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 �
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Mailing Address Mailing Address �
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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
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(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�'����
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( ) 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
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Construction Cost $ � Q� .�.. �
3ca�. 29 p • . � A Q �
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Sanitary Permit �� . QSr°`� _�jJ��1�L�B_ �L road ----�---------- o �
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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. �
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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.
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Wi ynei� e�.�i�Tt�ob. 5-130$r
Date: Mag 1,2{ S'�OTW � `
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� � 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
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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 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��..
DILHR SBD 6710 (R. 01 /82)
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