The URL can be used to link to this page

Home My WebLink About024-741-18-2106-LUP-1994-282 - . Application for Land Use Permit � County of Sawyer � '� 0 The undersigned hereby makes application Ior a Land Use Permit and agr.ees that � a11 work shall be done in comp�iance wilh the requir.ements of the Sawyer County o , 7oning Ordinance and the laws and regul_ations oI the State of Wisconsin. �+� PRINT - USE I3LACK INK OR PENCIL ��, �1�5/��=/� �,�J,!;i.,:;��,<-;;�:,�-� 7 !t' �'l��/ff/�/� l�� /�/�/--U:� � . Owner ` Builder " t� �, ,�� /' ��' r:�• ��; ,;'�;;-�% '% � � � !!�',-�% .�'i�~�/�'l.> .�J/�. Mai�in� ress Mailing ddress �/�� V I!�� J �i-' .�/ �/ �� 3 �/_..j� �> ,�/1 L.� 1i�� Y�/ � J'r��_'•%� Ci y, State , Zip City, State , Zip � o Bui�ding Land Use Zone District � ; ` 4 � ; ,'�' i r (l�'S New ( ) Filling " `� � � ( ) Addition ( ) Dredging Lot size v '� ( ) Altera�ion ( ) Grading � ( ) Moving On ( ) Acres��'�- %! '� �!�- �,:,,, , , � ( ) ( ) ' New Construction � � Size �%; ft wide ' wide ' wide - �� %� ft long ' long ' long � rloor area %!'_� ' sq f t sq f t j� sq f t �, �' O Total hgt / 2 � to peak ' 1 t/ ' hgt %�' � Stories 1 ` ,' No . of Bedrooms '�— rear lot� line Q��,,-�—�T� '-��:�a o (year round) or (seasonal) � ��' �` "� � � Type of Bldg , Addition, Use � l a o ( ) Dwelling f' rt ( ) Garage (1) (2) car , ; �• (✓j Storage Buildiiig ►�. ( ) Boathouse ° ( ) Livingroom �; � ( ) Bedroom - �- �` ( ) Kitchen-Dining � t m ( ) Porch (enclosed) (roofed) -', x ' ( ) Deck - open - ( ) � - � --- � rw ( ) � Type of_ Construction 1'� q •�/ � , �, � -- `_ ( � ) P'rame ( ) Blocic � �/a-`�"7 �'r-' -�� ( ) Log ( ) Concrete �.�_ ��,, . r�� ( ) Pole ( ) Steel " - ( ) ( ✓� Pole/Metal � t � � � Construction Cost $ ��/, �� .-- � \ ,--- � i I �Fy-� „ � � � i �_ �- � .�� , 0� Vo1 y3 � Pg `/ � 5 of Deed ' ' � �� _ _ �f3S,f�. c s vo 1 -_----�g--�.__. _, -f i�u ro � , ., �, Cer . Soil Test � ��- Ji J n m , - __ � - Sanitary Permit �2 �� -=�� road '--=�` : '' `'_ ---------- L - ---------- z . � � a o � ,/_� ,�1 /.,' s —,� . 7 . � � Issued 23 Au�ust 1994 Denied • � � r ' �g.;� �� !� , � - �,� — �� , �. " ��,-� � � � .�� , wner Zoning dministrator „� V �! �._ _ �, W � . — � . � �1 , W fV � N �t � U1 � � D . � :�� _ � � . � ; CJt C11 � Oo �p w �v '-` N t N I ! I W � N � � � w � � ! { N � `'� � � � � \ I N � I � ' `� � � �` � � � I N � I � N ` I I � I � � � �1 W � � � �n � �P IV Z - � y �V :� � - . � SANITARY PERMIT APPLICATION , N �DILHR In accord with ILHR 83.05,Wis.Adm. Code couNry N _'�"e'"�."'...�' S a e r u' C S T 9 2-317 STATE SANITARY PERMIT# ~ —Attach complete plans(to the county copy only)for the system,on paper not less than 17 9 92 6 8�X 11 If1Ch@3 If1 SIZ@. ❑ Check ii revision to prevfous application �ee reverse side for instructions for completing this application. srAre Pt�N i.�.NUMeeR I. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. � I �� PROPERTY OWNER PROPERTY ATION � � ., ' _Ys '/a, S �'' T , N, R �or) W PROP RTY OWNER'S MAILING ADDRESS LOT# BLOCK# CITY,ST TE � ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER � � �? . \ �+ � ..- II. TYPE OF BUILDING: Check one ��N � NEA EST RO D � � ❑ State Owned ❑ VILLAGE� � : . •J .\' 1^� ►`� ❑ Public 1 or 2 Fam. Dwelling—#of bedrooms� ARCEL TAX NUMBER(S) III. BUILDING USE: (If building type is public,check all that apply) 0 2 4-7 41-18-210 2 1 ❑ ApUCondo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/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 �eepage 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-Fill VI. ABSORPTION SYSTEM INFORMATION: 1.GALLONS 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 .-� : 1 .-,-� / � � \' 1 �j (: 1 1 Feet Feet CAPACITY VII. TANK Site in allons Total #of Prefab. Fiber- Exper. (NFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel 91ass Plastic APP Tanks Tanks structed Se ticTankorHoldin Tank � �'`� '� � �� fl��_ Lift Pum Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name(Print): Plumber's Signature:(No Stamps) :-MWMPRSW No.: Business Phone Number: •� ,ol! �� ' ��: ��_�� l~' P ber's ddress Street,City,State,Zip Code): � � - �F-'�- � � � /� � ��. 1 . COUNTY/DEPARTMENT USE ONLY � � Disapproved Sanitary Permit Fee(Includes Groundwater a e ssue Issu'ng Agent Signature No Stamps) Surcharge Fee) � �Approved ❑ Owner Given Initial $15� . �� 9-2 3-9 2 Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: cnn�aaa r}��.,,o.�.,DIh1:71/R „�an, �I�CT[71RI ITI(1N� llrininsl M f nnnfv (lna('nnv Tn•Rafofv R Ri�ilrlinna niviainn (�wnPr PlumhPr WisConsin Department of Industry, pRIVATE SEWAGE SYSTEM o tr=---..,._ Labcr and Human Relations INSPECTION REPORT ' � Safety and Bwldings Divizion (ATTACH TO PERMIT) Sanitary Per it rvo.: _ GENERAL INFORMATION l�9 q Zlp qz,-23 1 Permit Hotder'S Name: ❑ City ❑ Village (�Town of: State Plan ID No.: e.q.5��'Y1<r �4.r� Qv► Sr 'ilo�.a k e CST BM Elev.: Insp.BM Elev.: BM Description: Parcel Tax No.: ID o a� £x . SZ-. l� OZ —?�Fl — 1 — 2-loZ TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. GX Septic �x�s,�• — S-�,{�( '7S0 Benchmark ldp— Dosing Aeration Bidg.Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION � St/Ht Outlet -j TANKTO P/L WELL BLDG. �ventto ROAD Dt lnlet Air Intake �x Septic �O� ZI $� � p' - NA Dt Bottom Dosing NA Header/Man. 9 � .75 Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand { 9 j.59 Model Number GPM TDH Lift Friction System TDH Ft L s Hea Forcemain Length DiB. Dist.To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width � Length i No.Of Trenches PIT No.Of Pits Inside Dia. Liquid Depth DIMEN IONS ��. 40 --^ DIMENSI N SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type O CHAMBER Modei Number: System: �ed sSQ� IS� lD � � n cL OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribut�on Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length Dia. Spaang SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only i Depth O�er Depth Over xx Depth Of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present,etc.) -� vs��y �.x�s-��:�y -7's o s�-E{�.1 s.-ce i � � � I Plan revision required? ❑ Yes �No s .Z 3 $� � Use other side for additional information. 9 �� 9�- -�.�-� w• ac.�l.�, � SBD-6710(R 05�91) Date Inspector's S�gnature Cert No ' _� . . --- . � —240� . I a�J'bd �� Z L � n n A �- A � � p�ys � -�w.t oSL 6w:ts,x3 •-� ,�3 f��jy' 0 ► S -�nd +� 1� � �3 � ' t �� o}, ?(^ � �, r . cn�•�t,3 ..�►vb �q � w___ ; , . __ �. i.__�_.__ : ._:_____�.___;_____..__ ___�_.�._ _ ��._._ ____ -- , —�j- , �. --r , --� �_._ � k � ( � �� M..1' . y _ � r £z_ Z �f-Z ��138Wf1N lIW�i3d J��I`dllNdS } H�13�S aNV S1N3WW0��bN011laad � .