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� �
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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
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City, State , Zip City, State , 7ip
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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�$ � �
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New Construction }
W
Size �z ft wide ' wide ' wide �
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3� ft long ' long ' long ��
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Floor area ��� sq ft sq ft sq ft �,
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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� � ��
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( ) Dwelling -r5' �� `�
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( ) Garage ( 1) (2) car I �•
�.��'Storage Building ►�-�• �n
( ) I�oathouse !�n"i�
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( ) 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'
( ) ' ' � ~ -� �
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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
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Construction Cost $ I ?�%�= �- � �
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Cer . Soil Test � � -Z -`Jj� �t �._��, `�s � �
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Sanitary PermiL cj/ - 2Z�' __________ �L road --- ~ �
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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
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Owner 'Loning Administ -at r �
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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;
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` � �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.
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�'_'� � N .85 Ac t ` -- �,.
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� � �'� � •� !� �'� L . ELLIOTT land surve or
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� � 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
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' N��ss w , o-- z � �. `� � _ � ' ��-�,,,:.� �Z k- z _ ' ELLIOTT ..�s �
�_��241.pp N80°24��p��w �`ti° � o �-�; �Jl� NcTc: � Spooner, Vil �
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-� 34 q2� �OI.q2' �. � � U .0 L��rt u' 3 ��•6��-� : �: �• •
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TOWN OF' SAND LAKE
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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
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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
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Aeration Bidg. Sewer �
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(—� 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 ' � !
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Manufacturer �Jlds Demand � '
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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��