HomeMy WebLinkAbout006-439-12-1102-LUP-1992-038 l
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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
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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 �
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Cer. Soi1 Test �
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Sanitary Permit -7�-Q9'7j -- CL Road -�-���--- ~ �
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Issued �� �(,E} �C(�2, Denied
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wner Zoning Administ tor
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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).
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)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
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Department of Zoning and Sanitation o
Sawyer County �
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Inspection Report
Owner �,dward A. Collins �
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Address Route 1 Box 96 Loretta Wisconsin 54652 �
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Name of business
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Builder m
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Address °'
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Plumber John nuzv
Address 415 Phillips Avenue Ladysmith, Wisconsin 54848
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Ir.spection �
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� 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
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1�Zw'�'S 'Zy� 13 b� S4 GT, �
'�01 $7+ c Y
30' �. w4ll �
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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� � ��,��
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