HomeMy WebLinkAbout020-639-14-5301-LUP-1994-172 • Application for Land Use Permit '�
County of Sawyer � o
_ The under�igned her.eby makes appiication Eor a Land Use Permit and agrees that � -
all work shall be done in compliance with the requirements of the Sawyer County o
Zoning Orciinance and the laws and regulations of the State of Wisconsin. 'fi �
PRINT - USE BLACK INK OR PENCIL ��
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I�Cai�ing Address Mailing Address
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City, Sta�e , Zip City, State , Zip
r �Building Land Use Zone District (Z.-� - �..--_ �
� New ( ) Filling � m
( ) Addition ( ) Dredging Lot size v '�
( ) Alteration ( ) Grading --
( ) Moving On ( ) Acres � ���-'� �
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New Construction ,�
Size � � ft wide ' wide ' wide
� ft long ' long ' long
Floor area �G.�.� sq ft sq ft sq ft
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Total hgt � � to peak ' hgt ' hgt �'
Stories
No . of Bedrooms ��- rear lot line o�-�,v-a=�e�tline o
(year round) or (seasonal) v� �
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Type of Bldg , Addition, Use Q' �'
) Dwelling � � � � a o
Garage ( 1 ) (2) car �j � ��' �
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Storage Building '� �
( ) Boathouse ~�
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( ) Livingroom �
� ( ) Bedroom �
( 1 Kitchen-Dining �
( ) Porch (enclosed) (roofed) �.-:v �
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Type of Construction �
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( ) Log ( ) Concrete �
( ) Pole ( ) Steel �� F�`1
( ) ( ) Pole/Metal a�"��- _�_� �
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Construction Cost $ ��C?�• `' I �
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Denied ` �
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Owner �' � ' "_-- ut �
Zoning Administ ator
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:�. wisconsin APPLICATION FOR SANITARY PERMIT �
,`� D I L H R SAWYER COUNTY `�'
(PLB 67) o
r,.�o oEPaarmenT oF UNIFORM SANITARY PERMIT.# G`
6� IfIOUSTRV,LRBOp6HUTRfIRELRTIOflS� CST 8 5- 0 5 9 6 514 2 "'
Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8Y2x 11 inches in size.
See reverse side for instructions for completing this application. PLEASE PRINT
'RO ERTY OWNER MAILING ADDRESS
e 1 ` L� � ` �
'ROPERTY LOCATION CITY:
1/4���1/4, S / , T�% N, R(o E (o LN GE: tc b �
_OT NUMBER BLOCK NUMBER SUBDIVISION NAME N EST 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:
[�Q New System ❑ Tank Replacement � Repair
� Replacement Soil Absorption System ❑ Revision ❑ Privy
�J Alternate System ❑ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
� Seepaye Bed ❑ Seepage Trench � 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.
Total ,+''r of Prefab. Site Steel Fiberglass Plastic
Gailons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump Tank/Siphon Chamber
Holdin9 Tank capacity
Manufacturer: �
IF T�IIS IS AN ALTERNATIVE SYSTEfJI C01lIPLETE THIS BLOCK: ❑ Mound � In-Ground Pressure
Total �''rof Prefab. Site Steel Fiberglass Plastic
Gallons Tanks Concrete Constructed
Septfc Tank Capacity
Lift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
�y � � (}� Private ❑ Joint ❑ Public
I,the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (P�int): Signat e: MP/MPRSW lVo.: Phone Number:
� t - � S ? c�7 O n � b`�-'� � a
Plumber's Address: Name of Designer:
�T� � .1 � t � J p — `— �—�—�---'
COUNTY/DEPARTMENT USE ONLY
Signa re of issuing Agent: Fee: Date: ❑ Disapproved
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Owner Given Initial
�g 5 . �� 6- 14- 8 5 �� Approved Qdverse Determination
Reason for Disa oval:
Alternate course(s)of Action Availabie:
Dll_Ha-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing,Owner, Plumber