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HomeMy WebLinkAbout004-838-12-3201-LUP-1989-257 . � • � 1lpplicatio�i for Land Use Permit � County of Sawyer F� 0 $; 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 �� Ma'�y' /r, 't!G �o�.' <- 11//L4�/Ir)1 �, s��iGY:a i� . . �`� !��. ;xe Owner Builder 1 s /�.> ,'1r� .�� ';E t _ 4-- s t 1�_s mailing address mailing address ,�•�.f-<i•,.�' T i, G 1i:: �` ---� � . . city, state, zip city, state, zip Building Land Use Zone District /� / ( ) New ( ) Filling r E t' O (�"Addition ( ) Dredging Lot size /.�-��7 k i.3-�Q rt � ( ) Alteration ( ) Grading �, � ( ) Moving on ( ) Acres tl1 ( ) ( ) �� New Construction G'� C Size 2 g ft wide ft wide " �i� ft long ft long � ,• Floor area Co ~L sq ft sq ft u� �. Total hgt �'= to peak to peak 7~c- ' Stories f No. of bedrooms '-- re�-��I.ine or" waterliiie (year round) or (seasonal) J�� ~� � i i . i 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 � � ~� � I N ( ) Livingroom � � � � i � ( ) Bedroom � i i ( ) Kitchen-dini�ig , � i ( ) Porch - enclosed/roofed N� i ` ( ) Deck - open , � i ( ) C� i i ; ( ) i � �: � � � � , Type of construction � i (�Frame ( ) Block � i i � (,�, O Log O Concrete i � J �' (I�" Pole ( ) Steel � � i �, p.. ( � Metal ( ) � i i i i � � � Construction cost $ �%���� ����- � i � �f � ?~ � ._�i�_/'�� o �r-�'�, }' r � .�.�f-L/ �--�-�--� Vol ,3 6/ Pg ���6 of deed i � �y s�'`c��l . �� � ` i � �^` �,�r' i CSM Vol Pg . — i . �a8� �r:: � i w � - ' IIZ ; i n � Cer. Soil Test r,i � `/! i � � � , y � -----�`--t C road ------ ------------ z Sanitary Permit L ��\ o " �{��F�� t�-��� � �4 z -����IYI�� lGl�� ~ � Issued Denied `' � � ,. ,�f E ��tr�/- /F �T 4 'i^L�k� C.'.. . ✓�-".�IS.`��� � � -. owner Zoning Adminis rato /� _� ' � ii � t , �I I_'- -- _ ' �� I - �'a �?� � UI � r 2 � ti ��Y� � m 41 � �� � .a� �p "a i .p � ?� � �gi � � � � r�� in �n � � . 12 •. 'v 12, i L C .v � ro � d �Z n� � I �` � g' � i o •� �Tt 4l 3 \_8 m ��,� '�:�' ��� � n �: . ?. � I �o � � a � � � r .i'",' � I A � ��-- 1 J O f,_�'� � � I pp ��� 'V 0 o i �`' � I , . ------ --� -, - — — ._ --- -- -- I �, ; ���, � 1 ,., , ��� �, , � �/� '`._- � �� , � � � f�\ �i� I _. . _ _ . I _ _ _ � � �� � �� „�, � T/ " I "� �� � i �i � \ 1 ,�� i ` J1� i � 6- ._ .. . _ ___i (� I`� V � � - y• 12 � ti �' W � 1 ) �_ __ -{- �� �- - I ��� ��; � �i � '. � � „ I �- - �-- -- .��� .:- ----. .__ . � � - - - --__ . . . _. . --___----� - ---- . . , , _-- - --- - - --- - - -'-`--' � --._ I II I I I I � I - 12 �� -. II � .�; -0 '; i �� �b�� �� �:' ' � �I �I �I I I � I,I — II fi� R! I y I � I � p ���� �� �� �� �i� , �,� � �� �. � N �I I I _J � � - --_ ------. _._. ------- _ -- - - - - - --- -- - �J . � � Appli.cation for I.and Osc Pecmit � County of Sawyer "� 0 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 � G Mk,2y �, �� ;.: � � W/�t�AM r ,RIGD'1u _ wi=��L�ri:��r• L Owner BuildE•r � �;')t;�e�.� � � I-�.� N, 2 ,. • - E- � n_�a mailing address mailing address R����>; , �-: � =�__ _.__ __-____ _ I o� _ � 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 � O 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 � � 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 �I //�, � i i �. Type of construc[ion J� � � ( �Framq�W ( ) 61ock `' � � � i ( ) Log >�toF�r(= ( ) Concrete � , � �, ( �'Pole �`-O7 ( ) Steel i ' i � � ) Metal � ) -- vo --- � 1 6 � , i�� U . i � Construction cost $ _�5�c71_IcomixsUl i �8�-_-_ � �•^ � � I,soo o�,., eN�y � ��� D;' �� � j�� � Vol �G� --- �K —�/76 _ of deed �-�04 � �/I0� __7S � I F' Y �^� � CS ��OI _—__—"— ��+__'_—'" � . � (� . { � /zo � ; w '-� Cer. Soil �Tc�SC _ � � i 112' �,��;r' . � In � .._��-�----- ��- W { - - - - �-- - --�----`--m � -`----�� �road - - - - - Sanitar�� Permi.t �j' -O� ' , i� " z � -- -- `�Ct�F f�c���- �C'.RD o i 7. ______, —_ �,._�� _"_—_.__'—'__—____—'_—___--._-- I,�:ued_�.�__.1��`tt5� ��� _ lleniei(_ ---�--- --- - � �N�H�-��_!��v� �.Sl�t_U�R_l___��TI�LI_L��=--- ------ --- �—°�J --`-�'��������-------- -- ��yN k `�t�-�� � ,- �: 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� i � ��,�"%/�'� ` ,+,.> ,,.. .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� � _ _.i �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. - � / _J\� .� . � / � _ 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 ���"'�!' t4/`i1y > � �� �� �� ! , < ' �.�j ` I l6 �p �_ ��" �.l - == I � _�, - - �� ---- �- �� � � ' {�>. '� `— '�� . �� y ` a O _ \/\/ 1. � ��\ � �� �1, � � � '"' �= . �� �? ..,{ � ti �. o y` ;� �, � ;;; � _ '( a� ' '�j L. �' T'. � t � � � � � ��? `�-�,-� � l"- `� , � r� 5 L'1 ��1 ; :/�. =� � �'`. ;' o t' lt� �� c�,�� �� ;� �: -�� ;�, C1� � tn �� A t.�� � 11', t�W � ,. ,,.1 �• �,> � �.:, � t , _ `- `;�-1 ` � �. ,�'�, � i t�'� � ti f'� C� ; �, � � � _,a �� � ��- � r't, a � ;� �. � C ��. c:' /�" "- 'X � � � ` ,�* �, `_. � � r; � �� � � � C �"