HomeMy WebLinkAbout026-938-17-3102-LUP-1997-172 (2) • Application for Land Use Permit �
County of Sawyer : o
. The undersigned hereby makes application Eor. a Land Use Per.mit and agrees that �
all work shall be done in compl..iance with the requirements of the Sawyer County o
Zoning Ordinance and the laws and regulations of the State of Wisconsin. � �
PRINT - USE BI.ACK INK OR PENCIL
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ailing Address Mailing Address
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City, Sta e , Zip City, State , Zip
r �Building Land Use Zone District �� - �._._ o
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O Addition O Dredging Lot size v '� `
( ) Alteration ( ) Grading --
( ) Moving On ( ) Acres � ���-'� s�
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New Construction �'
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Size � � ft wide ' wide ' wide
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Floor area � sq ft sq ft sq ft
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No . of Bedrooms �"— rear lot line o�=�-w��e�rlit7e o
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Type of Bldg , Addition , Use a o
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Storage Building � �.
( ) Boathouse °
( ) Livingroom �
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Issued 29 June 1994 Denied
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� :��. wisconsin APPLICATION FOR SANITARY PERMIT �
�� D 1 L H R , SAWYER COUNTY `n
(PLB 67) o
F:� OEPLiFiTTTIEfIT OF UNIFORM SANITARY PERMIT.# G`,
6� I(IOUSTL7V,LRBOR6 HUTF7f1RELFiTIOf15 �ST 8 5-0 5 9 6 514 2 �
—Attach complete plans in ;3ccord 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 instruc:tions for completing this application. PLEASE PRINT
PRO ERTY OWNER MAILING ADDRESS
C � � � I � �
PROPERTY L'OCATION CITY:
1/4���1/4, S f , T3% N, R(o E (o N GE: r r� � c,c1
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME N EST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
TYPE OF BUILDING OR USE SERVED
i.?S� 1 or 2 Family Number of Bedrooms: � [� Public (Specify):
THIS PERMIT IS FOR A:
[�Q New System ❑ Tank Replacement ❑ Repair
� Replacement Soil Absorption System ❑ Revision ❑ Privy
u Altemate 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 Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump Tank/Siphon Chamt>er
Holding Tank capacity
Manufacturer:
IF TNIS IS AN ALTERNATIVE SYSTEfJI CO�VIPLETE THIS BLOCK: ❑ Mound U In-Ground Pressure
Total �r'`of Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
{Minutes per inch): REQUIRED (Square Feet): PROPOSED ISquare Feet):
� �p � Private ❑ Joint ❑ Pubiic
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (P�intl: Signat e: MP/MPRSW No.: Phone Number:
x l � S ? vz �n t7��-'� � �
Plumber's Address: Name of Designer:
�� �- ,� � t � 5 J � ''-- Q�`—'
COUNTY/DEPARTMENT USE ONLY
Signa re of Issuing Agent: Fee: Date: ❑ Disapproved
❑ Owner Given initial
�g 5 . �� 6- 14- 8 5 � Approved A�verse Determination
Reason fo�Disa oval:
Alternate course(s)of Action Available:
Dil_HR-SBD-6398 �R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing,Ow�er, Plumber