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HomeMy WebLinkAbout020-638-08-5303-LUP-1995-044 Application for Land Use Permit �� County of Sawyer o 7'he undersi.gned hereUy makes application for a Lnnd Use Permit and agrees tliat � all. work shall be done in comp]_iance wi.lh Nie requirenients of the Sawyer County o 7,oni.ng Ordinance and the l.aws and regul.atl.ons of the State o( Wi.sconsin. �-��� PRINT - USE BLACK INK OR PENCIL C;� L_ -{ I I,��1�.L%,u���� �U 5 f��-`�"'r� '`� ��,� � ��:. � "> �_ � . Owner Bui der ' /1 ~�� S . ' {'� � �� .; :y i; %c p . r. . Mai ing A ress Mai ing Address `'��W � '.�t�a��i�2 ��v � . : (� �<; -.? L < � i/ City, State, Zip City, State, Zip r o � Building Land Use Zone llistrict �:' �[, ° £ ( ) New ( ) P'illin� N j ( ) Additi.on ( ) llredp,ing LoL si,ze �, �j Alterati_on ( ) Grading �C` O Moving On � O Acres fr 3 7 � ( ) ( ) r . — r. New Construction � . �. r Size � ft wi.de ' wi_dc ' wide — `�`� ft long ' long ' long � rloor area ti �� sq fL sq fL sq it � N Total hgt � � to peak ' hgt ' hgt x' �� Stories - � No. of Bedrooms - rear lot line n•�-��a�e o� '' (year r_ound) or (seasonal) �'� G ' n 'I'y��e of i31dg, Addition, Use ��` � n. o ( ) Dwelling �� r' ( ) Garage (1) (2) car i �• � ( ) Storage T3uilding ��• �� ( ) Boathouse ���� °p ( ) Livingroom �, ( ) Bedroom ,, ( ) Kitchen-Dining ( ) Por.ch (enc7.osed) (roofed) ( ) Deck - open �� �V--i� G.;�CJ't ` �, � ) �� T pe of: Construction � ` I �Frame ( ) BLock � �� ( ) Log ( ) Concrete �� w ( ) Pole ( ) Steel. � ( ) ( ) Pole/Metal �' r-- - � .,, � ', � x n Construction Cost $ ': �;; ��� "'-�,tie� __\��, t�q�� � f- Vol -}i�- Pg ���{�: ot Deed _ � � � � CS Vo 1 -- pg __. _,.__�J� �' � I'� w Cer. Soil Test � _. . �,, � I . Sanitar Permit C ��c_____�____:: ~ Y 7I -aqOlaR ---------- L road y 0 �-.. . . . . ,� 7 '� Issued 14 March 1995 Uenied _ _ ���-��=_ /f�����s�•-�� ��.�1�'K-�—�)T�n s' Ocaner oni.ng Adminis rat r y� •�l;l,, .1�� � � . % ' . .. . . .. , .. � ; � l.�! � APPLICATION FOR SAWYE�'? �'OUll�7'I' ,`,� SAtVITARY PERI�%IT - v �ppZication # `:� z � � � Dute f� �� � � ��� � -....___.- r ee o f $ ZUo 00 rseeived � ' ` � ` `� " - `' �' � f < � �,.,�', • I _ - - '". _ } , �, , Date 4 County CZerk Y� � � � Apptication is hereb made or a Saw er Count� S nit � f � ,/ a a ry Permi � for �aork to be done on the premises de � cribed he �ein . � . � 8i �� kvsNN ��� � !J_I� �C /� t � ����'r'r �' �,� ! �t✓ � t�,� j,� �`� , O�ner Ad r� TeZephone The '� -� , o f tne � Sec . �y Twn . '�.3 � R, �u -��� o r Lot BZoek Su:� - division 0� � �W �- : � �� �t�r� t S . �Q�"7'L.1=i � L '�+r��f Y7't�cJ� . Work con ernpZat d To be performea bz� Number o f Bedrooms 'Z� Number o f Batjtrooms / Dishraasher .,..,:-�� Garbage Gr•inder _ �2_�� Automatie I�asher �.�� Soi Z D ' � �;i��C' _ escr2ption �- Septic Tank Size � 5�' gaZ . Seep �ge Pit h ze ght Diameter Seepage Prench L- Length � Ilidt 'rc '? ,�CDepth __�i� _�.�' Septic �'ank Permit � `� ' � .` �a. � Pereolation Test Form PLB 43 attaehed !-� Ye s No '� � -' . ,� . - ContempZated comp �etion date ��� l, / ' t ------�.-- . � 7� AppZieation Approve.d Permit #- � < ' .� :*�; Sanitariar� ,! , . . _ � �, ; T , .r Y M�:` . . ";`, � ` . Or�s2er Agent i:�ot2 � 2e Date7— Remarks �:- . , , . �' Finat Inspection. Sanitarian O � S —�� ��-�� � � �: , • � , Ou�ra� r/Agent Notz,fzed ( Date ) �:�: Remarks, :; ;�: X` * * �' Send originaZ � and thx�ee copies �vi �h . � � * €' , . • fee o f $��0 . 00 to Gounty Clerk =:�k=ti... . ' � Yl4soon�in Dep�rtssnt of Hsalth and SaeLl S�rviee� @Zb.�6� 3/10 . . � Divi�lan of Healtb � . SEPTIC TANK PERMIT APPLICATION � 7YPC or USS BWCR INK ?. ONNER OP PROPCRTY Nem� Addreas (StraeS, City, Z1p Coda) :7 � / � � _/ t� /1l t` i�� /�/v �� /3'tJ r} �i�r' .`: l�- B. IACATICN OF PAOPERTY iIHERfi SYSTLII WILL BE CONSTALCTED ALTERID OR EXTII.'DED COUHN ,�i�y � "�� Cheok Onee CSTY �YILLAGE LECAL DESCRIP7IWt --TOh'NSHIP, y-- � �_ ' ,l i C' /._ _ ��LV �/ i.. L',a.+-.. .�S '\-�- �� h y C. IS LWAL P6ATiIT REQUIRED FOR THIS;JOAK4 __YES _�NO '�`�J�_%��� PERNIR NUMBER D. SE:�TIC TANK CAPACITY /�.� - Caltons NEV7 INSTALLATION �� REPLACFI��NT _� ADDITION MA7'6RIALSi Pretab Conarete Poured in Placs Steel � Othe� NUlIDER OF TANKS 70 BE INSTALIED: I E, TYPE OF OCCUPANCY . Chaok Onea One or'11�o Fami�y Residence �' Co�ercisl J Industrial_ Other Speoify) Number of Persone to be Aaco�odated � N�mber of Badrooms "�? F. APPLIANLES, ETCs Food Waate Grinder YES i`NO Automatie Clothea Aeaher YFS�NO Dishwasher _YiS �e NO Automatio Pototo Paeler _YES�N� Other (Speoify) G. MA51tiR PUJMBCR l9AiCING INSTALLATF�i , . . ! \ tiams: �l� �`{ L� {'��e✓ ����'�%����Addresat �i_' ' 1�� � �'�Y' �L3oenss Number: �.� /� � � y(� `� Signature of Applloenti T-�� ' �C" - ' F:-' - - - "`" A1P ASN Addnsa: � -�� �-�.�-L-:.— r'- -- � H. (To be Compteted by Issuing Agent) / pate of Appliaa.tion �l ' ��' Fee Paid ; '! � _7"___ Permit Zseued (date) �f� " %- ;�� Permit NumbeT 1�{;"j;)',1 Agent (Name) �`, -���� f+, :�,e,� - . ^T`t��` ' For7 � ' ?i � � - - � Town� l aPe� Cit County� etc, �3?-vi,...__' � .�. . �� .' r i`.c.i.s.._� (Spe6 ) Note: The applioa�on aannot be eonsidered farYilir�until all of the above questions are swered and the � fee pnid. Agents nill to�ard appiieation, tne fee oP$1.Ou for aach septia tanx and the tnlyd oopy of th� permit (oanary) to tn�Diviaion ot Health. Cheaks and mooey orders should b�oade p�yabl� Lo the Dlvielon oP Hesath. Do not writ• in apace below - FOA DEPJRTttENT USE ONLY I�. DA1'E RSCEIYID ALCEPTED BY RE7'URNCD � . (Initials) (pate) See Corres.) � �� FEE RECEIYFD VALID, qo, PERMIT N0. es or No REVIEHC�BY APFROYED DATC (Initiale) Yes or No 4� ' � � . .4&Pt'IC 7�H1C PERtt1T N0. R i P 0 R T 0 N S 0 I L P L R C 0 L � T I 0 N T t S T � � 1 N D 9 0 I L B 0 A I N 6 S TO DIYzsIqf OF tl6AL?H - PLIZiB2N0 9ffi7FbN P.O.Hox ;f09, Msdiioa, YS�. 55701 pursusnt Eo H 62.20. N1�. 1ma1n1�trativ� Cods P i R C 0 L A 7 I 0 N T L S T T�at D�D� �'�ot�r of So11 Aou1�s NaLer Te�S Tim� Dro Sn iister Level Inohea utae 2UmCar Inohas Thialciess in Inohes Slnee Hoi� in Nol� Iatasval Secaad to NexL to Lant To Fali lat Ifatted Ovsrni in Hinutea last Period Iaet Period Period Qi` Inoh Exemyls P - 0 36�� To Soil 10" Cl 26^ 25 Y�e or No 30 1 2 1 2 1 2 60 / , r; _� i l. . U -'� � � . . _.,� �i G i t � � /r:�� � �:; / l.: i � �o i�(� ��i ' -". �� '- ."' . � �_��� ii -i . , � I��d ' " : � �lA:: rL�, / %. /1 �` `' % , L� ,.� - ._' .� � iI � T�J.�;1� !/./� l. L L� _>ii r�, /� � , RECORD DAYA FROM MINIIIUM OF 3 TCST HOLFS Cc.� -��t� dz� of absorption sna in aocord with H 62,20 Wis. ��Snlstretive Code. � S 0 I L B 0 R I N G S - tiiaimum 36� Below Pro oaed Abao tion S atw Borlr+g Total Depth De th to Grouad liatet Ds th to Bedrook Ii�ber Inoh�s Observad YKimatad Observed Estimsted Chnractar of Soil with Thfolmeas in Inohee Cxiaple B - 0 72'� 72^ Blaok To Soli 12" C 18�� $and 18��• Gravel 24�� � � / ;� �7 .� / .� �� �� � ��� � �,w�' . .. G iL.:L_.l.' �� ,.l q ` i „ ' ,� �i � <' :'/ .� . 0 , � ; _ _ < '�.,r..��, � % / C/ /, �'� �% _%� c/��!` f,�'lr`l�/ �-� � � A&CORII DAT1 FROM MINIML$1 OF 3 BOR6 N {.{:S P6 OR OCCUPANCYt / RESIOINCEf N�abar ot Badroame �- OTHER= (Speoify) Number of P�reons D WAST& GRIHDHi� Yes _� No �� Dislnrasher: 7ea _No -� AutomatSo Clathea Nashers Yes _ No _� F7UJENT DISPOSAL SYSPEFi: NE�' � E7CTENSION __ ADDITION REPWC}a�tEKf ___ Tile Sizs �� � No,Lin,Feet �1,�frenah Nidth � Depth � N�ber of Lines � Seapag� Bed� Length Width Depth Tila Size � No, Linea � Sespags PiSs Inaids Diameter Liquid Depth _ I� the undersiy�ed� Mnby aertiry that the penolation testa r�ported on thla form were made by me or under qy �uper vialon Sn a000rd xith the procedures and method speoifled in Chapter H 62,20 (13)� Hisooasin Ad�iofstrativa Code� and that tM data r�oorded and loaation ot test hoies ara oorrenS to the besL ot cry lmoxladge and beliaf. 7 _ NAME �� � L� TF�P N 1�}L� ��✓ ti � ' TITLC ��i L fz<'i_-�t � ' -C:�..-.�-.�._.��. _ � 1Type or PrinL) ` /, REGISTFiARION N0. o� MASTfiR PLUI�ER LICQ7SC N0. ��? 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