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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 -�. .�'� /-�?�(��r<a.. f�`: , "�- . ' � r / j� Y /�U7'��s �"��, �l.V^1 c� �� Owner Builder ������� ...r��:�. �o< � ailing Address Mailing Address �jtJ r/1 7�✓ (/�/ � �� d 1�6 City, Sta e , Zip City, State , Zip r �Building Land Use Zone District �� - �._._ o � New ( ) Filling � � O Addition O Dredging Lot size v '� ` ( ) Alteration ( ) Grading -- ( ) Moving On ( ) Acres � ���-'� s� ( ) ( ) � New Construction �' � Size � � ft wide ' wide ' wide �� ft long ' long ' long Floor area � sq ft sq ft sq ft � Total hgt r � to peak ' hgt ' hgt x' Stories No . of Bedrooms �"— rear lot line o�=�-w��e�rlit7e o C (year round) or (seasonal) G rt Type of Bldg , Addition , Use a o ) Dwe 11 ing �� � . � � �' � Garage ( 1 ) (2) car �j � �• Storage Building � �. ( ) Boathouse ° ( ) Livingroom � • ( ) Bedroom �� ( j Kitchen-Dining �j � ( ) Porc1� (enclosed) (roofed) ������ x�� � ( ) Deck open `;; ( ) r�4 c > � ,; , Type of Construction -_ � Frame ( ) Block �`" , � ( ) Log ( ) Concrete ;- F��+ ( ) Pole ( ) Steel '--- ( ) ( ) Pole/Metal �"'��� � �`� � 51� � �p Constructzon Cost $ �Gi��• �;-. � l ,� � . �,����_ - �` Vol .� 73 Pg �s of Deed �� • . �a.�fi m�J � 2 �.S VOl el�i`'i}.�_(w H b �f�� r� � Cer . Soil Test 8S� ��,;, —� ��` � �� � �J Sanitary Permi� ���� ���-�-.r.� �L road �------------- z � � o `� ,��',(t �-� :t ` �. . z __ m� 29?uy�44�iu.ac� : ' z Issued 29 June 1994 Denied � �� r� �--�� — vr � Owner Zoning Administ ator �' y � ,;���r � f3' /✓ f��i��>�#� ��G5% N + ti � w I ,'` t Y Q I � + �� ' t m • � — 0 � �� � � � �1�. � ` o i, . N � _ _ 0 ; I� i� � - � �, � �, � � � ,� . 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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