HomeMy WebLinkAbout004-838-12-3201-LUP-1989-257 . �
• � 1lpplicatio�i for Land Use Permit
� County of Sawyer F�
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The undersigned hereby makes application for a Land Use Permit and agrees ='
that all work shall be done in accordance with the requirements of the Sawyer h� �
County Zoning Ordinance and the laws and regulations of the State of Wisconsin.
PRINT - USE ONLY BLACK INK/PENCIL ��
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mailing address mailing address
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city, state, zip city, state, zip
Building Land Use Zone District /� /
( ) New ( ) Filling
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(�"Addition ( ) Dredging Lot size /.�-��7 k i.3-�Q rt �
( ) Alteration ( ) Grading �, �
( ) Moving on ( ) Acres tl1
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New Construction G'�
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Size 2 g ft wide ft wide "
�i� ft long ft long �
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Floor area Co ~L sq ft sq ft
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Total hgt �'= to peak to peak 7~c- '
Stories f
No. of bedrooms '-- re�-��I.ine or" waterliiie
(year round) or (seasonal) J�� ~� �
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Type of bldg or addition i i �n C
( ) Dwelling � i r-r
O Garage (1) (2) car i i �w r
(v}'Storage building i i C �
( ) Boathouse � � ~�
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( ) Livingroom � � �
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( ) Bedroom � i
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( ) Kitchen-dini�ig , � i
( ) Porch - enclosed/roofed N� i `
( ) Deck - open , � i
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Type of construction � i
(�Frame ( ) Block � i i � (,�,
O Log O Concrete i � J �'
(I�" Pole ( ) Steel �
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( � Metal ( ) � i
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Construction cost $ �%���� ����- � i �
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Sanitary Permit L ��\ o "
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� Appli.cation for I.and Osc Pecmit �
County of Sawyer "�
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The undersi_gned hereby makes applica[ion for a Land Use Pcrmit and agrees � t
that all work shall be done in accordance with the requirements of the Sawyer M
County Zoning Ordinance and the laws and regulations of the S[ate of Wisconsin. �
PRINT - USE BLACK INK OR PENCIL �
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W/�t�AM r ,RIGD'1u _ wi=��L�ri:��r• L
Owner BuildE•r �
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I-�.� N, 2 ,. • - E- � n_�a
mailing address mailing address
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Bui�iag tiZ '��`,.j Land Use 7.one District ____�
(✓) New P�'"` ( ) Filling
( ) Addi[ion g g �,3,. �' x %,31 J �" �
O Dred in Lot size o
( ) Alteration ( ) Grading ^ �
( !�Moving On Dw ( ) Acres �/U `" n
� ) � ) -- --
� .STa�P,,";G �
New Construction c(�Q4�'+.'i�=-:_; I�;.' �,�L}'�� �
(�UJt��l.l.l r,K't �
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Size �� ft wide 8 ft wide z� �(c �
y�' __ ft long __��_ ft long �32 �¢
Floor area ��'�' sq fC i$a_rrMet�f ��__ sq ft 7�8 �� �
� - AkCi
To[al hgt �G to peak to � r
-- �I Peak I 4,� 14� � �
Stories ?
--1--- --�—— 1 I
No. of bedroom�; _ �- _ rear lot line or �aat�rline rl
-- --��—`J------
(year round) � i------ � � g�
Type .of bldg or addition � � �
(�Dwelling i � � ,��.
( ) (�arage (1) (2) car �
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i � a c-�
( vYSt�rage bui.l.cling � � e n
( ) fioathouse i i m�
( ) Livingroom i � � o
( ) Bedroom ' � °
i �
( ) Kitclicn-dLning j � �
i �
(✓f Porch - enclosed/roofed i �
( ) Deck - open � � �
( ) ' ' �i
�� n1% i
� ) — --- — — � / 11�ki
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Type of construc[ion J� � �
( �Framq�W ( ) 61ock `' �
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( ) Log >�toF�r(= ( ) Concrete � , � �,
( �'Pole �`-O7 ( ) Steel i ' i �
� ) Metal � ) -- vo --- � 1 6 � , i�� U .
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Construction cost $ _�5�c71_IcomixsUl i �8�-_-_ � �•^ � �
I,soo o�,., eN�y � ��� D;' �� � j�� �
Vol �G� --- �K —�/76 _ of deed �-�04 � �/I0� __7S �
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Cer. Soil �Tc�SC _ � � i 112' �,��;r' . � In �
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W { - - - - �-- - --�----`--m
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Sanitar�� Permi.t �j' -O� ' , i� " z �
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uwner Ze;�ti� A�t��nLnist at�
-(� ��--- ` u SANITARY PERMIT APPLICATION , ____ '
i�'`• •� In accord with ILHR 83.05, Wis. Adm. Code � �ouNry -- � ���� ���-
--�-� SAWYER �
_—p�v�•�•� CST HZ-Z�FL STATESANITARYPERMIT# � i
-Attach complete plans(to the county copy onty)for the system, on paper not less than 124004 �
9'f, x 11 inches in size. � r
.� Check II ravision to previous epplicalion �
�E'P fBVB15@ SId@�Of IfiStfUCtIOf15 f01 CORIP�Btifl9 ShIS BPP�IC2tl0l1. STATE PLAN I.D.NUMBER
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION.
— — —
'Fl,O,P/ERTV OWNER r�� PROPERTV LOCATION � ` J
.Y�� :� r1_�. ��1�1 /� . ''�/'J _14.� ��a j�'��/a S ��LTaI� N, R J" E (Ofj��
aOPERTY OWNER'S MAILING ADF7RESS� LOT$ BLOCK f�
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��,�"%/�'� ` ,+,.> ,,.. .I%:,'�' t�, � �✓F�_
I i Y,STATE ZI CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
' ' ,° i"'� - %, / / � .
. TYPE OF BUILDING: Check one) ` CITY NEAREST ROAD
( � State Owned � �, vi��n�e_/!�,��/��r/i� � �f7 h ��' " �� ,
❑ Public �tor2Fam. Dwelling-#ofbedrooms � Pnace�TnxNun.teeR� 1 � - -� �'-��--'�`
1. BURDING USE: (If building rype is public,check all[hat apply) � � - -� � .,�
� . _ � �-� c1 _ .— ` .� CrJ
1 ❑ ApVCondo
2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 �� Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 17 ❑ RestauranUBar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wasli
5 ❑ Hotel/Motel 9 ❑ OBice/Factory 13 ❑ Other. Specify
J. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
.) 1.�New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.� Repair of an
System System Tank Only Existing System Existing System
) ❑ A Sanitary Permit was previously issued. Permit# — Date Issued
. 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 i� System-In-Fill
I. ABSORPTION SYSTEM INFORMATION:
.GALLONS PER DAY 2.ABSORP.AREA 3.ABSORP.AREA �4. LOADING RATE 5. PEHC. RATE 6. SVSTEM ELEV. 7. FINAL GRADE
REOUIRED(sq.k.� PROPOSED(sq.tt.) (Gals/day/sq.ft.) (Min./inch) � ELEVATION
� ���� � �+�a `i�� ♦�7 / �'�.���-Feet �� Feet
CAPACITV
'll. TANK in allons Total #of Prefab. Site Fiber- Exper.
INFORMATION New xistin Gallons Tanks Manufacturer's Name oncrete Con- Steel ylass Plastir, qpD_
Tanks� Tanks structed
eDilc Tank or Holdinp Tank ��'"i . r ^•� � . _�-�T .�
ilt Pum Tank/Si hon Chamber
'Eil. RESPONSIBlLITY STATEMENT
, !ne unde�signed,assume responsibiliry for instailation of the onsite sewage system shown on the attached plans.
��:irt+ber s Name(Prinq: Plumb�Signeture.(No Stamps) MP/MPRSW No.�. Business Phone Numbe�
� _
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�li � �/)/1) � �'` 'C P r' i . N�F' �,-{;._-1,' f _ � ,..i' �JJ O!'�f3G ��% �.�-� y5��2_ 'f 1-�
� �� _ �_ _�. r 1__' L__' _—)_ — •"_`
lumber�s Address(St �et,Ciry.S'e�p Code). � ,
) ,�' <�j, � l /, `-9. -
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Y. COUNTY/DEPARTM NT USE ONLY
❑ Oisapproved Sanitary Permit Fee pnclaaas Grounawa�er a e ssue Iss �ng Agent Signa�ure(No Stamps)
Xj Approved ❑ Owner Grven Initiel Surc�erpa Fae)
A verseDelerminalion $115 . 0� $-2's-$9
. CONDITIONS OF APPROYAL/REASONS FOR DISAPPqOVAL:
;D-6398 Qormerly PIb�7)(H. 11/e8) DISTRIBUTION: Original to County,One Copy To�.Safety 8 Hwldings Division,Owner,Plumber
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