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HomeMy WebLinkAbout006-439-12-1102-LUP-1992-038 l 1 ._ Application for Land Use Permit k � County of Sawyer o The undersigned hereby makes application for a Land Use Permit and � agrees that all work sha11 be done in compliance with the require- o � ments of the Sawyer County Zoning Ordinance and the laws and regu- '-^ lations of the State of Wisconsin. 'P�B�cR7 SGI+N.�Z'Zt_,6R; PRINT - USE BLACIC INK OR PENCIL � cF'FR.�y 5��r.�irz�e-; ' (�AR.� `XH N.i Tzl.-�R.i � Q�U�� sc��,v; rz ��T��r�� �o� �,��� i,�� ��,���u��o � Owner Builder �2209 � /1'��//�e,<<� /�/�'oo/C L�/��U� //_>'� � �z��� S ff�TC �St2EET �% Mailing Address RT Nom�. Mailing Address �1Ar���F������� ��,� �������,� i�»,�5��=��� �� ��,�,� Syvv� �� City, State, Zip City, State, Zip tc � Building Land Use Zone District R,- � o � (� New ( ) Filling n ( ) Addition ( ) Dredging Lot size m n ( ) Alteration ( ) Grading " �, ( ) Moving On ( ) Acres �'-7,'79 ��. ( UE. o�tJ ( ) � New Constr�uc�o�n L.o F 1 �-JY�� � Size �� ft wide �� �� ft wide � 5�0 ft long � `�' �� ft long Floor area //�0 sq ft ��4- 'ZL,� sq ft � �� Tota1 htg /;� %/ to peak �� to peak x ^ —���— � Stories � � � Stories � No. of Bedrooms � ,r� rear lot line or waterline c��y (year round) �er-tssasc�tgi� � rt�` Type of B1dg or Addition �� 5�1-l- —10 � r (X) Dwelling — ---- -- -°' ,°� ( ) Garage (1) (2) ca r, ( ) Storage Building �n ( ) Boathouse r� 0 ( ) Livingroom ..r � ( ) Bed'room � ( ) Kitchen-Dining � ( ) Porch - enclosed/ro fed 5- Y (� Deck - open j{ ( ) I r� ( ) . . -- , .-,,.�o � Type of Construction 1�� .o. ` 0 � Frame O Block h 6 r� �( ) Log � ( ) Concret ,�� , ( ) Po1e ( ) Steel 3 � a � ( ) Metal ( ) s � Construction Cost $ S OC��C�� �� a �`�` � T ` ao'_--- 1 N � Vol � Pg � of eed t �� " � I o CS Vol Pg —� , ro Io�iS t� w �a Cer. Soi1 Test � � � � Sanitary Permit -7�-Q9'7j -- CL Road -�-���--- ~ � -------- -- z 0 • z z Issued �� �(,E} �C(�2, Denied � � G > ��^'�F'-�,t� k-- llN4k� -�1`l1Tu � wner Zoning Administ tor m�ry�„ w � . i ' I v 'y ��`�,a �� 7� '� ti,..� � � I i ------- - - � � I I � O � � i �" z �_ �z. � � , � �� y �c � �n r O �p , c h. I / �✓�C� i I � II � ' ��2� I i \ I I ; � . � � I ���� � _ - - -- ----___--- � �.. �! L-n � I i� --> I � i 12. I � !i, w I� � . ��-� /�J I U) C"�ry�0 I�I � !� 1'. �.��:., �i �9 O � ' �' D � � � � '� -� z � � � � , � �� -;,. �.- ; �t:,n� � a a,n n ~ o i p : ` ��i I y � 'n ' .0 � _,' 9;� � �- �Q �� � u,] � �;� ' f't ' .n :'� -�� CJ !; �::.� �: ` �/- , J � ... 'J e�i �,� 1 C ,r :> I � �� ,.i t � � • �?��A j �y :9, u � c� � :, .. c i ' ' , -t `:i en Q ::. p :; n0 I h � �M r � �I � �o `- ,� � ' i i L � � � State and County State Permit # 1194 � � Permit Application County Permit # _ 8-093 for Private Domestic Sewage Systems County Sawver CST 8-14J "DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I .D. # A. OWNER OF PROPERTY Edward A. C011,1118 Mailiy�y Addres � / ,� �t� l, ��' X �� s � -�_rl r_z.��:,���� �i, C�'� �� t�S ��,:- � �`,� �,s: .y�` B. LOCATION: �Y��Y4 , Section ��, T� N, R� E (or)�L# City _ Subdivision Name, nearest road, lake or landmark Blk# Village Township � - C. TYPE OF OCCUPANCY�Commercial " Industrial "Other (specify) "Variance Single family �_ Duplex No. of Bedrooms �_____ No. of Persons_�~ D. TYPE OF H°F'LIANCES: Dishwasher YES � NO Food Waste Grinder _ YES�NO # of Bathroorn� Automatic Washer __YES �fv0 Other (specify) _ _ E. SEPTIC TANK Cl�P,>CITY /,� p C> Total gallons No. of tanks ___� "Holding tank ca�aci?y Total gallons No. of tanks New Installation � Addition _ Replacement Prefab Concrete �_ --f - ----- ------- -- --------- - -- *Poured in Place __________ ___ Steel __ __ Other (specify) _____ _ __ __ F EFFLUENT DISPO�AL SY�TEM: Percolation Rate 1 )� 2) �3) � Total Absorb Area _�sq. 't. New� Adc+�tion Replacement *Fill System Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches _ Seepage Bed: Lenath ��•Width �,Lf%, Depth � Tile Depth ��•• No. of Lines ¢' �/ Seepage Pit: Inside diameter Liquid Depth Tile Size _ Percent slope of land �� ��— Distance from critical slope �__ I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I tiave sized the effluent disposal system from the EH-115 prepared by the Certifi d Soil Tes,er, NAME .,��� v»�� �r� �P_ v� C.S.T. # - � - and other information obtained from — - ' / .' S� (owner/builder). Pl��mber 's Signature . _ ._.. _ �-, �_ Mp�„AF�R,,�„1pe,# SS�_�_ Phone # �ir- S3�"U��� Plumber's Address � � PLAN VIEW: P��ovide sketch below of system (include direction of slope and all distances in accord with H62 2�, including well). �-{- � �� _ _ , � _ __ ` ��o , _ . _ ��`� -� _ ' /r ..,� •T + �/` �.�1 � , { � . .-- -�---.___--�____ � � / y,Ly y�'' ���l��i� � 1� ' - � _. � , �r,�c. 1�a V � : � �r 1 � �_...._ i 1� __ � �l - 'U�� ; ! �� o z -f�Crs �`� ',✓y �" � - 5.�;- �,�� � y��� �� � �� _ �� � ����..�'�' )o Not Write in Space Below - FOR DEPARTMENT USE ONLY )ate of Application 7-17-7$_Fees Paid: State 10 . 00 County 15 . 00 Date 17 Jul� 1978 'ermit Issued/ (date) �-17-78 _Issuing Agent Name LOrl C�rrVl nspection Yes No Valid# Date Rec'd - - - _ . . _.... . . . .. ,,.,., , ,.,, ,-.,,,.. ~�\.\. Department of Zoning and Sanitation o Sawyer County � m K Inspection Report Owner �,dward A. Collins � r �+ Address Route 1 Box 96 Loretta Wisconsin 54652 � m Name of business na a Builder m _ � Address °' � Plumber John nuzv Address 415 Phillips Avenue Ladysmith, Wisconsin 54848 H O Ir.spection � a � P�.�.v�,te ( ) Public Property Sanitary-instal °, Dwelling Setback - lake Viol�:tion Mobile Hm Setback - road Garage Setback-lot line d ( ) Sanitary ( ) Zoning Privy a �o r � 0 �+ ~ �o I�r � � dr�u�, N m y�� � r�� 1�Zw'�'S 'Zy� 13 b� S4 GT, � '�01 $7+ c Y 30' �. w4ll � � � �o' a Ln 2 s1o,��+ �Q� . ~ `� C O F'• ���'+r1. 1Lc0 Gu�. u3�einerS m Y• o r ',3 N H � w � Discussed with owner yes no � Discussed with builder . yes no Discussed with plumber yes no ,� Discussed with yes no • Date ._ �� �.�7- �6 . . _ . . Signature of Officer� � ��,�� /�. ,�