HomeMy WebLinkAbout022-738-23-5803-LUP-1993-179 Application for Land Usc I'ermiL
County of Sawyer % -� '�
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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 o �
Zoning Ordinance and the laws and regulations of the State of Wisconsin. �
PRINT - USE BLACK INK OR PENCIL m
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P_._.o F3��t � � S r��.�t, lz. U N[=A-� .�o�+� C��-ho�.t o �'
Owner Builder Z
oL�iont Lon►S-t�rz�C_.Tior�l
4-22 ��4rv--� 5 T►Q-.��T �ovZ� to '�x 3 l�
Mai ing Address Mailing Address
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City, State , Z p City, State , Zip
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Building Land Use Zone District 2�. - 1 �
( ) New ( ) Filling -- �
( ,a�Addition ( ) Dredging Lot s ize � 5 c�' X �43'��SI � � �
(,��Alteration ( ) Grading
( ) Moving On ( ) Acres Z . SI z
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New Construction N
Size 12 ft wide ' wide ' wide
�g ft long ' long ' long �
Floor area ZJ(p sq ft sq ft sq ft �
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Total hgt �2� to peak ' hgt ' hgt x'
Stories �
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T�aro�SSo n� F Lo w��
No . of Bedrooms � �
�\a-�--.la�—1�n__=�_-v-� wa t e r 1 in e o
(year round) or (seasonal) � �
Type of Bldg , Addition, Use �86 � a o
( ) Dwelling �' �*
( ) Garage (1 ) (2) car oZ' r'
( ) Storage Building � IDI�� �.
( ) Boathouse o
( ) Livingroom �
( ) Bedroom _
( ) K' tchen-Dining ,Z�$ �
( P o r c h (e n c 1 o s e d) �___._�_$� N
( ) Deck - open D•N �
( ) �5' y4 �R� � �l F
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Type of Construction � iy ` � �
(�'Frame ( ) Block W
O Log O Concrete N w F��
( ) Pole ( ) Steel � �
( ) ( ) Pole/Metal o ,� �
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Construction Cost $ 3�0�,—' p
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Vol SZ1 Pg � 12 of Deed �.�
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CS Vol � �.. Pg �� � �'� H
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Cer . Soil Test G3 - p-ig `'� �
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Sanitary Permit G 3- 12� �' �_ �L road -------------- ~ �
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Issued u ���5��y��(�L�. Denied �� �
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Owner Zoning Administ ato
, Application for Lancl Use Permit
County of Sawyer o
The undersigned hereby n,akes application Lor a Land Use Permit and agrees that �
all work shall be done in compliance with tl�e requirements of the Sawyer County o
Zoning Ordinance atid tlle laws and regulations of ttle State of Wisconsin. �
PRINT - US� BLACK INK OR P�NCIL 1
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Boncler Inc. Boncler Inc.
Owner f3uilder
P..O. Box 98 P.O. Box 98
Mai ing A ress Mailing Address
Radisson, WI . 54867 Radisson, WI . 54867
City , State , Zip City , State , Zip
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Building Land Use Zone District RR-1 � �
( X) New ( ) Filling -, r�
( ) Addition ( ) Dredging Lot size 167X622 `� �
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( ) Alteration ( ) Grading 2.5� o
( ) Moving On ( ) Acres � �
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New Construction � �
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Size 24 ft wide �32 ' wide _ _ ' wide �
32 f t long �- Z8 ' long ' long
Floor area 768 sq ft � sq ft _ sq ft
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Total hgt 12 to peak � ' hgt _ ' hgt x'
Stories � 1
No . of Bedrooms 2 - �,��, �,� waterline o
(year round) or (seasonal) Lake Radisson cn r�r
167' �. r
'I'y e of Bldg , Addition, Use /� Q, o
Dwelling ( �' rt
) Garage ( 1) (2) car �O�f� N•
( ) Storage Buil.ding r. �
( ) Boathouse o
( ) Livingroom �
( ) Bedroom �--��
( ) Kitchen-Dining � �{ �
( ' Porch (enclosed) (- � :) 3Z� �
( �-) D e c k - o n e n 15'�--- '80' r°v' �
( ) �y• Wcxl S e., � '_'"'�i�v a ��-'
( ) c� ��
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Type o� Constructi�n � �
(x ) Frame ( ) Blocic
( ) Log ( ) Concrete � ��
( ) Pole ( ) Steel � r
( ) ( ) Po1e/Metal 480 �
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Construction Cost $ 15,000.00
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Vol 475 Pg 39 of Deed
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CS Vol 6�_ Pg 71 �& 72 ro �
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Cer. Soil Test '�,;�n�;>.� �s
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Sanitary Permit - 7 � __ '� `''
---------- L road ------------ �
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Issued � l�a�p ��9'3 Denied I %� ,
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Owner Zoning A minis rato
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� DILHR SANITARY PERMIT APPLICATION �o�Nn �
In accord with ILHR 83.05,Wis.Adm.Code
_"'-�..�,-..�—,..�- S awy e r N
, �
C S T 9 3-0 7 8 STATE SANITARY PERMIT#
—Attach complete plans(to the counry copy only)for the system,on paper not less than 19 0181 �
8i4 x 11 inches in size. ❑ Check if revision to previous application
—See reverse side for instructions for completing this application. sTATe P�nN i.�.NUMeER
I. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. S 9 3-2 0 3 5 0
PROPERTY O NER PROPERTY LOCATION
T `G "/4 ''/4, S �T��N, R E(o
PROPER OWNER'S MAILING ADDRESS LOT# BLOCK#
���T� a�- � s.� �y o
CI ,STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
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II. TYPE OF BUILDING: Check one CITY � NEAREST ROAD
� � ❑State Owned ❑ VILLAGE� ��SS�,�f w� .�
❑ Public �1 or 2 Fam. Dwelling—#of bedrooms� AR ELTAX N MBER( )
111. BUILDING USE: (If building rype is public,check all that apply) 0 2 2-7 3 8-2 3-5 8 0 3
1 ❑ ApUCondo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ RestauranUBar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. �New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.❑ Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit# — Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21�Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Filt
VI. ABSORPTION SYSTEM INFORMATION:
1.GA�LONS PER DAY 2.ABSORP.AREA 3.ABSORP.AREA 4. LOADING RATE 5. PERC.RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED(sq.ft.) PROPOSED(sq.ft.) (Gals/day/sq.ft.) (Min./inch) ELEVATION -
' �a U � �Z1 , � Feet Feet
CAPACITY
VII. TANK Site
in allons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- p�astic Exper.
INFORMATION New xistin Gallons Tanks oncrete glass App.
Tanks Tanks structed
Se tic Tank or Holdin Tank �U
Lift Pum Tank/Si hon Chamber O
VIII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans.
'lu ber's Name(Print): Plumber's i nature:(No Stamps MP/MP o.: Business Phone Number:
�CQ��/�?- !� L�1�/t /d
'lumber's (Street,City,S ,Zip Cod :
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K. C UNTY/DE ARTMENT SE ONLY �
❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issui Agent Signature(N Stamps)
�Approved Surcharge Fee)
❑ Owner Given Initial
Adverse Determination $2 0 5 . 0� 6-18-9 3 �
. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
)-6398(formerly Plb-67)(R.11/88) DISTRIBUTION: Original to County.One Copy To:Safery 8 Buildings Division,Owner,Plumber
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i ADDITIONAL COMMENTS AND SKETCH '
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SANITARY PERMIT NUMBER:
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