HomeMy WebLinkAbout020-639-23-5503-LUP-1994-032 Application for Land Use Permit
County of Sawyer o
The undersigned hereby makes application Cor. a Land Use Permit and agrees tliat `� �
all work shall be done in compliance wi�h the requir.ements of the Sawyer Cotinty o
Zoning Ordinance and the laws and regulations of the State of Wisconsin. 'fi
PRINT - USE BLACK INK OR PENCIL �
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Owner Builder
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Mai�ing Address Mailing Address
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City, S�ate , Zip City, State , Zip
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Building Land Use Zone District �� �
(X� New ( ) Filling � r�
( ) Addition ( ) Dredging Lot size � '�
( ) Alteration ( ) Grading
( ) Moving On ( ) Acres . j �j
( ) ( ) �
New Construction �
Size 2 � ft wide ' wide ' wide �
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�10 ft long ' long ' long �
Floor area 9(o C� sq ft sq ft sq ft
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Total hgt � Z � to peak ' hgt ' hgt x' (��
Stories �
No . of Bedrooms " �,��,�,� or waterline o
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(year round) or (seasonal) �- �`'_ -°`'F� ` ` '' � 1 ' � �n rt
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Type of Bldg , Addition, Use p�, o
( ) Dwelling �• '�
(K) Garage -(s� (2) car �•
( ) Storage Bui ing r. �
( ) Boathouse �� � �� °
( ) Livingroom �� �
, �...
( ) Bedroom - ` � 0
( j Kitchen-Dining � �' �
( ) Porch (enclosed) (roofed)
( ) Deck - open �
( ) � rw
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Type of Construction '
(X) Frame ( ) Block fi`�
( ) Log ( ) Concrete �`' r��
( ) Pole ( ) Steel `
( ) ( ) Pole/Metal � v�
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Construction Cost $ 0� ��:
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Sanitary Permit `=�;�, �- ;�_ � C T�' , � __
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Issued 12 April 1994 Denied ►t �
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U I°�llf N�C CAPITAL SURVEYING, INC. �
523 E. OGDEN ST. TELEPHONE 715-748-5597 SURVEYING SERVIC�.
� � � SUBOIV1910HS �
MEDFORD, W IS.,54451 PROPERT�Y SURVEY9
TOPOGitAPNIG MAPPING
STREETIYPROVENENTS
CEFTIFIED SU��VEY T�AP N0. ROUTEIOCAT10N5
PLOTPLANS
N. LINE GOV'T LOT 3 ` N 89' 25' 19_E 938.50'
N 1�4 COR. s �
23-39-6W 781.98' '9:.'o
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�'��� AREA E. OF ROAD
.46 ACRES
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CURVE DATA FOR Q. OF CURVE � AREA OF ROAD
TANGENT BEARING RAOIUS ARC LENGTH CHORD LENGTH, BEQRiNG �
, .38 ACRES
S2l� IB' 2YW � � y
5 7' S6�14" W 107H.63' 231.70 251.I3 �, /N AREA W. OFROAD
5 I4�37' 20"W . ,o ya 1.89 ACRES
0 ANGLE V ,fi�o
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WEST 521'* ��--- -- ��(A _ 18
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9 374.38' , •/ 35.43' 35.4� 5232' 23��
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EQST 458�+ ��1-- —�-�-.^�,�i �'
I , Charles Offer:nan, L�;nd Surveyor of the St�.te of Wisconsin, do nereby
certify that I have made ttie follo;aing survey of part of Government
� Lot 5, Section 23, T. �9 N. , R.6 Yd. , Sawyer Count,y, Wisconsin, mcre
� particularly describedlas follows: Comriencing at the N4 corner of said
sect�on 2? , thence N 89°2� '19" E, alon� the N. line of the said
Government Lot 5, 7�'1.98' ; thence S !�!f 32 '!�0" E, alon� a randoM 1;ne ,
Z�„ lOR.591 ; thence S 24°21 � �7" W, al ong a random line 7bl�.76' to the point
�« of reel begtnning: Thence West, 1�09. �1� ; thence South, 2��.00 ' ; t�ience
�im �ast I{.5R ' more or less to the shore of the Chi.ppewa River? thence
uo� Northerly a�o�ig said shor-e , 250 ' more or le9s; . thence West, 111 '
��� more or les� to t�e said �oi_nt of real beginning.
mu, Said parcel bein� s�xbject to all exceptions, reservat�ons , easem3nt� ,
y� and restrictiens , either in use or of record.
N,y •
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mm Register's,Office � g � 3 .� oD M�`aSe�!?�'�•„
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�m Sawyer County } y'��i'4�'`-."?".. F�:s;
D z /� ^.�t'�Ll.,`„":v"t S?ti" -'�.,m
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m Received for record the day o� � n:•� y< � '�,�''i� .�
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rmn ���✓ A D 19 3�o'clock � �� �;-i��E7.1 r�.�-. ,` -''.r
�o I.t and recorded in vol�_ � �� �`ryF�f.,` r�
�_ �(Jbil'- N, on page_�3� ' ,J Q� � c:�. :ru� :
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LEOEND
—�-- IfiON PIPE FOUND
TM�S iN$TRUMENTORAFTEpBY DEVON VANDEN HEUVEL --�'J t"X24��IHONPIPESET�MIN.WT. 1.13�BIlIN.FT
�� ��-� —�-- 2"X 30"IRON PIPE SET,WIH.WL 3.65�B/LiN.iT
--�— fTON[ MONUM[N7/OUNO
��-- IRON PIN$ET (NAII�R.R.SPIKE,ETC.i
� 7' DIAMETER, CAPPEO GALVAHIZFD VIPE F.I.P.
1 CHARLES OFFERMAN �LAHO SURVEYOR OF THE STATE Oi WISCONSiN,DOHEREBY CERTIFY TMA7pN NOV. 2, 1983
� ��.tvE�tG 7ME A80VE JESGRiBEO PROPERTY ACCOROINO TO OFFIC�A� RECOROS ANO CMAPTER 236 OR THE REVISED STATUTES OF 7ME STpTE 0►
"'•SC�,w:'iM;TMAT TME ACCONPANYINO MAP IS A 7RUE AND CORRECT REPRESENTATiON OF TrIE EXTERIOR BOUNOARIES 0� E�AND SURVEVEO;TMAT 4�.
j�.O�NGS ANu �NPROVEMENTS �iE WMOIIY WIT111N THE 60UHOARY �iNES� ANO T T N NCROACMMENTS BY AOJA PROPERTY OWNER8 AP�EAFt rROw
`.. ,��RvE` 6xCEPt' AS �wO�CATEO.
MIKE MARGAS
23 -39-EW
��f� ���MM y'�`� �� � � RE(t�STgREU .AHD $URVEYOR
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DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR sa,FEry& Bui`_�.-
LABOR & HUMAN RELRTIONS pRIVATE SEWAGE SYSTEMS DIV{'ST
P.O. BOX 7969 BUREAJ OF P!.,UM.911
MADISON,WI 53707
�CONVENTIONAL ❑ALTERNATIVE S�atePlanl.D.Numbec
11f assignedl
❑Holding Tank ❑ In-Ground Pressure ❑Mound
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE�.
' u � �l l�Y ,�S /� 0 %�Q i�% �f/����e.� �.c�r s c� /- i�/- �3
BENCM MARK IPermanent reterence pom DESCRIBE IF DIFFERENT FROM PLAN. REF.7T.ELEV.: CST Rk F.PT.ELEV.:
Name ol Plumben MP/MPRSW No.� Counry Sanrtary Permn Numbec
1�v rv.o-/� �o.z, 0`2�' � ��u/ e� 3- J....
SEPTIC TANK/HOLDING TANK:
MANUFACTURER�. LI�UID CAPACITV. TANK WLET ELEV.. TANK pUTLET ELEV.. NIAFNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
�— 4C J�(� �� ,?j ��' � R�YES ❑NO CYES ❑NO
BED ING: VENT DIA.: VENT MATL HIGH WATER NUMBER OF ROAD: PROPERTV WELL BUILDING: VENT TO FRES
,/ �� A�AR"'. FEET FROM LINE: ���.�. IAIR INLET�.
❑YES ❑NO �7 C •� ❑YES ❑NO NEAREST �
DOSING CHAMBER:
MANUFACTUREF BEDDING�. LIQUID CAPACITV PUMV MODEL �UMP/SIPNON MANUFACTURER WARNING LABEL LOCKING COVEF
PROVIDED�. PROVIDED:
�YES ❑NO ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: runnr nNo coNnio�s arri+nn�>n,n� NUMBER OF �'�����'f F�iv wt i.�. euii nirv�, vcrvr ro Fr+esi
(DIFFERENCE BETWEEN FEET FROM ��"r niR w�er
PUMP ON AND OFF) ❑YES ❑NO NEAREST
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIA�AND MARKING
or excavation, (lf soil can be rolled into a wire,construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONALSYSTEM:
WIDTH� LENGTH NO.OF DISTR.PIPE SPACING. COVER INSIUE DIA stPITS LIQUID
BED/TRENCH � � TRENCHES ' ti��+T IAL' P'T DEPTH
DIMENSIONS ��t" s—L� ��p�/
GRAVEL DEVTH FILL DEPTH UISTR PIPF DISTF.PIPE^_DISTR.PIPE MATERIAL rvo.o�sTa. �NUMBER OF PROPERTY WELL BUILDWG: VENT TO FRESF
BELOW PIPES A80VE COVER ELEV.INLFi ELEV.END PIPES LINE�. AIR INLET�.
� n FEET FROM
Z � � a c� r� �� 9S� /- ��C- J��J`� 3 NEAREST—s
MOUND SYSTEM:
Mound site plowed perpendicular to slope �heck the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
aYEs ❑No
SOIL COVER TEXTURE PERMANENT MARKERS OHSEHVATION WELLS
❑YES ❑NO ❑YES ❑NO
� DEPTH OVEH TRENC��!BED UEPTH t1VfH THENCH/BEU UiPTH OF TOPSOIL SOUDEU SEEDEO MULCHED
CENTEH EDGES
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH� LENGTH. NO.OF LATERAL SPACING. GRAVEL DEPTH BELOW PIPF. FILL DEPTH ABOVE COVER.
BED/TRENCH TRENCHES
DIMENSIONS
MAMFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MA7ERIAL�. NO.DISTH. DISTR.PIPE DISTRIBU710N PIPE MATERIAL a MARKING '�,
ELEV. ELEV. DIA. ELEV. PIPES DIA.: ��.
ELEVATION AND
DISTRIBUTION
INFORMATION NOLE SIZE HOLE SPACING DRILLED CORREC7LY COVER MATERIAL VEFTICAL LIFT COfiRESPONDS t0 APPROVED j
PLANS I
❑YES ❑NO ❑YES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS�. NUMBER OF PROPERTY WELL BUILDING:
FEET FROM ��"E
❑YES ❑NO ❑YES ❑NO NEAREST
Sketch Syscem on Retain in county file for audit.
Reverse Side.
SIGNATUFE- TITLE. �
� �GZ��-C,�/�-?�%� ?��—__—, LL.�-(z`„ .
DILHR SBD 6710 (R.01/S- ' _ _ . ��r .�
•�.. wisconsin APPLICATION FOR SANITARY PERMIT �
� ��r C'IL. HR (PLB67) SAWYER r,OUTy �
"s:.n:�s oevc+alrnenroc UNIFORM SANITARY PERMI �r �
�iMT'Ii�i� IfIGJSTRV,I.IiBOR6MUrt1FIflRELfiTlOflS
CST 83-275 45498 �'
-A,ttach com�lete 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
PROPERTY OWNER MAILING ADDRESS
f �p � � r
ROPERTY L CAT10 CITY:
L(�1/4��'1/4, Sa�3 , T,3 , N, R E (or) VILLAGE: O�` 1�� �
LOT NUMBER BLOCK NUMBER SUSDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
TYPE OF BUILDING OR USE SERVED
� 1 or 2 Family Number of Bedro�ms: � [� Public (Specify):
THIS PERMIT IS FOR A:
� New System ❑ Tank Replacement ❑ Repair
❑ Replacement Soil Absorption System ❑ Revision ❑ Privy
iJ Alternate System � Reconnection ❑ Petition for Modification
I IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
i
' �'i Seepaye Bed ❑ Seepage Trench U Seepa�e Pit ❑ Holdiny Tank �
J 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.
Totai #of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity SQ
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacturer:
IF THIS IS AN ALTERNATIVE SYSTEfJi COMPLETE 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 �/�IATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
(� �d � � Private ❑ Joint ❑ Public
�
�!,the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
1 Name of Plumbe (Print): Signa re: MP/MPRSW No.: Phone Number:
� �v d S a � �64 � d' `
Plumber's Address: Name of Designer: �
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� --P L" C.GJ .� � !�rs'� -`�+�_
COUNTY/DEPARTMENT USE ONLY
Sig re of Issuing ent: Fee: Date:
❑ Disapproved �
$�0 . 0 0 11-2 3-8 3 � Approved � Owner Given initia�
Adverse Determination
,Reason for Dis rov :
I
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(
;Alternate course�s)of Action Available: �
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DILHR SBD-6398 IR. 5/82) DISTRIBUTION: Original to Co�nty, One Copy To; Bureai:of Plumbing,Owner,Plumber �
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