HomeMy WebLinkAbout002-940-09-3203-LUP-1992-011 Application for Lan3 Use Permit �
County of Sawyer o K�
The undersigned hereby makes application for a Land Use Permit and �
agrees that a11 work shall be done in compliance with the require- o �
ments of the Sawyer County Zoning Ordinance and the laws and regu- M
lations of the State of Wisconsin. -
PRINT - USE BLACR INK OR PENCIL ,
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Owner Builder ' "
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Mailing Address Mailing Address _
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�-(���C,, ir��:t, '< � .,�/1�"t,� ��:r:�r_��/ �� �
City, State, Zip �ity,` State, Zip _
Building Land Use Zone District �.' � o �
(X) New ( ) Filling �T
( ) Addition ( ) Dredging Lot size g.3o��}7�' �c Cp7�' � n
( ) Alteration ( ) Grading
( ) Moving On ( ) Acres (o.� �
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New Construction
Size l �� ft wide ft wide '
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��^ ft long ft long
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Floor area �f `-'` sq ft sq ft
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Total htg �3 to peak to peak �, ` �
Stories � Stories �
No. of Bedrooms C rear lot line or waterline c�
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(year round) or (seasonal) �}�]�, cn rt
Type of Bldg or Addition ��,� o' t'
( ) Dwelling �r o
(yU Garage (1) 2� car py.
( ) Storage Building � �
( ) Boathouse 2�o r•
( ) Livingroom U1 ,p� � �
( ) Bedroom � _ ��� -
( ) Kitchen-Dining �' / �
( ) Porch - enclosed/roofed � �
( ) Deck - open �
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Typ e of Construction � "6' � i I _-
(K) Frame O B1ock � � O ��
j ) Log O Concrete i /J�� i
O Po1e O Steel E T cn
(� ) Metal ( ) � '� � W �
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Construction Cost $ � � ! , �
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Vo1 `333 Pg �c� of deed � �
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Cer. Soil Test ��-��(o� � v , n
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Sanitary Permit ��- �7 --'�---=----CL ltoad '�3�-'--------- z �
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Issued �� F�`QUi��n �q�2 Denied `
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Owner Zoning Administ ator
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f DEPARTMENT OF � APP�ICATION '��' SAFETY& BUILDINGS
iNousrRv, FOR SANITARY DIVISION �
LABOR AND PERMIT P.O. BOX 7988 �'
HUMAN RELATIONS (PLB 67) MADISON,WI 53707 iv
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Attach plans for the system on paper not less than 8Y� x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal
and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specitied in chapter
H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master
Plumber,the date,signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be
included.
Property Owner:{� Mailing Address: I C/
/1 O I� � r7— R W e�r a �, I' � �L �-t ��� tnJ���� �� f � �. ( <���
Property Location: :Liiy LtiNege or Township: County:
�U I�'/a.�iCJYaS �T y N�R � (or) W /�-SS � — S�w �1°L�
Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number:
Uf assi ned)
, Cc�>' �h <�. 9
TVPE OF BUILOWG �
Number of
❑ Public' ❑ Variance" ❑ Other (specify)" sedrooms:
�7 or 2 Family "State Approval Required. �
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OFTANKS CONCRETE PLACE INSTALLATION MENT (Specify�
SEPTIC TANK CAPACITV , jf �C
HOLDING TANK CAPACITY
LIFTPUMPTANK/SIPHON CHAMBER
MANUFACTURER:
EFFLUENT DISPOSALSVSTEM
PERCOLATION RATF qBSORPTION AFiEA
IMinutes per inchl: PROPOSED (Square feet): � NeW ❑ Replacement ❑ Experimental � Seepage Bed ❑ Seepage Pit
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;� . ❑ Alternative �specify) ❑ Seepage Trench
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Water Supply: Owner's Name as Listed on Soil Test Report (lf other than present ownerl:
� Private ❑ Joint ❑ Public
I,the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name ot Plumber: ,� Signature; . 4�/ MP/MPRSW N .: Phone Number.
C1 c�� eN c_e (rlcTcc�l +- ;�-� ... '''"� �� ��% � y9 ,� ��is� !.�'v-a�
Plumber's Addresr. /� f� � - � - '� Name of Designer:
�� �o � �C�^ cti� t� '\ � �1`� U)I c cl (.,��1 C�.��t,�
COUNTY/DEPARTMENT USE ONLY CST 81- 261
Signa r Issuing Agent� Fee: Date: � pppROVED Sanitary Permit Number:
$50 . 00 11- 20- 81 ❑ DISAPPROVEO 23614
Reason for Disap val:
F�Iternate course(sl of Action Available:
Change of ownership, building use or plumber requires a Sanitary Permit Transfar Form (67-T� to be submitted to the county prior to in-
stallation. Failure to comply will void the sanitary permit.
DiSTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
DII.HR-SBD-6398 (N.03/81)
Department of 7.oni_n�.; nnd Snnit�.tion
' Sawyer County
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Inspection Report �
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Owner Robert R. Warder
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Addrese Route 6 flayward , bVI 54843 �
Name of business �
Builder �'
Address "
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Plumber Clarence PAetcalf
Addres� Route 6 Hayward , WI
Inapection
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(x� Yrivate ( � Public Property A Sanitary-instal o £
;< Dwellin; Setback - lake �* �
Vio.lation Mobi].e FIM Setbacl: - • road o
Garn�;e Setback 1ot lin '"'
( ) Sanit�.ry ( ) Zonin� Privy
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Discussed ti•i�th oianer yes no �
Discus;ed wj.tli Uui.lder yes no
D�.ecu��scc� with plumber ye� no
� Discu�sed i�rith ye� no tD
Date � �y �
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