HomeMy WebLinkAbout010-941-26-2105-LUP-1992-049 Application for Land Use Permit �
County of Sawyer �.o �
The undersigned hereby makes application for a Land Use Permit and � �
agrees that all 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 BLACK INK OR PENCIL M
�}-}al l y f�- �' -
`%';vl $ f'�}i;I��'> � Own►�R- �
Owner Builder
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Mailing Ad�ress Mailing Address
/ ,� ' _ ��.T 'y�° � �
Cit , Sta e, Zip City, State, Zip
Building Land Use Zone District �'- � o �
(� New ( ) Filling rt �
(� Addition ( ) Dredging Lot size � n
( ) Alteration � Grading v �
( ) Moving On ( ) Acres , 27 �- ,Sy = .8�0
� � � � 5''f 7'7 �
New Construction D� �DP1TLow1 )' '�I
Size � ft wide �o`� ft wide ���
D
,�.aZ ft long �_ ft long ��
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�n
F1oor area ��y sq ft �� sq ft �.�
t �o�rp-�2. �
Total htg �$ to peak �-�eaK 'J
x
Stories j ---�-���--es
No. of Bedrooms /',;, 1;:� rear lot line or waterline c�
0
(year round) or (seasonal) i`! �' i !- m rt
Type of Bldg or Addition 1d.E� '�yE a o
( ) Dwelling --�, ---- r• ,-r
(� Garage (1) �2�+ car _r__��� / "r,
( Storage Buil�ing �, �
( ) Boathouse o�
( ) Livingroom '� p � 11 �
( ) Bedroom �1� 5 ' �.`''�
( ) Kitchen-Dining ��' � O �c
( ) Porch - enclosed/roofed ' m
Q� Deck - open ,4� 'T� �
f ) �—--, � r�
( ) � x.
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_ �
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Ty e of Construction N,�S V� �
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( ) Log ( ) Concrete , r�
( ) Pole ( ) Steel _ �� ,j _�o��� -�- �
( ) Meta1 ( ) - _ . _- �' '- �o
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Construction Cost $ t�00, � �_ i+ r,l� �,�
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Vol y�� Pg ^�(;� of deed � .�. '' I
cs voi 9 Pg 199 � 1 �' � �
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Cer. Soil Test ��j-ad� 1 i �
Sanitar Permit �?` `'� �'
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Owner Zoning Administrator
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I , Robert R. Swanson , Wisconsin Registered Land Surveyor ,
do hereby certify under the provisions of Chapter 236 . 34 of the
Wisconsin Statutes , and under the direction of �ank P., 5mith ,
owner of said land , I have surveyed , divided , and mapped the land
herein described , and that said land lies in the northeast one-
quarter of the northwest one-quarter (N . E. 4 of NW .4 ) and a very
small portion of the northwest one-quarter of the northeast one-
quarter (N .W .1t of N . E.; )" of Section twenty-six ( 26 ) , Township
forty-one (41J North , Range nine ( 9 ) West ; Town of Hayward , Sawyer
County , Wisconsin described as followsi
Co�unencing at the north ; corner of Section 26-41 -9 � thence
South 1 23 ' East 68. 27 feet to an iron pipe lying 25 ' west of the
shore of Lake Hayward which is the point-of-beginning :
Thence South 34°58 ' 40 " West along the meander line of said
Lake 169 . 47 feet to an iron pipe lying 44 ' west of the water ' s
edge ;
Thence South 14°08 ' 30 " West along the meander line of said
Lake 116 . 28 feet to an iron pipe lying 33 • 92 feet west of a stake
at the water ' s edges
Thence North 83�51 � 30 " West 169 . 60 feet to an iron pipe on
the east R . O .W . line of the Riverside Road ;
Thence North O1°23 ' West along the east R . O .W . line of said
Road 277 .60 feet to an iron rebar ;
Thence South 81°41 ' 00" East 304 . 06 feet to the iron pipe
which is the point-of-beginning.
Said lots are to include all the land between the meander
line and the water ' s edge between the lot lines extended .
Said lots aTe sub3eCt to easements and reservations of record .
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SA;dYEk COUNTY ZONING ADMINISTRATION
INSPECTION REPORT o
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Owner Hol1y A. & Scott J. Barnes
�
Address _goute 1 Box 1002 Hayward WI 54843 �
Name of business �
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Builder owner �
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Address y
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Agent/Pur^haser
Address
Inspection ( ) Property ( ) Setback - lake
( ) Dwelling (�' Setback - road �
( �Private O Public O Mobile Hm O Setbacic - 1ot line � y
(<%I Garage (.�' tiJe•� 6�.�c�_ ; °
Violation ( ) Addition ( ) U\ �
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( ) Zoning ( ) Sanitary '-''
R-1 . V 411 P 26 � CS V 9 P 199 . . 86 ac ��
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Discussed with owner/builder ��b � L = 4 3 � ��• I � z
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Discussed with �e6„„ � �
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Date _� 3 - 9Z-
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Signature of officer �--�T���' /� 3s�( S4h �� a„i I�,
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SANITARY PERMIT APPLICATION �o�"TY
fl' DILHR In accord with ILHR 83.05, Wis.Adm. Code SAWYER a
� � STATESANITARYPERMIT// �
CST 87-203 104194 �
—Attach complete plans (to the county copy only)for the system, on paper not less than srnrE a�nN i.�.Nunneea a
8Y x 11 inches in size.
—See reverse side for instructions for completing this application. pennoN
i. APPLICANT INPORMATION—PLEASE PRINT ALL INFORMATION. Foa vnainNce ❑vFs ❑ No
PROPERTYOWNER P P�iQ",�CATION
Scott J . Barnes NE '�aNW '�<, S 26 T 41 � N, R or) W
PROPERTYOWNER'SMAILINGADDRESS LOTNUMBER BLOCKNUMBER SUBDIVISIONNAME
P . O . Box 68 ��
CITY,STATF ZIP CODE PHONE NUMBER CITY : NEAREST ROAD,LAKE OR LANDMARK
Alexandria MN. 56308 ❑ VILLAGE :
II. TYPE OF BUILDING OR USE SERVED:
Number of 8edrooms if 1 or 2 Family tW� OR ❑ Public(Specify):
III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4, if applicable)
1. a. � New b. � Replacement c. ❑ Replacement of d. ❑ Reconnection of e.❑ Repair of an
System System Septic Tank Only an Existing System Existing System
2. ❑ A Sanitary Permit was previously issued. Permit# Date Issued
3. � An Existing System has been inspected and soil conditions meet minimum requirements.
4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy.
IV. TYPE OF SYSTEM: (Check only one in#� and only one in#2)
1. a. �Conventional b. ❑ Alternative c. ❑ Experimental
2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP
In-Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. � See a e Bed b. ❑ See a e Trench c. ❑ See a e Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REOUIRED(Square Feet): PROPOSED(Square Feet):
—10 410 420 97 . 69 Feet �Private ❑.loint ❑ Public
CAPACITY
VI. TANK in allons Total Site
INFORMATION #of Manufacturer'sName Prefab. Con- Steel Fiber- Plastic Exper.
New xisting Gallons Tanks Concrete structed glass App.
Tanks Tanks
se ucTaoko�Hoid�� ra�k x x 800 1 Rasmussen ' s � ❑ ❑ ❑
LiftPum Tank/Si honChamber ❑ ❑ ❑ ❑ ❑ . ❑
VII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the private ewage system shown on�the attached plans.
Plumber's Name(Prin��: Plumber's SignaWre:(No St ) MP/MPRSW No.: Business Phone Number:
Andry Rasmussen � w,y��.�.�,._� 3938 715 798-33�5
Plumber's Adtlress(Street,City,State,Zip Code): Name of Designer:
P . O . Box 66 , Cable , WI . 54821 Dennis Rasmussen
VIII. SOIL TEST INFORMATION
Certified Soil Tester(CST)Name CST#
Dennis Rasmussen
CST's ADDRESS(Stree�,Ciry,State,Zip Code) Phone Number
Rt . 1 , Box 16 , /cable , WI . 54821 715 798-3704
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved SanitaryPermitFee Groundwater Date Iss in gentSigna re(NoStamps)
� Approved ❑ Owner Given Initial Surcharge Fee
$90 . 00 $25 . 00 12-7-87
Adverse De�ermination
X. COMMENTS/REASONS FOR DISAPPROVAL:
56D-6398(formerly Plb-67)(R.03/86) OISTRIBUTION: Original to Counry,One Copy To:Bureau of Plumbing,Owner,Plumber
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DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY& BUILDINGS
LABOR & HUMAN RELATIONS pR1VATE SEWAGE SYSTEMS DIVISION
P.O. BOX?969 BUREAU OF PLUMBING
MADISON,WI 53707
IX�CONVENTIONAL ❑A�TERNATIVE S�a�ePlanlD.Nvmber: �
(11 assi9ned)
❑Holding Tank ❑ In-Ground Pressure ❑Mound
NAME OF PERMIT HOLDER: ADDRE55OF PERMIT HOLDER�. INSPECTION DATE:
co
-.T• ��rn/.a �O �OX �08 A(� N i N• 56.30r5' /a- 7` 8 7
BENCH MARK IPermanent reference poini)DESCRIBE IF DIFFEHEN7 FROM PLAN REF.PT.ELEV.: CST REF.PT. 3LEV.�.
N:irni�ol Pi�mher: MP/MPHSW N�� Cn�,�,iv Sanii�ry Perm��Numher�.
�9�✓o�r ,os u Q� 3�38 r.�.�y��/o� �7- a a8
SEPTIC TANK/HOLOIPdG TANK:
MlaNUFACTUR[R. LIOUIUCAPACITV TANI:IN�ETE�EV. iANKOUTLETELEV WNRNINGLABEL LOCKINGCJVEfi
PAOVIDED. PROVIDED�
r�5 u � � r��¢ �00 9� �� 7 �YES ❑No ❑YES CJNo
E3EDDING: VLN7DIA.�. VEN7Mnil HI(HWA7EH NUMBER OF = ROAD: PA07ERTY W[LL BUILDING�. �VENT70FRESH
�L�F7h1 LINE AIR INLET:
❑YES ❑NO C�YES ❑NO NEARESTOM 7S I �LS/ 7'S,
DOSING CHI�MBER:
IA�7.1fJUFACTURER BEUDING LI(]llll�(:nf'.��.IfY I'11M�'Mfil)FI �'lIf.1PSl{�rl()NM19ANl1iAl:itifiFft WARNINGLABE� LOCKINGC�JVER
PROVIDED PROVIDED-
❑YES ❑NO ❑YES ❑NO ❑YES ,�JNO
GALLONS PER CYCIE: Punna aNu con,rc�o�s oaeRnriorvn� NUMBER OF �'�t�"'F"T` wE�� e��i�owc, I v!Nr ro Faes�
(DIFFERENCE CiETWEEN FEET`FROM ��"E a�R iN�ET.
PUfv1P ON AfJD OFF) ❑YES ❑NO NEAREST-�
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowing i�N�,iri ui�,��r r[�, �inrF Hini nrvo n�nNKw<�
or exca��ation. (If soil can be rolled into a wire,construction shall cease until FORCE
,he soil is dry enough to continu^.) MAW
CONVENTfONA�SYSTEM:
, W�Or11 LEN(��n� No oF uistH wvt svnc�Nt� coveF� �NS�nE n�n =P�rs uau�o
BED/TRrNCH i Tuehcr+rs � r.,nrErtint. P�T oePrN
DIMEN510NS �a � S"a, --` � �l--
'vf7AVELDEPTII FI�LDLfiV1 IIISiII t'I�'I �)ISTf� PIPF DISTR.PIPE MATEHIA� N(1 I�lft (�UMBER OF �� PNOPEHTV LNELL BUIL.DING VENTTOFRESH
[�ELI)W�'IPES Ak3()VECC)VEH EIE�V INII I ELCV f.NU Plf'f1 �..� IINE AIRINIET.
'/ FEET FROM 7S- � �S�� 7 2S� 7 LJ
� �� _ / �(d. � �� _ �UC_�D.� Z NEAREST--►
MOUND SYSTEM:
Mound site plowed perpendicular to slope �heck the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and fur�ows thrown upsiope: mound systems to make certain that it ON REVERSE SIDE.SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
❑YES ❑NO
SOILCOV�ER rExruae vtr+ainNtNt ��+.v�Ktiu a�{sEravnn��Nwe��s
C_�YES ❑NO ❑YES ❑NO
I)EPIrI()VFf+iH[:'V(:II ISE.f) UFV111()Vf f1 �11E N(:��Ifl il I)I I'lll i�f It11";tlil ti��lil)I II �Ff()FI) h1ULC��EU
C[Nfflt EU�I[-5
L_�YES UNO ❑YES ❑NO ❑YES ❑NO
PRESSUFiIZED DISTRIBUTION SYSTEM:
WI[)1H LEN(;T11 NO.OF LATEIiAL SPl1CIN(� (��Hl�Vl.l 1)k PT11 HF LI)W i'IV! FILI DEPTMI ABC7VE C()VEV�
BED/TRENCH TaErvc�{Es
DIMENSIOfVS
MANIFOLO PUM7 M1tl1NIFnLI) DISTR PIPE MANIf nL()Ml1TEfVIAL Nn IIISTN UISTH PIPE f)ISTf11dU11()N PIPE MATEHIAL&h1ARKING
ELF�". ELEV. UTA ELEV PIPES DIA.
ELEVATION AMD
DIS?RIBUTION
INFORMATION "c�e size No�e srnr.w�, u�+i��t.0 cnw�rt ci i v coveH MnrE�iin� vEHricn�uFr coH�+esPorvus 10 naaRovEo
��nn�s
1_ ❑YES ❑NO _ ❑YES ❑NO
COMMEP.ITS: PERMANENTMARKEf95. p�SGRVATIO��we��s. NUMBER OF PAOPERTY WELL�. BUIIDING
FEET FROM ��"E
I ❑YES L�NO ❑YES ❑NO __ NEAREST _
Skeccr, Sy>tem on Retain in county file for audit.
Reoerse Side.
SI(�NAilJfif TITLF
DILHR SBD 6710 (R.01/&'7) ���%n�(� _�� ����--
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