HomeMy WebLinkAbout016-637-08-4401-LUP-1994-167Application for Land Use Permit% y
County of Sawyer o
The undersigned hereby makes application for a Land Use Permit and agrees that
all work shall be done in compliance with the requirements of the Sawyer County 0
Zoning Ordinance and the laws and regulations of the State of Wisconsin.
PRINT - USE BLACK INK OR PENCIL
Sherrie L. and
Theodore S. Mataczynski
Owner
Route 1 Box 268
Mailing Address
Exeland WI 54835
City, State, Zip
Building Land Use
(New ( ) Filling
( ) Addition ( ) Dredging
( ) Alteration [ ) Grading
( ) Moving On ( )
( Replace ex ( )
mo i e—home
New Construction
Size 14 ft wide
70 ft long
Floor area 980 sq ft
Total hgt 12' to peak
Stories 1
No. of Bedrooms 2
(year round) mrxXxm=) )
Type of Bldg, Addition, Use
( ) Dwelling
( ). Garage (1) (2) car
( ) Storage Building
( } Boathouse
( } Livingroom
( ) Bedroom
( ) Kitchen -Dining
( Porch (enclosed) (roofed)
( } Deck - open
( Mobile Home
( )
Type of Construction
(✓' Frame ( ) Block
( ) Log ( ) Concrete
( ) Pole ( ) Steel
( ) ( ) Pole/Metal
Construction Cost $24,500.00
Vol44.5 Pg 139 of Deed
1
Richard Moore
American Mobile Homes
Builder
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1102 Lake Avenue West
Mailing Address
Ladysmith WI 54848
City, State, Zip
Zone District A-l*
Lot size 1287' x 1287'
Acres 38.06
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y��=�t.�':� , �,�;� /�pplication for Conciitional Usc Pcrmit -
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{,��.y� rt�;::Ui'T'S1�JJ1Cc� hereb� mak�`s �lp�)11 C�1t10I� fOT' a CC�I1C� . UtiC 1�C'I'Iili i: a?1Cl � �
:�`'` , �es t�hat�all w.o�rk�:shall be done in accordance with the require-
"" ' nts o n'.t+11e Sa��yc''r f�o�:��ty Zonin�; OrcliTia�icc ancl .<t�� l ;:ti:�s �incl rcg- �
� ��� �,�lations ot�� thc "St�ate � `.� Wisconsin .
.;:;� PRINT t I: BL1�Ch �I�K �;�:: PENCI�. � � � ,
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Owner ' � ' ' �� �'
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mailing address maili g aci ress
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Bui ding Land �;�e Zone I�istrict �_— � r o
(�New ( ) Filling o �
O Addition O Dredging Lot sizc _ r., �
( ) Alteration ( ) Grading `� '�
(t/�Moving On ( ) /lcres � ��
c✓ ' �N c �
+
New Construction I ,
Mobile rome garage ��'� deck fV�vZ
Si ze _ ��j/ ft widc __ fr ��i cie '
�Q _ ft 1 ong _ __ ft 1 ong r .
Floor area b Q sa ft _ � sb it �
i F—�
Total hgt �� to peak _ ? ' to peak �
Stories � _.
No . of bedrooms � ne -
(Ycar rouncl) c��1:G��c��cl ) o�
Tvnc oL- I31�?c; , ;icl�litioll , or ti_;� �' 1
C rr
) Dtirell iil� �'
�arage �) � j c�r �: o
) Storage building � �*
) Boathouse ' � ��
; Livin; quarters � a� ,
v�"' T9obile home � '
, .` __ I '
( ) � fi���� � .
�,��s � �'
T��pe of construction mb���� �
✓'� I=ramc ( ) 131ock � I" b p'�
� ) Log Concretc � ,
( 1 nole ( ) Stccl ��.,�k �� Q�`'� �
( , �letal ( ) r I
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g,;ld.`k� ��
Construction cost $_� ��� � �,
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APPLICATION F�R SANITARY PERMIT ,
� �ILHR ��<<--y�> >- COUTY �
� OEPRRT7TIEnTOF �P�B 67� UNIFORM SANITARY PERMIT#'�
� InDlISTRV,LFBORSHUTFf1RELFiT10f15
CST 86-018 77020
—Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8Yzx 11 inches in size.
—See reverse side for instructions for completing this application. PLEASE PRINT
PR ERTY OWN�R MAILING ADDRESS
c�L-�r /.:� �I7� �� I'li' I < l�. i�� f Lc.�,�.5 ��"</SS � �',
PROPERTY LOCATION CITY:
>> 1/45 1/4, S , T� , N, R (r �' (or) W owA F„ '1 �4���tv� 1-cc���
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
--'�-�'�� �7�_�� �I"1 �L �� � �c_� �-c�
TYPE OF BUILDING OR USE SERVED
i� 1 or 2 Family Number of Bedrooms: ��l [� Public (Specify): -�---- •
THIS PERMIT IS FOR A:
� New System ❑ Tank Replacement ❑ Repair
❑ Replacement Soil Absorption System ❑ Revision ❑ Privy
i� Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
❑ Seepaye Bed � Seepage Trench U Seepage Pit ❑ Holdiny Tank
❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # issued
❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total #of Prefab. Site Steei Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity ,'� � !-
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer. � ;
IF TNIS IS AN ALTERNATIVE SYSTEfJI C0IIIPLETE THIS BLOCK: ❑ Mound � In-Ground Pressure
Total #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA NIATER SUPPLY:
(Minutes per inchl: REQUIRED (Square Feetl: PROPOSED (Square Feet):
�l -1 l. � �7�; '_� L� Private ❑ Joint ❑ Public
I,the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (Pnnt): Signatu{e: . j MP/MPRSW No.: Phone Number. ,
�; - /;� �1 !�..f:. � ,: � ,�-.:. 'rl, ' ? --� � ,_� � �� �� (ji�> 1 ;'y'; -� � ,'.;.
Plumber's Address: ` � Name of Designer: -
� i� i: ��L �-,_� ✓� f )�� `� �� "_ �1�_.�.�-vz��� ��/G�� 3�, ,,. _���-
COUNTY/DEPARTMENT USE ONLY
Signa e of Issuing Agent: Fee: Date: ❑ Disapproved
�9 5 . �� 5- 5- 86 '� APProve� � Owner Given Initial
Adverse Determination
Reason for Dis p roval:
Aiternate course(s)of Action Available:
OILHR SBD-6398 (R.5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber
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��� I C� � 1102 WEST LAKE AVE_.
�C � � � � � �k' * * '� LADYSMITH,WI 54848
HOME SALES
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PHONE:715-532-3371 FAX:715-532-3431
RUSS THOMPSON EXCAVATING
SAND AND GRAVEL - SEWER SYSTEMS - BASEMENTS
SHOP RESIDENCE
703 FRITZ AV�. W.. LA�YSMITH. WI 54648 ROUTE 1. BOX 237. EXELAND. WI 54835
PHONE (715) 532-5892 PHon�E 1715) 943-2675
JUNE 1 , 1994
TU WHOM IT MAY CONCERN :
I Russ Thompson , of Russ Thompson Excavating , have
inspected the sewer system of Ted and Sherry Mataczyniski
located at Rte . 1 Exeland , SE4 of the SEa Sec 8 TN37R6 ,
, state of Wisconsin , and to the best of my knowledge the
system seems to be working properly .
The tank has been pumped within the last year and
there was no standing water in the drain field .
RUSS THOMPSON EXCAVATING
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MPRS 2777
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- �� "'� 1102 WEST LAKE AVE.
* * * * * * * * * �' �':.y��'.-'_- ' DYSMITH, WI 54848
HOME SALES 'i���
� ` MAY 2 4 1994 �
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