HomeMy WebLinkAbout032-540-36-5305-LUP-1994-339 ^ Application for Land Use Permit ,� � �
County of Sawyer o
7'he undersigned hereby makes application for a l.and Use Permit and agrees that 7 �
all work Sha11 be done in compliance wi[h the requi.rements of the Sawyer County o
7.oning Ordinance and the laws and regula[ions of the State of Wisconsin. � ,
PRINT - USE BLACK INK OR PENCIL
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Owner —T Builder
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Mai ing Address Mailing Address
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City, State, Zip City, State, Zip
r �Building Land Use Zone District (Z -� rt
( ) New ( ) Filling N �
(%) Addition ( ) Dredging Lot size
( ) Alteration ( ) Grading
( ) Moving On ( ) Acres � .-]p �
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New Construction �
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Size ia ft wide ' wide ' wide
�(, ft long ' long ' long
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Floor area .� /aZ sq ft sq ft sq ft �
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Total hgt i0 ��' to peak ' hgt ' hgt x 0
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Stories pi�c -�— h
Cal.i�Ck�- O H-� f'
No. of Bedrooms D �r l;na�_�aterline o
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(year round) or (seasonal) �' "
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Type of Bldg, Addition, Use � a o
( ) Dwelling , �� r• "
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(k) Garage (1) (2) car r•
O Storage Building F o• w
( ) Boathouse `L p
( ) Livingroom
( ) Bedroom v ��'
( j Kitchen-Dining ��
( ) Porcfi (enclosed) (roofed)
( ) Deck - open �C
( ) GPI� ��oR i • �
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Type of Construction � o,�a¢� , i� �
(A) Frame ( ) Block �� � �
( ) Log ( ) Concrete �"` 35 i �'
( ) Pole ( ) Steel ���"'-�t-'
( ) ( ) Pole/Metal ' o � �"
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Construction Cost $ D D � ie �
Vol a/6 Pg _g3S� of Deed �� �20�� � c
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Cer. Soil Test 84 -�1�.� '
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Sanitary Permit 8� -D43 M � road C
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Issued 15 September 1994 Denied (J� �
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Owner Zoning Administ ato
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REF : qERIAL PHOTD P 10 - 1970 SCALE : I INCH = 40[� FEEI
t15. G.5. BLAISDELL LAKF QUaD 1972 DRAWN BY : D: M. E . D�
COLON (:) INDIGATES GO�
'�`�"�'^ APPLICATION FOR SANRARY PERMIT
� DILHR SA,�ER r0
�+„enroF (P�B 67) UNIFORM SANITAKY PER
' I(lOtFiTRV,lq90R6M11rtWl1{ELqTIO1l5
CST 84- 047 52284
� —Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8%:x 11 inches in size.
—See reverse side for instructions for completing this application. PLEASE PRINT �
PROP�T�WNER � , Eleanor L. $ MAI�SADDRESS � �r �
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PROPERTY LOCATION CITV:
� 1/4 1/4, S.3(a , T D, N, R SE (or)� VIOLLAGE: /� PY
� LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEARE T ROAD, LAKE OR LANDMARK STATE PLAN I.D. NU
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TYPE OF BUILDING OR USE SERVED �
y� 1 or 2 Family Number of Bedrooms: �-7 [� Public (Specify):
-- "Y ---
THIS PERMIT IS FOR A:
[�1 NewSystem ❑ Tank Replacement ❑ Repair
❑ Replacement Soil Absorption System � Revision ❑ Privy
❑ Alternate SYstem � Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
� Seepaye Bed ❑ Seepage Trench U Seepa�e Pit ❑ Holdiny Tank
J System-In-Fill ❑ In-Ground Qressure � Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # issued ,
❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total #ot Prefab. Site Steel Fiber:�lass Pla�
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump Tank/Siphon Chamber
Holding Tank capadty
Manufacwrer. G
IF THIS IS AN ALTERNATIVE SYSTEfJI COi14PLETE THIS BLOCK: ❑ Mound U In-Ground Pressure
Total #of Prefab. Site Steel Fiberglass PI:
Gallons Tanks Concrere Consvucted
Septic Tank Capacity
�ift Pump/Siphon Chamber
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA y1JATER SUPPLY:
IMinutes per inch�: REQUIRED (Square Feetl: PROPOSED (Square Feet�:
� -��jJ � �j0� � Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (Pri Signat e: MPIMPRSW No : Phone NumbeGr:
6n10� S o'���o � � G� ��a -
Plum6er's Address: Name of Designec
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COUNTY/DEPARTMENT USE ONLY
Sig ure of Issuing Agent: Fee: Date: ❑ Disapproved
� ']� . �� 5- Z(}- Q[} "� Approved � Owner Given Initiat
Adverse Determinat
Reason for Disap val:
Alternate coursels)of Action Available:
DILHF�SBD�6398 (R. 5/82) DISTRIBUTION: Originai to County, One Copy To; BUreaU of PlUmbing,Owner,Plumber
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� �� I , Charles OfYerman, land curveyor of the State of 4lisconsin, do hereby certif5� that I have made the � � �
� follo�.+inr, survey in the �overnment Lot 3, Section 3C , T, 4p N. , R, 5 W, � 5'awyer Coi�nty,Wisconsin, more � � ° � � �
particularly descrihed as follows: Commencing the the SE corner of caid Government Lot 9� thence N 86°57' " � � ; s `
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. ' 45" W � gg,00' to the westerly 1�ight-of-way of a tovrn road and the point of real beginning; t?�snce continuing � " ^` i
V tr g5°57'45" W , 54p' , more or less , to the shore line of Black Dan Lake; thence Northeasteiiy, along said shore � �n" '- o a
z line , 1�0' , more or less; thence S 86°57�45 ° E . 455' , more or less; thence S �°20'4�"' W , alung the said o � a� a � ; a �
— vesterly �ight-of-�ay of a To�+�n Road. , 150.00' , to the said poin�. of real be�inning. Said parcel contains� z � a 'o d ' : � t
_` ^ 1.7 acres , more or less. Said parcel being sub,ject to Highuray� Utility or other easements in use or of w "� o c �, o � � �
� �� record. n � � c o � � �
Z N I further certify that I have complied with the provisions o£ Chapter 236 of the revised statutes of a N °i � ^ �`�� •
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� � the State of k'isconsin , in surveying and mappin� the same. �r/�o ya� _ � � _ N S o � ` =�
� � `1'his instrument drafted by Charles Offerman. Register'sOfHce � �� �)�
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W Z ��� ( -� � Sawyer County T Q ❑Q � i • V
\ — APYROVED TH�S •%:_, DAY OF : • i �' , 1977. a 7 � � � o ; ;
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