ' � . ORIG.�NAL � 377�2. � Own�r ?dusr. �1-�_�:�rv� T;.'.:. . Certific�t� CERTIFICAT� CF COMFL7ANC�? Pre�nise� located in N_...�:_�`� N��.�._.u� :=:�ct�_ora » 2U � 37 ;V°. , �t 6 h�._, Tow.� �f' I,��::tclor•rbrook.�__._.._..��. °_�' -- -.----j 8�.o r.k_._._.�..a. _ _...-...�. �._....__..��'�d i v- �i e.: �z?.te� �1��,191_ 197v ��i+�c F.....,� ._ . ..,_.m.---�._.......r_,._...�.__._,w t;}:�:c::L Cn�: ��s�z��r ..�..�.__..�-._. J�rr r�c o,jkE�__..�.._.....a_.�_.......___........�. TJo L�uildin �1�ti; � 1�.��.'t"£�8.�. .,... , �:XBticst�Q�. ;�� SO.OtIS��,+�?.�'��._..._ f?.i:Cl;� �....._. Contam�lated ��a�="•��` ` , - t+s e _�.:_- - -�-- Tr+ i 1�r... 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