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HomeMy WebLinkAbout002-940-22-5708-LUP-1992-446 Application for Land Use Permit � County of Sawyer `o The undersigned her.eby makes application for a Land Use Permit and agrees that • all work shall be done in compliance with the requirements of the Sawyer County o Zoning Ordinance and the laws and regulations of the State of Wisconsin. � PRINT - USE BLACK INK OR PENCIL � m�� �-- � ' ��T� wner � Builde � �. ��k d 0 � �' Mailing Address Mailing Address � / Gc91 s�y� �3 C�� - ,� /6 � City State, Zip it , State , Zip Building Land Use Zone District �'�' 2- o � ( L�New ( ) Filling � � ( ) Addition ( ) Dredging Lot size a�� � �j� � � � ( ) Alteration ( ) Grading ( ) Moving On ( ) Acres q. �(� � ( ) ( ) New Construction � Size �� ft wide ' wid ' w' de �'� f t long ' ng ' long Floor area �Z(�(' sq ft sq ft sq ft a' , Total hgt __�_ to peak ' hgt _' hgt x ' Stories '�� No . of 33edrooms -- rear lot line or waterl.ine o �._ __,_,.,: .-�_._._-��__. .._....__-_---.._..-.__ .-. C (year round) or (seasonal) � `� Type of I31dg , l�ddition, Use a o ( ) Dwe 11 ing �� `� ( ) Garage ( 1 ) (2) car � �' (�., Storage Building � �• ( ) Boathouse -�J- ������ O ( ) Livingroom „P,t.-�C ( ) Bedroom � ` �� � ( ) Kitchen-Dining �l ( ) Porch (enclosed) (roofed) L�'���� �� ( ) Deck - open r''� � ( ) � �� � r�� ( ) _ y � Type of Construction � � �a4 �' ( ) Frame ( ) Block � ao / �4 ( ) Log ( ) Concrete Q � ' �'�" O P o 1 e O S t e e 1 � .. ._. ,�_ ��` N � � (�'' Pole/Metal � N "' � �� �,: i � � � Construction Cost $ � Q� .�.. � 3ca�. 29 p • . � A Q � Vol �� Pg `�.�C:� of Deed 4 — ! CS Vol =� Pg 2"7'CO y b � , � w Cer . Soil Test �'3 ` ���� � � f L ' ►--' Sanitary Permit �� . QSr°`� _�jJ��1�L�B_ �L road ----�---------- o � . � — . . � Issued � �9q2-- Denied �! _._.�.. . � ..,.,a...,�. .....�,.�.,.�..�....... � � ..,« � ......�.a...�..,„,.�.w,«�_ _. . .__ �. � �.�: r._,__.,__.. �,..�.... .. ..__.� � � , . . ,,.4 , — �; � � �--- ' wner an ng cn .t� �t a c�r _ � rear lot 1 e or Nate e � � �. � � � � � � � i � '�I : ' � � / h 0 J V N Ul 'h : ?� / L�^ � � . � � � ,� ' ° 0 z3� .� �� � � . � i � q'°o � 4 ,,/ , BO�, 4��, i � � . , . . r S -� � zoQ � � � � � `� ---- - - -CL road ------ -- - --- � _N--t� N-t—I N�. ���4-D - � � �o �.,. . i CERTIFIED SURVEY MAP FOR: WALLY PARTLOW � A PART OF GOVERNMENT LOT 7 SECTION 22 SE COR.GL.6 sec.z2 i � T40NR9W AS REFERENC D TOWNSHIP 40 NORTH,RANGE 9 WEST,TOWN I m ro Br R.PETERSON ON JOF BASS LAKE,COUNTY OF SAWYER, STATE g cSM No. io�i OF WISCONSIN. � I w o � z w 15+ S89°46�OS��E � Z 33.0 � 454.60 � W N Q "—'- S ee W -ml o W �8� O � � Z - Z zs'= 180,302 sF. � 0 4.14 AC.t r- N 3 House r m�' _ o F J N O �J _�I� � j Z o � � �F Z Garage -a, I w o � w mc z m a -� W M M F Y m a Q in w � J 35: 5 89°51�20"E 30 Q I 436.42 I� w Z 0 3 O � O � � H 3 � O �O_ 2 �. ol o -o z N � 85,580 SF. o � QIg 1.96 AC.3 � I N 2 3p: 420.84 � 33.0 �I . N1 B9o4605 W 436.08(meos) S89°5857 W 438.01 (GCULD) / N89°4fi05�W 453.84 F�a,«,,r�o��� 1 1�u�2 2 0� � ��J i/, ^i:1. a F�� s�„y,�co��n;v f E �rn � day of 'm-o i �.tJ. lj f ll.�l.4 Fr;a:ecd lo:cc.ord the 1�_ � , . ���(� A D 19�3 at�o'docY � � p ' � _ N _�' \,, �I.`�o:dd 111 VOI.��� � ,1 c anPcoe 2� �w V_ i�� 1, �� � . �---�� Req�ster Z I ��Y � SE COR.SEC.22 T40NR9W SCALE I°=I00` FND seC . � ,,,��„��,,.,, , o' ioo 200 ,.°�>p SUR V��,o :v� ,... ...,, O�, L E G E N D c`S`'�'oner,`N�� ` . � � FOUND I�� IP. `'��<......, •°• :. . y� � �J� • SET �/4'�X 24�IP.WT,I,13 LBS/FT. ,,�'%.,,5- 1300 i� "•uuuu•�,, �- .' -8� / pO "7�,<�f ti�.atL L LE LLIOT '�-t��Stcvzl Not�a-_:,S _'`,t..._.?i., �+ ���u,y CtcCw RLS . 1300 ..:...f �?,L-L �7�� C I . SIIRVEYOR'S CERTIFICATE I, LYI,E L. ELLIOTT, registered land surveyor hereby certify that by the direction o£ WALLY PARTLOW, I have aurveyed and mapped the land parcel which is represented by thia Certified Survey Map: That the exterior boundary o£ the land parcel surveyed and mapped ia described as £ollowe: A part of Government Lot �� Township !y0 North� Range 9 West, Town of Bass 7,ake� Section 22, County of Sawyer, State o£ Wieconsin, and more particularly described as follous: Co�encing at the Southeast corner o£ Section 22, thence N 0° E along the East line of Government Lot 7� 199•58 feet; thence N 89° 46' 05" W 33.00 feet to an iron pipe being the point of Beginning: thence R 89� !�6' 05" W 420.81� feet to an iron pipe on the shore of Windgn I,alce: thence N !y° 28' W on a meander line o£ said Lake 200.00 £eet to an iron pipe; thence N 5° 28' W on said meander line 300.00 feet to an iron pipe; thence N 5° 58' 15" E on said meander line 100.00 feet to an iron pipe; thence S 89° 1�6' 05" E l�51�.60 feet to an iron pipe; thence S 0� E 597•34 feet to the point of Beginning, sa,id parcel containa 6.10 acres more or less, including all land £rom said meander line to the waters edgeand aubject to a�v easement of record. That I have i1�l�y complied with the provisions o£ Chapter 236.31y of the Wisconsin revised Statutes and the subdivision ordinance SaNyer County in susveying and mapping eame. � , ,t�� 1 Illl.� ��� i., , � / �� Wi ynei� e�.�i�Tt�ob. 5-130$r Date: Mag 1,2{ S'�OTW � ` .� : : �o ,,. ^����'`����...n�"� ,`�� ��°�.,5 - 130� �.�`��� �,,,,,���������` ., �� � � APPLICATION � SAFETY& BUILQINGS C3'EPARTMENT OF INDUSTRY, FOR SANITARY �ivisiory � LABOR AND PERMIT P.O. E30X 7969 W HUMAN RELATIONS (PLB 67) MADISON,WI 53i07 0 u, m 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 specified 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. A legible reproduction of the soil test report or the owner's copy must be included: D4ary L. F, Wallace F.. Partlow, Jr. Property Owner: Mailing AAdresr ^ . n ✓ 1i 1 C✓ " C 6 � / roperty o a ion: C.it�--ti'rMa9e-erTownshi : County: � Q v<�,o ,�� ,T O NiR �) w �"' �c w� e�- Lot Number: 81k No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Nurrber. 1 r j C (lf assigned) •'t TVPE OF BUILDING Number ot ❑ Publict ❑ Variance" ❑ Other (specify�* sedroom�:: 1 or 2 Family "State Approval Required. � . . TOTAL NUMBER PREFAB POUftED-IN STEEL FIBERGLASS NEW � FEPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT �Specify) SEPTIC TANK CAPACITV O U HOL�ING TANK CAPACITY LIFT PUMP TANK/SIPHON CHAMBER MANUFACTURER: �� CYC EFFLUENT DISPOSAL SYSTEM � PERCOLATION RATE ABSORPTION AREA ,�y (Minuces per inch): PROPOSED (Square feetl: yQ New . ❑ Replacement ❑ ExperimeAtal �Seepage Bed ❑ Seepage Pit � � /r� � ❑ Alternative (specify) ❑ Seepage Trench 7 Wate Supply: Owner's Name as Listed on Soil Test Report (If other than present owner�: Private ❑ Joint ❑ Public I,the undersigned,hereby assume responsibility for installation of the private sewage sYstem shown on the attached plans. Ni ot Plumber: �t ign MP/ Phone Number: � 0�02 � • `i�l f122� (�. Jr'� �i3`�� '�d7�a Plumber;$Address: Name of Designer: ��F �a w COUNTY/DEPARTMENT USE ONLY CST 83- 068 Sign u f Issuing gen . Fee: Date: � pppROVED Sanitary Permit Number. $60 . 00 6- 1- 83 ❑ DISAPPROVED 39303 Reason tor Disapp al: Alternate courseis)of Action Available: Change of ownership, building use or plumber requires a Sanitary Permit Transfer 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 D I LH Fi-SB D$396 (R.07/87) DEPARTMENT OF INDUSTRY, INSPECTfON REPORT FOR SAFETY & BUILDINC LABOR & HUMAN RELATIONS pRIVATE SEWAGE SYSTEMS ' �ivisio P.O. BOX 7969 BUREAU OF PLUMBfN MAD�SON, WI 53707 ' I� CONVENTIONAL ❑ ALTERNATIVE StatePlanl.D. Number: Ilf asslgnetll ❑ Hoiding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER�. INSPECTION DATE�. c,v t� � u.�a �) wc f �- as�- £� 3 BENCH MARK P manen� relerence pomtl DESCRBE IF DIFFERENT FROM PLAN. qEF. PT. ELEV.: CST REF. PT. ELEV.� Namc nl Piumber�. MPiMPRSW No. County. $amtary Permii Numben s ���cv �. g� - osP' SEPTIC TANK/HOLDING TANK: MANUFACTURER�. LIOUID CAPACITV. TANK WLET ELEV.. TANK OUTLET ELEV.�. WARNING LABEL LOCKING COVER /` -�^ G� PfiOVIDED: PROVIDED: ►-' [9G wC':-.e L�. C� � J �!�� � �a ` � Y E S ❑N O ❑Y E S ❑N O BEDDING: VENT DIA.. VENT MATI. HIGH WATEH NUMBER OF � ROAD: PROPERTV WELL. BUILUING. �VENT TO FRE:� ` / �_ ALARM FEET FROM � �'"E y AIR INLET. . ❑YES ❑NO �� G L- ❑YES ❑ NO NEAREST 7c'S DOSING CHAMBER: MANUFACTURER BEDUING- lJf)UII> C�Vl1C1Iv PUMP MUpEL PUMPiSIVHON MANUFACTUREH WAqNING LABEL LOCKING COVER PROVIDED GROVIDED-. ❑ YES ❑ NO C� YES ❑NO ❑YES ❑ NO GALLONS PER CYCLE: Punna arvu corvrHo�s oaEanliorvn� NUMBER-OF �''�O�'E'�ry �NE�� eui�owc � verur ro FRe: (DIFFERENCE BETWEEN � FEET FROM `�"f AiR iN�Er. PUMP ON AND OFF) ❑YES C' NO NEAREST—> SOIL ABSORPTION SYSTEM. Check the soil moistureat the depth of plowing �rNcni uinti�ErFt+ niA,� Hin� nrvo MaRrciNc or excavation, (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BEO/TRENCH� wiorN �Ervar�+ No oF uisr�a ai��E s��ncirv��, covEr� � � �rvsiuE uin =alrs uouio ( i THENCHFS � ".1ATFHIAL: .PI-r DEPTH� DIMENSIONS I� yln �;� �.�.�-t-c.J ,HP.VELUFPTfI � � � FILLDL'PTH UIS�It PIPE 1115iH PIPE DISTR. PIPE MATERIAL NO DISIH NUMBER�OF � �'HUNEHTV WELL� BUILDING�. VENTTOFRE. BFLOW PIPES AHOVE COVEH EI f V INLf I EIEV. END / PIPES . . i LINF � AIR INLET �a� �� Z �r � S�tF � �0- I �/'"lJL� ,�j0 .3 ��_ � NEARESTO---s � SU MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows throwr upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES CJNO SOILCOVER rextur:E atr�tiinNFNtnnnr+KeNs oi+str�vnn��rvwe��s �—� YES UNO ❑ YES ❑ NO UEPTN OVFH TNEN(:�� HtD OLPIH UVf H iHEN�:11 Nf U ULVTH OF TOP5�11L tif1UDEU �EEDE.-D MULCHED CENTEH EDGES ❑YES ❑ NO ❑ YES ❑ NO ❑YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: � " �=� WIOTH LE_NG111 NO.OF LATFHF1l. 5Pl1CING GHl�VLL DFPiH NELOW PIPF . f ILL DFPTH f1CiOVE COVEH BED/TRENCH' raeNcr+Es DIMENSIONS MnMFOL� PUMP Ml�Nll O�U DISTH. PIPE Ml�Nlf OLU MATFNINL NO UISTH UISTH. PIPE. UIS11iIBU I ION PIPE Ml�TERIAL & MAHKING � . � � FLEV. EIEV DIA ELEV P�PES U�A�' ELEVATION AND DISTRIBUTION�..r VEH ilCnl. IIFT CORRESPONDS TO APPROVEU INFORMATION�,. "o�E size t�o�E s�nr.irvc, o�;i��EocoNi+Fcri v covE�3 nnnrFNin� v�n�is ; ' .. r ❑ YES ❑NO ❑YES ❑NO COMMENTS: � PERMANENT MARKERS�. OBSEHVATION WELLS�. NUMBER OF PROPERTY WELL BUILDING�. FEET FROM L�"E ❑ YES ❑ NO ❑YES ❑ NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. s�cn,nTURE -- r'T`E ��� � 7,ti+�-..�r •c��.. 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