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HomeMy WebLinkAbout026-938-06-5815-LUP-1994-251 Application for Land Use Peimit � � � County of Sawyer � 'Cl�e tm der.signed hereby rnakes application Lor a Land Use Permit and aQrees that � all work shall be done in comp�.:iance wiCh the r.equir.ements oI the Sawyer c�>�,►,�y �� .7.�rning Ordinance and the laws and regu]_ati.ons of the State of Wisconsin. �i� ' wi�,�-�-�, �����f�' PRINT - USE BLACK INK OR PENCIL � �.U. �A�C. 353 � � ��c.�-s�� W � 8300� � �. K v�r-t-� L�c.cr s��r/ �� rn,�r� �',�z� ;-t 2 � Owner Builder � � R;l i'�� x � r �T�- � �x 24 3 d Mai ing Ad ress 5vvr�t����� Mailing Address S7� �� c.�-r�� ti.� � s�-t�7�= s Tz:- � � ��r,c� �- � s�r �7 �= City, State , Zip City, State , 7ip r o Building Land Use 7,one District �.�?, -�. � � ( ) New ( ) Filling � � (>C) Addition ( ) Dredging Lot size �j�.zj x, S�f� ,� ( ) Alteration ( ) Grading ( ) Moving On ( ) Acres �j. 1�$ � � � � � � N r � � New Construction } W Size �z ft wide ' wide ' wide � - �. 3� ft long ' long ' long �� � Floor area ��� sq ft sq ft sq ft �, � 4 � To tal hgt ��� to peak ' hgt ' hgt x' r Stories � No . of Bedrooms G -`r� iv _____ _ _ waterline o (year round) or (seasonal) � `� �`�'''���, �' rt Type of Bldg, Addition, Use L`�k`' .i`5''r,3`�'`nr�"�- M3t� � �� a o ( ) Dwelling -r5' �� `� � ( ) Garage ( 1) (2) car I �• �.��'Storage Building ►�-�• �n ( ) I�oathouse !�n"i� �" . ( ) Livingroom v- i�`'�N:ow.� � ( ) Bedroom / h __ ►�►-�' Q � ( ) Kitcherz-Dining �� �� 4 � ( ) Porch (enclosed) (roofed) ; N � ( ) Deck - open tti� _ ,� -�4; `� � ) �-`A, j G�� G��� �5�v U) � rV' ( ) ' ' � ~ -� � ' ' J'! � Type of Construction �1 n�'i, � �G-x�N'S � r, C� ' (S�) Frame ( ) Block y c�'�� ( ) Log ( ) Concrete 'f � � F�� (�C) Pole ( ) Steel_ �-- e ._---__ � � ( ) ( ) Pole/Metal � 4�' � cn �t -_._ � m � L 1 C) Construction Cost $ I ?�%�= �- � � � --- 1 � \ I ��� �. Vol �� Pg _ 1_l"1— of Deed F-- ��c` _. � �, , J G �":�'� -� __ CS Vo1 � Pg Z� .�-3� � � �d s Cer . Soil Test � � -Z -`Jj� �t �._��, `�s � � �, Sanitary PermiL cj/ - 2Z�' __________ �L road --- ~ � ---------- z S I S s i�/�/f G.�l'Y��4 �'.._v.�4✓J � Z �!`l 51� �.r;��i , y' (.�/�'2 e e � Issued 09 August 1994 Denied � �� � � � / — ; � Owner 'Loning Administ -at r � J LEGEND ' Q Fd I/2�� I.P. � Sef 3/4��x24��I.P.,w1 1.131bs/fl. SURVi:.,'YOR�S C�'RTI�'IC'�_T^: (xxxx) Deeded distonce I, LYLI: L. �LLIOTT, registered land surveyor hereby certify that by the _ direction of G�R���T COLLATZ, I have surveyed and mapped the land pascel sCA�E i"- i0o' which is represerited by this Certified Survey Map: F That the exterior bol:.rdarys of the 12r�d parcel surveyed and mapped is 0' 100' 200' described a� follo�;�: � A part of Goverr_em.�t Lot 8, Section 6, Townahip 38 Ir'orth, Ra.nge 9 Weat, Fd.3/4"i P Fd i" i P To��m of Sand Lake, Cour_ty of Sawyer, State of Wieconsin, and more p�.rtic1�la � -- 338.00' described as follo�as: S89°32'IS'�E � I "rn� '.., '�,I � � 26,815 S.F .62 Ac� 3O o0 Commencin� at the �ast Quarter corner of Section 6, thence N 0° E 77.00 fee , i`, '� i _ _ o thence N 89° 32' 15" ',J 511 .82 feet to the point of Beginning; ��•, , — _ _ o '.. ` � �a I� � _ � S.81 31 E _ -34�•74�_ thence S 0° Sd 90.l�l� feet to an iron pipe on the ehore of Lal:e 3lsaba ; i � �� �t0w� r� ` — o`` thence Pt 80° 56'41 on a meander line of eaid Lake 3l�2.1�2 feet to an i e � ——_ __ - -v �a pipe; .:�� (,�� ��_�: ,- !^ 240.63 - - � thence N 0° � 488.27 feet to an iron pipe; �`N° � therice S 89° 32' 15" E 338.00 feet to an iron pipe; iCO ���•�o � thence S 0° 'rl l�50.00 feet to the point of Beginning; i N81 31�w o �' � � sad axcel conta.ins 8 acres more or lese inclu.din a11 l�nd from . �w �: �r P 3•�t � 8 . �o J 3 said m�ander line to the waterg edge� and aub,ject to any easement of recorc i���Z � 87,415 S.F °0 1 ""' � �� 2.01 Ac ± �, That I have fully co��lied with �he provisions of Chapter 236.31� of tne � - '�� � ,�% Wisconsin revised Statutes a.nd the subdivieion ordinance of Sawyer County �00 ' 2 U 36,9;55S.F '�''=� in surveying and nappin� same. ,'i� o �'_'� � N .85 Ac t ` -- �,. � �n ��' �'�� M � , , -- • _ • � I �� � �,. �� � O N � '� �(3 -- i J � � �'� � •� !� �'� L . ELLIOTT land surve or � o _, � �'� >. .;: I I �,. , � y C � � M �� :° � rn,I � _t �� 'rliaTonsin Re�i�t ation 5-1300 - z (5i2.s') �N� I '�,,I�`�-fl:: Date: Februas^✓ 19, �983 I 511.82' � I � N89°321`J��W � � I �i ��� ` ���`ttrr������ ' �� '� � I��� �I � — �' �i � /� `\�., !� J��' �/,L��i I.I � ,�I •`� µ � �_ l.;�t,-� � �cLn.CL' `,•�•.- " ��i -� . ` r� c^� C '�'C � ��� ` �� � � ,___�._� �.3 � � , ,y , ���.. . .�' �2 `� ti o � Q � �, `-1<-�u�t�,_ �� �v�,..;� <<�.r :� •LYLE L.• _ ' N��ss w , o-- z � �. `� � _ � ' ��-�,,,:.� �Z k- z _ ' ELLIOTT ..�s � �_��241.pp N80°24��p��w �`ti° � o �-�; �Jl� NcTc: � Spooner, Vil � 1 �� -� 34 q2� �OI.q2' �. � � U .0 L��rt u' 3 ��•6��-� : �: �• • �AKE �._ �� 1 Fd 6G E/4 'J j �' : .��, '� , ) % �'� :� : S�SAB �—�� 'Sec. 6 38-9 .� E •�� ��' �� �} "Ir, =�'r"�"� c`.�� ',� �''••....•••� ��•`� qGqMq N ���� a � ��� ��s� � ��•�r- «-,ut�, • � , 13� , � _ �•, S p ��,. � M ,'�����IlIIII1���`t O TOWN OF' SAND LAKE � � UTI� PART � EC. � T�VP 3� N . R. 9W � � I ' I �8.1 �8.3 �8.2 �8.16 ( 3 � �9.1 � /� � �� � �10.1 � - \ =9.10 :8.13 3 'g.5 I � r .62 , � � ► I :9•7 7 � 22.oi�' 'e� ^ � �10.2 v :9.s 3 .l S� �@.t5 �8.7 - - - - - - �9.3 � 8 g �� -� � � 2 _� �11.12 :8,14 � � :8.4 � :9.9 �9.2 `9'6 :8.6 \ :11.5 :9.5 � :II.8 s9•4 �8.8 I �11.6 :g.12 � 2 � �I1.9 :11.7 �8.9 \ 3 I � :11.I I r, .�� � ' � � SANITARY PERMIT APPLICATION ~ � �ILHR In accord with ILHR 83.05,Wis. Adm.Code CouNn —��; Saw er � o� C S T 91-2 5 6 STATE SANITARY PERMIT# —Attach complete plans(to the county copy only)for the system,on paper not less than 16 4 2 3 4 8'fz x 11 inches in size. ❑ Check if revision to previous application —See reverse side for instructions for compieting this application. sTATE P�AN i.o.Nunnsea . I. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. Q � � _ S' �C PROPERTY OWNER Rll t E . E e S OTl PROPERTY LOCATION � '/a '/a, S T,3$�, N, R �or) W PROP RTY OWNER'S MAILING ADDRESS LOT# BLOCK 5� . . � s _ ' I � �► ITY,STATE ZIP CODE PHONE NUMBER SU DIVISION NAME OR CSM NUMBER VC � 11. TYPE OF BUILDING: Check one ��N � NEAREST ROAD � > State Owned VILLAGE: ��N � � � ❑ PUbIIC �1 or 2 Fam. Dwelling—#of bedrooms� PARCELTAX NUMBER(S) III. BUILDING USE: (If building type is public,check al►that apply) 0 2 6-9 3 8-0 6-5 815 1 ❑ ApUCondo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ RestauranVBar/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 Y. TYPE OF SYSTEM: (Check only one) Non-Pressurzed 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 V1. ABSORPTION SYSTEM INFORMATION: 1.GA�LONS 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 �� ; � S ,3 � ��� l�� '� Feet Feet CAPACITY VII. TANK Site in allons Total #of Prefab. Fiber- Exper. ItJFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel 91ass Plastic App �Tanks Tarks i structed � Se tic Tank or Holding Tank�OV �' � � . I � Lift Pum Tank/Si hon Chamber � � � I j t ; � VIII. RESPONSiBILITY STA'��RAENT ! I,the undersigned,assume responsibility for installation of t�onsite sewage system shown on the attached plans. ; Plu�nbe+'s Name(Print): Plumber's Signature:(No Stamps) MPRSW No.: Business Phone Number: �1 ' � .w� ,� �'�1i � �. .� �� \ i Plumber's ddress(Stree,Ciry,State, ip Code): c�e f , �— IX. C UNTY/D PARTMENT USE ONLY � Disapproved Sanitary Permit Fee(Includes Groundwater ate ssue Issuing Agent Signature(No Stamps) �Approved ❑ Owner Given Initial Surcharge Fee) , Adverse Determination �1�� . �� 11-0 4-91 X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.11/88) DISTRIBUTION: Original to County,One Copy To:Satety 8 Buildings Division,Owner,Plumber R� � �PRECKEL� CONSTRIJGT'I � � ��. ROUTE 2 F30Y. 2006-A HAYWARD, WISCONSIN 54843 (7?.5) 634-8250 ,�;; � � e� ~7-- �1, ��•-Yh �, �/ / �(:-5c�i�1 -- � ✓� S c - 7S('�i\'� � ; _ } ���Yr 0�n ! 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I r„ r ��j\�t� � � �` � i � i , ; ; ��s`���v��-�f �� j � � r �,.�„ � ; , pN .�•�;,�,Cc��� � � .� 1 �� � � � ,: _���� s _ _yn, � , ; � ; r� � ; ---//�y �r r �v.•;, .t 's NS ,l- +-' �_i,�)Gr{_ ;��.1 � � � l/ ���@.�,�„:� R� ',� �' , , j � �,+�� �;, '� ��,J���� % ; � L ` ,� ;� ��,.�,������p,z a��o 1���`N�S 1- , � ; V , ,�,�r �J�� �� PN�� �. � � � ' r' \ ' ,T�; ,,� ��F � SP� 1 � r'�' ' I`fl `,� �' �� a���ti''�,1�,y�����' , N�� �� ;� �:� ''� � ; M � � ,,� RESp�N�� �� �, � ��" ��,: + � �G � l ,;, I (,,�.�' � ^� � �_,', � ' ��, I ; ,,�i , _ ► i , � _..--- � � i � � ,�--� � }`yr i i �,..___._.._�\_ ,,---'_ -.�'`.. 'j . ;' � � I / �—`—� _ / . � I . �.�---��— �� I I { / � � ,/ ' ��� �,1�h.lc •-- ��_5 �"�" "� I ! ' �. ..-:�' , ; : ��—-- _..- r- t. <s►; �;;,. � ��, � 4�- i . � ; ; . ��.,_�____..�� ;.b` � �-... 7 ' � '{ ( ' � �J �t� 1....C�' i�'1� �- � i . �� ' �' f,l__ . �E',l- �1`.I t /J 4't,,��. �,�� (,j �` �------- �� C � �' � ' n ti � �r c,�: i �` �-,�._ - � i , . • -- -� ` �� ` ,:;�.��; '+.�,�2.,`-C:�-� r�� - ���t� � ``� \... .- � r � wisco�si��epartme�t ot�ndust�y, PRIVATE SEWAGE SYSTEM �o��ty: —'� � Laborand Human Relations INSPECTION REPORT " Safety and Buildmgs Division 4� � (ATTACH TO PERMIT) Sanitary Perm�t o : GENERAL INFORMATION lb Z3�f � 1 — Z—Z- � Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No � v-E—1,, � • ��l e-� S�►� 5�.►�c���C S � l - zc� 8S3 CST BM Elev.: Insp.BM Elev.: BM Description: Parcel Tax`Jo ' l Q'� ' P�u -{- . ��-lo -�38 -O 6 -S9� TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELE:V. Septic � _ �O�G ��d Benchmark ��� ^ Dosing « �i 600 � � Aeration Bidg. Sewer � � (—� I Holding St/Ht Inlet , o� r], 3S" TANK SETBACK INFORMATION St� Ht Outlet c��, Z.p TANK TO P/L WELL BLDG. qe Intake ROAD Dt In�et I I � � �7 1� Septic �'SO� ��� �U� ZS � NA Dt Bottom � � �4,� Dosing .�'�� .}-SO 'J�� Zsl NA Header/Man. � I ��p•`l S Aeration NA Dist. Pipe � ; �D��"7S' � Holding I Bot System ! ' ' ; I PUMP/ SIPHON INFORMATION � Fir.a! Grade ' � ! i � Manufacturer �Jlds Demand � ' � Model Number �- � 72_ GPM � ; � TDH Lift ' Friction System --� TDH ,3�SFt I— � ' �o L s 2•�� Fiead �S I1 i � � Forcemain Length 23p Dia �' Dist.ToWell �.�pp i � SOIL ABSORPTION SYSTEM �� g x�� BED/TRENCH �Nidth � Length � No.Ot Trenches pIT Nu Of Pits Inside Dia Liquid Depth DIMEN IONS Z 6� — DIMENSIONS I ^.1anu`acturer. SETBACK SYSTEMTO P/L BLDG WELL LAKE!STREAM �'tACi-iING INFORMATION TYPe� � � I � --�— ; �HA�J?�EI-: -,.��„ce ":�.:mber. System: D� -�1� -�'1C�0 I-1� 10� -�-Z50 _; 1RL��1iT __ _ __� DISTRIBUTION SYSTEM — -- --- - -- _ -- Header/Man�=��� DistnbuUonPipe{s) � > � � �;� �� ��e � Ven� � � �r��. �-�r��: � � _ l enyth _ Dia Length _ _ Dia ___ Saaung ___ j �C.�. ___ ' _ __� SOIL COVER x Pressure Systems Oniy xx Mot,nc �r ��- ;3r: ,�r ��;si�r-�s �nly Depth Over De rth Over ( xx De�t�,���� � � � U F �� F d � � xx S�'�'d<<1 ���;ii��d xx MuiChed � BedlTrenchCenter �� Bed/TrenchEdges ��� Tupso�l � �� ��es �� fd.� �}-Y"s i) f`l �� � COMMENTS: (Include code discrepancies, persons present, etc.) ��s��s _ � o — iz � iS � z3i zS — �1 � Plan revision required? ❑ Yes No LQ ,ZS �' ` , W p , n p S 3 Use other side for additional inform �ion. f'l /`'`o�Ct�. � I�I SBD-6710(R 05/91) Date Inspector's Signature Cert N��