HomeMy WebLinkAbout026-938-06-5808-LUP-1994-094 Application for Land Use Permit
County- of Sawyer � y
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T}ie undersigned hereby makes application Eor a Land Use Permit and agrees titat �
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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wner Builder "" �
I1.3`� 7�� si, 5,��, s���T��cF ,��l�� , R�'1 �3cX��3--c-�
Mai�ing Address Mailing Addre s
�iC',tf�si��� , 1L�n,, �'��90� Si�ti�r L/}K� ��'.�, S 5��7(
City, St te , 'Lip City, Stat , Zip
Plb�;� S o'7-��St�'-��s"s``f r o
Building Land Use Zone District jZ�-2 0 �
( ) New ( ) Filling � � � , � m
�) Addition ( ) Dredging Lot size 77.�'',�� X J�i� X 3'�/ v '�
( ) Alteration ( ) Grading �,
( ) Moving On ( ) Acres . ��.r
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New Copstruction �
►�O�iC{� (SC'r2��nJ��� ���k'C�c�iY� ��1�iTiL�i����,f'DA,�'Sio,v� ��
Size � ft wide �' wide ' wide �
/� ft long �' ' long ' long �
Floor area �(� sq ft `�� sq ft sq ft � "
Total hgt g to peak /,,7 ' hgt ' hgt x'
Stories -- .�
Na . of Bedrooms .,_._ �%(� S/s�h��3r�4r1 M�3 �r�-K4 ���
r waterline o :1
(��a„� or seasona �I G rt -�',�
Type of Bldg , Addition, Use ,� 3� a. o
( ) Dwelling �' �
( ) Garage (1 ) (2) car � _ 'Z' - �. ,�
( ) Storage Building � P�aeu
8 S�tox:itif �.
( ) Boathouse T-- /s' sit�a � '�,
( ) Livingroom '�M 8 � "
(� Bedroom �.r.���¢b� �?c�s��t� �'aot�r �X(Si�^'G 4
( j Kitchen-Dining ► l�'�'``���� � O �,,,
� Porclz (enclosed) (roofed) 3� 3y'---�
( ) Deck - open �' � �
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( ) �,��� ° S�n�m �y� �1`� �
T�ype of Construction " ,e /.�c� � �
Frame ( ) Block n �,
( ) Log ( ) Concrete �C �'�
( ) Pole ( ) Steel � � �
( ) ( ) Pole/Metal ` �
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Construction Cost $ `t�CJG Z����"� :,
l�� S��Ty�� r
Vol �� Pg ��_ of Deed '�v�i
C�-� �j P g 13 � '�
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Cer . Soil Test 2���
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Sanitary Permit �- �'�] __________ �L road -------------- z
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Issued 12 M� 1994 � ,�
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1 � +-c�..� �f.CZ-U � �i,�'f �-�(� � 1 �(=-�' _ �l)T4 �
wner Zoning Administr to
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Register's O[fice �/`�/ ���
J Sawyer County }� �� ,
Received for record the �� day of
���,, � A U 197) at ? o'clock
_� f:: cnd r,:corded in vcl� '
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Regioter
lleputy
SAt�1YI?R COUNTY CI�,RTIFIED SURVLY MAP N0.
Easi 8, West I/4 Line 20.0� FD SBC.
p � I/4 Cor.
�,h`ti �� a� Sec 6 8. 5
m T38N.,R9W
L E G E N D a �
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0 Found 3/4�� I P � � �so�
• Set I�� X 24�� IP. wt. 1.681bs./ft. �� s'��
G Set I�� X 30�� IP. wt. 1.6 Blbs./ft. �I F `9!�op�
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99� �` �7 SUftVLYOR�S_CTI?TTFICATL
9� �o�c� I, LYTd: L. L;LLTOTT, re�-i.stered land ;�urve�;ror cert� f� ec3 th�t
9 \ h,y the di_rec-t;ion of I�4ICHAL'T, CLANlrR, T h<��re stirve�Ted anc�
mspped �,he lanc� parcel ��hich i s repre:�ented hy thi_s
certif:i.ed Surve,y P�Iap:
That the er.t,erior boundary of the ].and parcel s�zrve,yed and mappec� i s described
as foll��as:
/1 n�rt of CTovernment Lo�; £�, Sec.t,i.on E�, an�i part of Government T,ot, 13, Section
5, To�-m:,hin 3£� nlorth, Ran�e � j�1es�;, Soiith P<�ri; of Sand Lalce, Crnmi-,,y of Sat�ryer,
State of ilisconsin and more particular],y �lescribed as foll��•�s:
C�mmr�nci.n�. at the l�li corner of. secti�n 6 anci 5, thence l�lest 20 feet
alonr� the I�,a.,t and Z�lest 1�14 ]_ine of Section 6 to an iron pi.pe, t,hence
S li.0� 01' 1.F0" L�J 33.20 feet t� an i.ron p:i.pe bei.n� i;lze noi.nt �f T�e�inni.n�;
thence S 35° 57' .50" T; 1?_3.£�6 feet to an ir�n pipe;
thence S l,.�i° 09� 20'� 4J 321.2.0 feet to ,zn iron pipe on the TTorth Shore of
Lalce Sisah<�R�ma;
i;hence T1 3h" 0�3� 3Q" U1 77 fee�L on a me,zn�ler I.i.ne of :,<�i d 1<�l.e to an iron p i.p�;
thence T1 I,0° Ol.' 1,0" F 329.55 feet to the �oint, of f3er�inn�nr, inclt�di_nr� �3] l
lands from said meander line i;o the water� s ec-3�e, saici parcel c�nta�ns .'75 acres
morr or less <�nd subject to an,y easement of record.
Tha{, I h�ve fu].l,y complied ti,ri�t;h the prrn✓i.sa.on of �o``',,`�;1SC•�NS11��,,.
.�'� '�
Chan�;er 236-31,. of the t�Iisconsin rev�.se�i Statue :i.n ,`� �e '=
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survey�.ng and mapping same. ,, ., .i � � � �� LYLE l. r �
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t � • SPOONER, �
� .. [rlisconsin Re�i.stration S-1300 � ; W,m. ; �
L'.autified Survey Nar,� �� � Dat e: I�u�u st ?_3, 1�17 � ���'• . . '�.`;
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� DILHR SANITARY PERMIT APPLICATION � N
In accord with ILHR 83.05,Wis. Adm.Code couNry
���� CST 92-351 Sawyer
STATE SANITARY PERMIT#
-Attach complete plans(to the county copy only)for the system,on paper not less than 17 99 8 2
8'f�x 11 inches in size. ❑ Check if revision to previous applicaUo.:
�ee reverse side for instructions for completing this application. SrAre PV4N�.o.NUMeER
I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. �p �D J� �b�- �-
PROPERTY OWNER PROPERTY LOCATION
%a Ya, S �' T��", N, R E-fe�')W
ROP TY OWNE MA LING ADDRESS LOT# BLOCK#
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TY,ST TE ^ ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
II. TYPE OF BU DING: (CheCk one) ❑ State Owned ❑ VILLAGE� NEAREST ROAD
q C
❑ Public 1 or 2 Fam. Dwelling-#of bedroomS�'L PARCELTAX NUMBER( )
111. BUILDING USE: (If building type is public,check all that apply) 0 2 6-9 3 8-0 6-5 8 0 8
1 ❑ Apt/Condo
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.�eplacement 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-Fill
VI. ABSORPTION SYSTEM lNFORMATION:
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
� � > � � �' � � Feet Feet
CAPACITY
VII. TANK Site
in allons Total #of Manufacturer's Name Prefab. Con- Steel Fiber- plastic Exper.
INFORMATION New xistin Gallons Tanks oncrete glass App.
Tanks Tanks structed
Se tic Tank or Holdin Tank �c a�� v
Lift Pum TanWSi hon Chamber CC. C�> >�
VIII. RESPONSIBILITY STATEMENT ���lg�� /Y K
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) MP/MPRSW No.: Business Phone Number:
� ����
Plumber's Address(Street, ity,Sta e,Zip ode):
1 5/
IX. COUNTY/DEPAR ME USE ONLY
� Disapproved Sanitary Permit Fee(Includes Groundwater a e ssue Is ing Ag nt Signatu e o Stamps)
Q Approved ❑ Owner Given Initial Surcharge Fee) ,
$205 . 00 11-13-92 '
Adverse Determination
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398((ormerly PIb�7)(R.11/88) DISTRIBUTION: Original to County,One Copy To:Safety&Buildings Division,Owner,Plumber
Wisconsin Department of Industry, pRIVATE SEWAGE SYSTEM County:
Labor and Human Relations
Safety and Buildings Division INSPECTION REPORT
(ATTACH TO PERMIT) SanitaryPer itrvo.:
GENERAL INFORMATION ��q q Z q.Z � Za7
Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.:
tto � Sone S °C '2.. - �.1 zz-'Z.
CST BM ev.: Insp.BM Elev.: BM Description: Parcel Tax No.:
� ' covtc. por��. S ' OZ.Io --938 - �6 --580�
TANK INFORMATION ELEVATION DATA �
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic v � _ Co c- t000 Benchmark ��.
Dosing ic �� (vOZ�
Aeration Bidg.Sewer
Holding St/Ht Inlet q-7 c.fs-
TANK SETBACK INFORMATION St/Ht Outlet �c7. 1g
TANK TO P/L WELL BLDG. ventto ROAD Dt Inlet
Air Intake . �7.��
Septic -�25+ -30 �O' Z S _ NA Dt Bottom c.�3���
Dosing 7 30 3�� �O� 2.S' NA Header/Man. �S�Sd
Aeration NA Dist. Pipe
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer ���d5 Demand �,,�a _ L-�s�,( sure , LoS.SO
Model Number ��� � � GPM
TDH Lift 12,,�' Lriction 3.� �eadm Z'� TDH �S.Y Ft
Forcemain Length ���' Dia. �,�' Dist.To Well �30�
SOIL ABSORPTION S�STEM �
BED/TRENCH Width � Length No.Of Trenches PIT No.Of Pits Inside Dia. Liquid D
DIMEN IONS b 4�- 1 DIMENSI N
SYSTEMTO P/L BLDG WELL .LAKE/STREAM LEACHING Manufac .
SETBACK CHAMB
INFORMATION Type O � a � � n/�odei rvumber:
System: Mo�.+� ��� �' �� 7-1$ T �oo IT
DISTRIBUTION SYSTEM
Header/Mani�old i� Distribution Pipe(�) �� ii x Hole Size `/ x Hole Spacing Vent To Air Intake
Length 6 Dia. �— Length � Dia � Spacing �s � �S't� > 2.5"�
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over �� Depth Over �� xx Depth Of j� xx Seeded/Sodded xx Mulched
Bed/TrenchCenter �$ Bed/TrenchEdges 1,1,, Topsoil L � �es ❑ No 0'S'es ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
� �„5��-{.o„�S �t � tZ � ll- i� � E i 1 -�$ -�z"
Plan revision required? ❑ Yes �No �
Use other side for additional information. �� 1$ �Z -'�-�� w' �`� � .s Z 3 8
SBD-6710(R 05/91) Date Inspector"s Signature Cert No.
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ADDITIONAL COMMENTS AND SKETCH
SANITARYPERMITNUMBER: (79`�BZ� � Z--Zg7 '
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600 �� P.r , 8�
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