HomeMy WebLinkAbout026-839-07-5108-LUP-1994-084 Application for Land Use Permit
. � County of Sawyer �� o
The undersigned hereby makes aPplication [or 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. �*�
PRINT - USE BLACK INK OR PENCIL � ,
� �. 1��Z'cz.��I�.. J . �u m�R S
/%�f/� -��:� ��.�.���� � � . �/�'�'�S ��G�!�/'
Owner Buil er
�:�
/��// �/ /�. '/ �
/�/ �- � ��� \ l�LY� �(_.� `L�V/` / �
ailing Addres Mai ing Address
� /�,
� i�'�'� �% 5��~f�--S �/��✓f�� �j S��'�'
City, State , Zip City, Stat , Zip
Building Land Use Zone District '�Q-Z, r �
0
( ) New ( ) Filling � �
(r�' Addition ( ) Dredging Lot size v '�
( ) Alteration ( ) Grading
( ) Moving On ( ) Acres ���f
( ) ��v ( ) �
New Construction
,
Size �_ ft wide ' wide ' wide �
�"�
�p ft long ' long ' long
Floor area rfft'o sq ft sq ft sq ft
�
Total lzgt ��{� to peak ' hgt ' hgt �' �.
Stories /
No . of Bedrooms --�' c�
�;,�cyt., -ine or waterline o
C
(year round) or (seasonal) � rt
Type of Bldg , Addition , Use � �i�/�� COv�� a o
( ) Dwe 11 ing �-��v�-'�� �' rt
(r� Garage � (2) car �____�-r--/i/ , -"' �.
( ) Storage Building �� `� ''
r. ,
0
( ) Boathouse � � ��s� � D �
( ) Livingroom 3� _� ��� S
( ) Bedroom �
( j Kitchen-Dining � -'� �
( ) Porc1� (enclosed) (roofed) 4 � _ �.� �
( ) Deck - open � 8��� ��- �' �-�
( ) ; ,�o� _ F�
( ) �Z � a--
� '�
� � . .
Typ of Construction � � . • �
(�Frame ( ) Block i5�� �
( ) Log ( ) Concrete � F��
( ) Pole ( ) Steel •
( ) ( ) Pole/Metal �
�o
'` �
Construction Cost $ � pp °%
Vol ���� Pg �.;�'_ 1 r of Deed �
CS Vol � Pg � r`� ,� �
\ w
Cer . Soil Test QJ -22(e �
�
Sanitary Permit g` -�(p __________ �L road z
�FF 1�1�2.W A� cS�bR�, ��.��• o
z
Issued 06 May 1994 Denied � � �
�i� L�-���—t�£�,��-( �
(�Cvrrer Zoning Administ ato
gu«o�R
� _ _-- o.co '
. � — — — ---
� uo�.w�.� s��—�-�c�. � 1 �3 Q � � .
� :I.10 , -
(-- �
� � 7-39. �/ � I
_ •�,c
� ^ � �
� �
'���° -% P O n
� O� .� . � ;
� � i .'/. 7 � % � C !
��:/. G �
.\
�.i.s ;' (� --� I
� :; � �
7� ,� (�
� � � �.. ����� n � �
, :,._ � ,� �
� __:� �
, . , , �
I N �� �v ���
I �� �`\\`\ �p 'Sl
'ro .�iw ��1';`, � �
R�� ',a o g� o``\\'1 .7 � � .
� �
� � � �,�v �A'' � l9
� � I �
i v, `o , ,\1\ � g. �
�,
�\
,
------ 'Q \�\. � � � I
�r ��1 —�y g• �
(lA � � �
0 � =-� ;� �._ , � � �
� , ON �'. (� ;. � �
\ / � N , � � � ��
\I 0 � '' �1 I . -A ry � ''
� O ' }�1 t�'' lr� i N �
\ W� ! �� � � N
_ i �i `N . ��i� �
l � ' +
.. _ -------�_ ._ __ . ..__-- --- � �
---- ----_ _--------- ----- � 1
-------- — _ _._ i 0 D_ '� C .
O
�\( �r , , ' �
.l � W
� . I v �
. ; z
; .
; . .
„ ���, ; ;� . �--
, . � �
`�' � j �w )
�°1 �M, �
I . rn �
i W
! :� �
� �
i�
�—_ � !�
I S G1S � � '�7
� ;� b � y� �
; �
, . � m � A.
� I ►�,' �' N
: �r � cZ7 H
i • � ca �^ �
, � � �.
�� �. �
. ;�, � ,�.,
� . � �
_v� ; % J .;.,;� =� c .
� � I r�� ,n-� m
(� � �
�
� � , 4
�°�' i � � n
:5�� � �� .
`�
n'�;��'�
'
�
� �
I \ .
;�
, _,�_ '<<
'` -- - o o� ._.
, / � _
�-. •
�AC
. , �����T__E��ES
2Q3 �--� SIIRVEYOR'S CERTIFICATE
, _ N83°46'�p�� �r� �' I, LYLE I,. ELLIQTT, registered land eurveyor hereby certiff thats by -
` —_ `_ ii►_45' ^ �z�# direction of M. CAROLL, I have aurvayed and mapped tha land parcei wh
�; ���y fd Q�9�e is represented by this Certified Survey Map:
ti �ron
� HousE Tha�u the exterior boundarys of the land parcel surveyed and mapped i�
-/ '; described as follows:
�<J 1� _�_— _.. �,' /)4�0 �.
- _ _ _ _ _ A part of Government Lot 1 , Section 7, Townahip 39 xorth, Range 8 Wes
, '�, Town of Sand Zake, County of Sawyer, State of Wisconain, and more
I o �\� � � partic�alaxly describeci aa followa:
� �
o � , � � Commencing at the West Quarter corner of Section 7, thence N 3° 26' W
M a � along the West line of Section 7 1312.L� feet; thence N 88� 30' 30" E
� � caRa N �
� "o Q 508.11 feet to an angle iron being the point of Beginning;
� � J " m a�i ' .N
� � .o i I� 9 N 3 • o �, thence N 3° 10� W 216.10 feet to an angle iron on the shore
�..i � ,,, �,, 26�3 o z of Lac Court Oreilles;
� � � o .6� ac 3 . "' thence N 83° 46' 30" W on a meander lina of said Lake 111 .l�5
.Y
e ° o Fd ������P °, °, Z feet tc an iron pipe;
� �I �� a S�ec 7 M 39 8'�ne `� N thence S 3° 10' E 231 .07 feet to the Southweat corner of a
_. "� o +
,_;,_, � Q .� 2'x2' etone and concrete pillar;
� � � �trnvel road thence N 88° 30' 30" E 110.00 feet ta the point of Beg{nn�
J T :' � 7� '
- � I said parcel contains .61 acres more or leaa, inclwd.ing a11 land from
� �' �_ � � Fd. ang;e said meander line to the watera edge, and sub�ect to any ea.sement oi
;� ;. - ��v` I �� 2'x2�rock .pillar iron
� � a I I� �' � Prop.cor. cor, T2COTd.
N , ,;, Fd. II/2��I.P.
o� �I 0.00' �
c � That I have full com lied with the rovieions of cha ter 2 6.34 of t
v u� N 88°30 3 � E 508.11 meo . Y P P P 3
m � � 53C�"1'S deed � WiBConain reviaed Statutes and the subdivisiou ordinance of Saxyer
N cv ' i 978.08mea
o v° 'v� 1000.75 deed Coun ty in surveying an d m a.pp i ng e a m e.
M
y c Z c7
,n —
O ' N i
m 3 rn _ �
Q 50 100 �
SCA LE !`�= 50� � - L�%' , l�� gvxveyor
$M EI,EV. 100� S`0.� . Wi. ��nein �eg�,s �e��c�a��4•,��3Q0
�i � 1�i1�'.A 2 MBy 1t��,��3�i���• �,! ,�i
I Fd.3/h Fte-ro d ;`� �o•► •,•., �%
1 W/4 Sec. 7 , 39-8 � E�RE • � �
� �. .�. 'p�
' � LnE '
. ;
. O o P�R LEGE(�lD .�s= ��-x�3 � ELLIOTT
r3 �: �
,:
•, Set 3/4'�x24��1.P.,wt 1,131bs/ft. ��Q ��Q;I�L � y:. Spooner, Nll �= �• «
. ��l�v._.�t, t �
LO �G��'..-l�rd �G'i/',u , : � �4, �••J. ��
�' '•.. �f������f�� -' v�
-�.� /�/��Z
f�'�.. S' ,�n(l ��,�.
. �
SANITARY PERMIT APPLICATION - ~
� DILHR In accord with ILHR 83.05,Wis.Adm. Code CouNn' Saw er ��
csT 91-226 y
STATE SANITARY PERMIT#
-Attach complete plans(to the county copy only)for the system,on paper not less than 16 4 212
$�f�x 11 inches in size. ❑ Check if revision to previous a{�plication
-See reverse side for instructions for completing this application. � STATE PLAN I.D.NUMBER
I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
�.-'- C �OG��� '/a '/a, S � T3� , N, R 8 E o 1N
PRO ERTY WNER'S MAILING ADDRESS LOT# BLOCK#
,�3Gk ��C'
CITY,STATE �ZI'P`�C'ODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
�4 W (�U./� �-�l
II. TYPE OF BUILDING: Check one ��TY � NEAREST ROAD
� � State Owned ❑ VILLAGE� �J/� �� ����.
/'�
❑ Public Of 2 F3111. DW@Illfl9—#Of b@dfOOfT1 — PARCEL TAX NUMBER(S)
III. BUILDINGU E: (Ifbuildingtypeispublic,checkallthatapply) 026-839-07-5108
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-Pressur;zed 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-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1.GALLONS PER DAY Q.ABSORP.AREA 3.ABSORP.AREA 4. LOADING RATE 5. PERC.RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED(sq.ft.) PROPOSED(sq.ft.) (Gals/daylsq.ft.) (Min./inch) ELEVATION
��Q /G� , C� . � ���g Feet — i'. Feet
CAPACITY
VII. TANK Site
in allons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper.
INFORMATION New xistin Gallons Tanks oncrete structed 9�ass App.
Tanks Tanks
Se tic Tank or Holdin Tank C��i� � ✓ �r/ ,cL'�Ct� �
Lift Pum Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the onsite sewa e system shown on the attached plans.
Plumber's Name(Print): Plumber's Signature:(No Stamps) MP/MfR9CPl�o'.: Business Phone Number:
f!e'sr� �! C�' � � CJ � ,.:�7 /
Plumber's Address(Street,City,Stat Zip Code):
/� J �C;' �� 'G
�
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (inciudes Groundwater ate ssue Issuing Agent Signatur (No Stamps)
Surcharge Fee) —
�Approved ❑ Owner Given Initial $115 . �� 10-2 8-91
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398(formerly Plb-67)(R.11/88) DISTRIBUTION: Original to County,One Copy To:Satety&Buildings Oivision,Owner,Plumber
C.-PARTMENT i�F INDUSTRY, SAFETY&BUILDING ,`
INSPECTION REPORT FOR
LABOR&HUMAN RELATIONS DIVISION
1�.0 BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES 8 APPLICATION �
�Vl/-�Q�S�N,WI 53707 _ � � ' ' State P�an I.D.Number
� CONVENTIONAL ❑ ALTERATIVE (Ifassigned) �
❑ Holding Tank L� In-Ground Pressure ❑ Mound
NAME OF PFF�}�<�,T r��:iL.DER�. ADDRESS OF PERMIT HOLDER� INSPECTION DATE:
��co �� 'Z 8 k Z-6?C ��. �o�.d w S`f6�y3 !0 -L7.. -9/
BENGH MAHKese��anerit referense point)DESCRIBE IF DIFFERENT FROM PLAN�. REF.PT.ELEV.: CST REF.PT.ELEV.:
Name of Plun:be�� �_ MP/MPRSW No.'. County: Sanitary Permit Number:
Utti ��c�.�2 Y �?.OS Sta,w r ��+ 21 Z. 4 � _ 2��0
SEPTIC TANK/HOLDIN TANK:
MANUFACTURER: LIQUID CAPACITY: TANK W LET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
� PROVIDED: PROVIDED:
(,t1�Sa� C-0�C. (000 1 • � ����� Ql'ES ❑NO L�YES ❑NO
;BEDDING� i VENT DIA.-. VENT MATL_-. H�GH WATER NUMBER OF ROAD�. PROPERTY WELL BUILDING: VENT TO FRESH
ALARM�. I LWE: AIR INLEL
�i � i FEET FROM ?�S/ »,�� '�� 30, 3 b '�
❑YES ❑NO I � y _� C� ❑YES ❑NO NEAREs7—►
DOSING CHAMBER:
,A1ANU�ER-. �BEDDING: LIQUID CAPACITY: PUMP MODEL PUMP/SIPHON MANUFACTURER�. WARNING LABEL LOCKING COVEfl
'�. �'� PROVIDED�. PROVIDED�.
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP nN�CONTRo�s oPERnTioNa�: NUMBER OF PROPERTY WELL BUILDWG VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM �iNE: AiR iN�ET:
PUMP ON AND OFF ❑YES ❑NO NEAREST—�
SOIL ABSORPTION SYSTEM. Check the soii moisture at the depth of plowing FORCE LENGTH. DIAMETER: MATERIAL AND MARKING:
or excavation. (�f soil can be rolled into a wire,construction shall cease until MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
BED(TRENCH I WIDT'; LENGTH�. NO OF DISTR.PIPE SPACING. COVER INSIDE DIA.� �PITS� LIQUIO
1 1 TRENCHES: /—� MAT RIAC P�T DEPTH:
DIMENSIONS �g �{O —� v S��+J —
GRAVEL D�PTH '�.rILL DEPTH DISTR.PIPE -DISTR.PIPE DISTR.PIPE'.'��=c=.��AL� NO.DISTR. NUMBER OF PROPERTY 'NELL: BUILDING: VENT TO FRESH
BELOW PQIPES�. ?.BOVE COVER�. ELEV.INLET�. ELEV.EN,D/�. I n PIPES. FEET FROM LWE i • '/O� AIR WLpET: '
L O�t 3��� I��'� IO7•`I TUC .303� � NEAREST—� J�O I �7O 7�t �' C7Z
MOUND SYSTEM:
Mound site plowed perpendicular to � Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
islope and furrows thrown unslope: I mound systems to make certain that it ON REVERSE SIDE. SHOW
i �YES ❑NO 'i meets the criteria for medium sand. ELEVATIONS MEASURED.
�
SOIL COVER � TEXTURE� � PERMANENT MARKERS OBSERVATION WELLS:
❑YES ❑NO ❑YES ❑NO
DEPTH OVER TRENCHBED DEPTH OVER TRENCHiBED DEPTHS OF TOcc���.L�. SODDED: SEEDED: MULCHED�.
CENTER� �EDGES.
❑YES �NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH� LENGTH�. NO OF LATER;;L S�ACING. GRAVEL DEPTH BELOW PIPE� FlLL DEPTH ABOVE COVER�.
TRENCNES-.
DIMENSIONS i
i
I MAMFO�D PUMP MANIFOLD DISTR.PIPE !�tANIFOLD MATER�AL NO.DISTR. DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING�
I ELEV.: ELEV.' DIA.�. ELEV.: '� PIPES�. DIA.:
ELEVATION AND '
DiSTRIBUTION �
i HOLE SIZE�. I HOLE SPACMG. DRIL��_ED CORRECTCr"�. CO'�iER MATERIAL VERTIGAL LIFT CORRESPONDS TO
INFORMATION APPROVED PLANS
❑YES �NO I ❑YES ❑NO
PERMANENT MARKERS�. vBSERVATION WELLS. NUMBER OF PROPERTY WEL�: BUILDING:
COMMENTS: FEETFROM '`iNE
' ❑YES ❑NO i_i YES ❑NO NEAREST—►;
Sketch System on
Retain in county tile(or audit.
—
Reverse Side. SiGNnTuF� nr�E
SBD-6710(R.06:88) � - -a��'�- — �-- --- S� �'-k.T��a
� - �1= --- ---'� -� �-
� .
' Q�...meC: ma,.�C-e>ev� �arro (� L,.C.G. �.u.1�2 �.v�� ��e. Tw� S 7 T 3�IlJ �.�w+.
PL��..I��.r: 14�u�� ���(z �
�4�
Co�,� � vr�e��
�S ,�
,,, - �
e
±�, �--`
6
3 bd
ne�., + a�l;� �we l�
�6� '1
Y'
r p��
y Oc�
�'-- i eoo conc,
!Z pvc
.`
�
n
�-I 40`
��o� o
ig�
la��e '�
-T 2o rf �'^
/ �
k
. c
d°'�
��`°
���N,...�-� Q�
,�y,�.,
��
�
rQ!