HomeMy WebLinkAbout022-738-22-3102-LUP-1994-138 , Application for Land Use Permit �
County of Sawyer ` y
, _ o
Tiie undersigned hereUy makes application [or. a Land Use Permit and a{;rees th�it �
all work shall be done in compliance with the requir_ements of the Sawyer County o
Zoning Orciinance and the laws and regulations of the State oI Wisconsin. � �
PRINT - USE BLACK INK OR PENCIL �
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Owner Builder �
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Mailing Address Mailing Address
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City, State , Zip City, State , Zip
Building Land Use Zone District rr - � ° �
(� ) New ( ) Filling � -, �
(� Addition O Dredging Lot size j�p X �r,�p� � '�
( ) Alteration ( ) Grading
( ) Moving On ( ) Acres 5,,� C�L�sDja•�� (to►4p �,
( ) ( ) Q.1��� C�c-- w``�Y
s�, �s � �
New Construction �
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Size �_ ft wide ' wide ' wide
�- � ft long ' long ' long �
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Floor area 3 $ sq ft sq ft sq ft ?'0
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Total tlgt j to peak ' hgt ' hgt x'
Stories � C'
No , of Bedrooms � r e o
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(year round) or (seasonal) � �� G rt
Type of Bldg , Addition, Use ,� a o
( ) Dwelling � 5 �' `�
( ) Garage (1 ) (2) car L ~•
( ) Storage Building �J�� r•
( ) Boathouse / ,�,;�, �
( ) Livingroom C� (,
� Bedroom � �``�'� � � �'
( j Kitchen-Dining ��':� 1O 3° '? � Z
( ) Porch (enclosed) (roofed) �--- � � 35 � , �
( ) Deck - open � �5
( ) � s�/ F�
( )
Ty e of Construction �pT��� (3y � �
� Frame ( ) Block _
( ) Log ( ) Concrete � r�r
( ) Pole ( ) Steel �„p�'
( ) ( ) Pole/Metal � U'
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Construction Cost $ (�D � �
Vo1 _�',�� Pg _� of Deed �
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Sanitary Permit � -�'S �2 L road -------------- z
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Issued 17 June 1994 Denied
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Owner Zoning Administr tor
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Application for Land U�e Permit o
County of 3a�yer �
The under�aigned hereby makes application for a La,nd Use Permit and �°a
agrees that all work shall be don� in accordance with the require-
ments of the 3a�qer County Zoning Ordinance and the laws and reg- �
ulatione of the State o� Wiaconsin.
PL�A88 PRII'�T - USE BLACK Il�R OR PEI�CIL �,
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Susan M and �'
Gar W. Jasek owner ' o
er er �
Route 1
ma a ress ma a ess
Couderay Wisconsin 54828
Buildir:g Lend Use Zone Diatrict A-1 �
X New Filling �
Addition Dredging Lot size 330 ' x 660 � �
Alteration Mining
MoVilig Ox� Qrading ACTeB 5 . 00 excludin road �
��i t-�-w a y �n
rn
x
New Construction (qear round) o . ) -constructed �
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31ze � ft �rid� t wide �
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�_ Ft long long �
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Floor area �b � sq ft ft �
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Total height +�_ to peak to pea,k `''
Stories __1___
--r----
No. of bedroaffis 1 regr 1ot line or wat�rline
-,. . z
� �
e of structure
DNel.ting � �.,
Garage (1) (2} car �
Storage building
Boa,thouse �
I,ivingroom
Bedroom ?� �.
Utility room t �
Kitchen-diriing -- ��� � _- - 2 � �
Porch - enclosed �- - � �
Deck - open �
i �
, w
e of construction �;; � ti �
x Fra�a4e slock � � -
Log Concrete � �
Pole Steel , - �
Metal �
�I�=�'�
Estim�ated cost $ �('T� � pWo
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CST 83-055 '� �
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Vol 3 S 0 �'S 3 4 8 Of de�d �
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CS-�To1.- - - - - - - �'g- --- - - ; ' ; �
Sanitary Permit : 83-051 � � � hi
-------CL road rl=-----=---- �� � �
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Issued 27 Mav 1983 Denied �
OWNER ENGAGED IN AGRICULTURAL ACTIVITIES ON PREMISES . :°
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G y W. sek _,nx�_.x� x�
DE�RTMENT OF � APPLICATION � SAFETY& BUI LOfNliS
INDUSTRY, FOR SANfTARY oivisio►v`;�.
LABOR AND PERMIT P.O. BC�X 796y c
HUMAN RELATIONS (PLB 67) MADISON,WI 537;�7 c�-
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Attach plans for the system on paper not less than 8'/z x 11 inches in size. Inciude a plot plan that is dimensioned or drawn to scale. Horizontal
and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter
H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed,sealed and dated by the designer. If designed by a Master
Plumber,the date,signature and license number must be shown. The owners copy or a legibie reproduction of the soil test report rnust be
inciuded.
Susan M. � Gar W. Jasek i
Property Owner: Mailing Address:
� /'Si7 ' �
Property L ation: CjZy.r�i�ege-cc Townsh' • � County:
�G�'/a ,'/aS T , �R f-f et�) W 1��
Lot Number: Bik No.: Subdivision Nam : earest Road, Lake or Landmark: State Pla I.D.Numb�r:
(lf assigned)
TYPE OF BUILDING
Number of
❑ Public* ❑ Variance* ❑ Other (specify)� Bedrooms:
1 or 2 Family �State Approval Required. �-
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify)
SEPTIC TANK CAPACITY �
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER: ' w
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA _
(Minutes per inchl: ?ROPOSED (Square feet): ' New ❑ Replacement ❑ Experimental (�Seepage Bed ❑ Seepage Pit
J ❑ ,4lternative (specify) ❑ Seepage Trench
. �
Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner):
�Private ❑ Joint ❑ Public - �
I,the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
N of P mber: Sig re: MP/MP�iSIN-IVo.: Phone Number:
c� , ( )
l> ,C' �. �, � � J d
P umber's Address: � Name of Designer:
G'
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COUNTY/DEPARTMENT l�SE ONLY CST 8 3- 0 S 5
Signatu of Issuipg AgeTi : Fee: Date: � qppROVED Sanitary Permit Number �
� ^ $6 0 . 0 0 5-2 7- 8 3 ❑ DISAPPROV ED 312 41
Reason for Disap val: �
Alternate coursels)of Action Available:
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in-
stallation. Failure to comply will void the sanitary permit.
DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
DILHR-SBD-6398 (N.03181)
DEPARTMENT OF INDUSTRY, INSPECTICJ,�; f3EPORT FOR SAFETY& BUIITDINGS
LABOR & HUMAN RELATIONS PRIVATE SEiNAGE SYSTEMS � �ivisi�r�v
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON,WI 53707 '
❑CONVENTIONAL ❑ALTERNATIVE Sia�ePlanl.D.Num6er
. (I I.�55iqnM1�
� �Holding Tank � � In C�i��unci Pressurr. � �Mound
NAME OF PERMIT IiOIOER�. ADDRESS Of PEFMIT HOLDEF INSPEC710N DATE-
�v',�r �a, �'� c/, � � -- �/` f?3
BENCH MARK erma�en�.elr.rencc uoint)OESCRIBE IF DIFFERENT FROM PLAN. REF.PT.E�EV.�. CST NEF PL ELEV.
N:i�n�.nl Plui��l��•r MPiMPHSW N�� � �����iv 5�+��ii.�iv�'�•������Numt>er:
/ !G ` �-c.� �'3 -O S'/
SEPTIC TANK/HOLDIPJG TANK:
MANUFACTUHER LIOUID CAPAGTv InNK INLET ELf V TANK OUTLET EL[V WARNWG InBEL �OCKING COVER
PROVIDED PROVIDED-.
/�" G — ,�^D � d /�� � YES ❑NO ❑YES ❑NO
BEDDING�. VENT DIA. VENT MATL HIGH WATE+ NUMBER OF ROAD: PAOPEHTV WELL BUILUING. VENT TO FRESH
� ALAHM FEET FROM LINE �IAIR I�N_LET
❑YES ❑NO "Y /I �'_L._ ❑YES C�NO NEAREST ��, l� �
DOSING CHAMBER:
-- — - I --- — PRO NING LABEL LOCKING COVER
MANUFACTUREN BEDIJING 1_I(11111)l:Af'!�(;I�v I'UM�'M(11)El I'iih1P:SIV11()NMANUFACiIIHEH WAH
VIDEU PROVIDED�.
nYFS �_iNo L r_'YES C�NO 1-IYES C�NO
— - -- —
GALLONS PER CYCLE: vumr nNucnrvu�ni s�u�i i�;��� ,uni NUMBER OF ri���ri i�i� svi i i uun um�, vervi ro Fi+i s�i
(DIFFERENCE BETWEEN FEET FROM ��"� vr�iNi_t r
PUMP ON AND OFF) L.�YES LINO NEAREST—�
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth o(plowiny �f N�,n� u�nn,r rr i+ n�.�i t rcini nrvo nnnF�KiNc,
or excavation. (Ii soil can be rolled into a wire,construction shall cease until FORCE
the soil is dry enough to continue.) MAtN
CONVENTIONALSYSTEM:
-- —
' IVIDlt1 IfN(;Tli N�) C7F I)ISIIi f'I�'[ Sf'.11 INi, �:r)VFfi INSII)LI)Ill �PI�S lIOUID
BED/TRFNCH i _ rrieruc�Es r.,nrt E, n P�T DEPTH
DIMENSIONS �a �S — �. �.�Lv
(�,1��1V�'�()F�'ili �ILL I)fl'I11 lii':II� I'll'I f11SIlt PI�L DISTH PIPF MATEfiIAI �'V�1 I)Itilli NUMBER OF �'Hl)VCfiIV WCLL BUILDING VENTTOFHESH
f:Flt)�^�f�IVfti AHf)VEt:t)Vtlt flfvlNllt ELEVlNU n 1'll'fti �� 4r AIRINLET
/� !I ISI. ��. Q � U,,s~ /`'' L�C,�. ,�O.S` FEET FROM ��G� .a"�S �---_
�__l_ _^1 � � NEAREST--s
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check 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 saiid. TIONS MEASURED.
❑YES ❑NO
SOIL COVER rt xiur�t ri i�MnN�rvi MnHKt ias— ni;si�+vnnr�ry w�u s
____ ❑YES ❑NO ___ CIYES ❑NO
UFPi11f1VEH1VtEN(:IIIlEf) UE�'111�7V(�� 1HEN(:�IfiFl) UEP111()f i�ll'SIIIL '���I11)If) JFkUfll MULCI1fD
CEN1 F�� Ef)(�ES
❑YES ❑NO ❑YES C_�NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
----
"�..= WIDIVI �EN(�Tli NO.OF LATEI7ALSPACIN(� ���H�Vf l.()EPTf{tiFl l)W PIF'F FILLIJEf i41 Af30VECOVEH
BED/TRENCH rHervcr+es
DIMENSIONS"
nnnrvn�ii�i riinii----- ninNiiniii—_. ur:in�f�ir(--- �nfnr�i���ii�n�,iiii-�i,ii tii�iic,�i�--- i�l:iiTrn�i- i�i�.i��iiiii-iifirvwi�i nonT�iiiini wrnnukir��,
111 v I I I V I�III I I 1 v I'11'1.'�� I�IA
ELEVATION AND
DISTRIBUTION
INFORMATION HOlE51ZE HOLESP�(.IN(� L`FiILIEUCf)HNECIIv Ci7VfHM�IEftIAL VEHTICl1L LIFTCORRESPONUSTOAPPHOVEU
PL,�NS
❑YES ❑NO ❑YES ❑NO
COMMENTS: PERMANENTMARKERS�. OBSEHVATIONWELLS NUMBEROF PROPERTV WELL�. BUILDING.
FEET FROM ��"E
❑YES ❑NO C�YES L_�NO NEAREST—
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNl1TU1 TITLE
DILHR SBD 6710 IR.01/82) � ����� � �'�
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DOCUMENT NUMBER AFPIDAVIT
w./� Fe '�LJ� !� � .
EXISTING SEPTIC SYST�M
ONE AND TWO FAMILY �
� ('�oe{;At1'�T.'�3 r.�nC>A �
If the existing septic system does meet the n�iriimum re- `�`' ' � ` `"�`"`y �
Tl�:�.:;•'r.:ti; '�p rnc��+�, i�'rf'��, c�l� 9�
quirements for groundwater and bedrock depths and if it `�-
� 1'i IG � �+4 13, n`rlic,r�
is functioning, an addition to or replacement of a hab- ���� � �
itable structure can be made in most instances without --�'� "' � `��""'```' ;:� `•"�.'''�"3"�-
c:i ': -..,.�: : ::; ...;= ..�1� .
updating the existing system. If the existing system � '����-� '
is utilized for the addition, every attempt should be �-���s'� T T.- �.-
_,�+;,.;:.;�,.
made to locate and reserve an area which is suitable
for a code complying replacement system for when the � � �e
system fails. If the addition will substantially in-
crease the wastewater discharge, the existing system RETURN TO
will be replaced with a code complying private sewage Sawyer County Zoning Admin
system. P.O. Box 668
Ha ard WI 54843
owner(s) Susan M. and Gary W. Jasek
Mailing address Route 1
Radisson Wisconsin 54867
Property description �part NE� of the SW� S 22. T 3fiN, R 7W_ Parcel . 9 . 2
5 . 00 acres . Vol 350 Records Pg 348 . Town of Radisson. _
{�t) (we) Susan M. and Gary W. Jasek plan to
(�Add onto existing dwelling
( ) Add onto existing mobile home
( ) Replace existing dwelling
( ) Replace existing mobile home
The present private sewage system has been working satisfactorily as far as disposing
of wastes. If the present private sewage sysi:em does fail, it wi11 be replaced with
one that is code complying.
/ �
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/ Gary W. Jasek % date
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� r„. l\�:� �� ��� �—�� �� � —
� Susan M. Jasek date
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Personally came before me this
th day of ay , 1994
�� -�- � ✓� ,�
V _/ � "
,,4T r�?�t I� +�F'�orson Notary Publi:c
► �
��-�a�y�r _� _. County, Wisconsin
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l�,�r� �mmi�sir�i�� is expires 10-27-96
'�':} �,�:
, ;
Existing septic system - Sanitary Permit 83-051
Date system installed 07-11-83
���-� w. �� ' ZA or AZA
—r
S -zb- g y
. date
This instrument was drafted by +�
��. � � � � �. � �
Gary W. Jasek