The URL can be used to link to this page

Home My WebLink About010-841-35-5404-LUP-1992-051 �� Application for Land Use Permit � 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. , ,.{ PRINT - USE BLACK INK OR PENCIL y� C"�'.(.1 ST{�t..C�I �� ,�/� :�/ % � ��.�I/VC.YI�YIJ �V �� ".G-Y� ~��%.�L'7��"Yl.' %� ��LC.�.- i:-li.;. Owner Builder l� � X,��'� � l�.JG�� 7 J� `�j�:�'� iJG�' l`/�3 Mailing Address Nfailing Address _ �� ' �� f' /!/' �� ,y,,� _ , �7rQ,U:;�:/•-,Z,r ��( ti ^4��1; v�G7�c,w��,l�r,�; �. +%fi,. .`�y(�%i City, State, Zip City, State, Zip Building Land Use Zone District ��: 6.'. o � (?� New ( ) Filling r* ( ) Addition ( ) Dredging Lot size � n ( ) Alteration ( ) Grading ( ) Moving On ( ) Acres , (y � ( ) ( ) �f, r New Construction Q � Size ��-I' ft wide ft wide L �� ft long ft long n�1 � Floor area �J 7CD sq ft sq ft ?' m ✓ Total htg �y to peak to peak x ' Stories ,� Stories _ No. of Bedrooms rear lot line or waterline c� 0 (year round) or (seasonal) <c. m rt Type of Bldg or Addition �� ' a o ( ) Dwelling !� C rr Ck�1 Garage (1) (2) car \ ( ) Storage Building ~ m (� Boathouse � ~� ( ) Livingroom �� ( ) Bedroom \ ( ) Kitchen-Dining ( ) Porch - enclosed/roofed . ( ) Deck - open 2.'";.� ti� .'�i,,' ( ) � 7 .� o - y �<� ( ) J�0 (, 4 ♦ P Type of Construction � ; ( ) Frame ( ) Block _.�,,, �� i r� ( ) Log ( ) Concrete ,: ( ) Po1a ( ) Steel , � �"'�'�� (\�� Metal ( ) - �C n � � Construction Cost $ I,��oc�, lo� ' — � --- - 7i p W � �---- � Vo1 /DO Pg �l�o of deed I � ` � ;� CS Vo1 Pg � � � /J' � y ,� , ;ro 1. �'ti�' ' ` � _ Cer. Soil Test :Gi'` �� , �= � �� , 4 n __ � G �Road ------=- �---- � �� Sanitar Permit y' , r--- '----"- L ' Y � � o ( V ° � i _ . 'z r '�i � _ Issued �(.p �Q.\L (Q�Z Denied �� 0 , � � . ,. �ll� K- 1'1YE1�'+Z_ZL��-1 £ Owner �� Zoning Adminis rato� :►.4 � : .Y �" ROUND � - :�.�o �.eY .1.6 �. . .. ,- ` i•fy �1.14 � .�� :,.,5 L A K E :�.2 /) , � ,.. : i.i � J.Py. :I.Iz : 3.b � :� 3 SEE: M/XED PINES :3•7 :� T \\ coNo�� .3.1 � �` -�� :z.5 :�e \ , ,v� ---i .g.l .�; :3.9 :2.2 :2.3 .3z '3'4 Z :3.12 � :3.1 M � :2.1 � .3.8 . x : �' .n :3.3 :2.6 3'Y :b.5 :2.} � r.rs =vr s�� 3 4 ,.., �, - - -- - -- - 36 .14.4 � :3.10 13.7 .9.2 -i34 i�.� .14.1 D PG 14.6 .14•5 13.� .9.3 O .�3.� 13 .I .14.3 = a .13•2 0 14.2 0 x , 0 .15.4 :4.4 :4.3 , :4.2 �4.1 15 I .15 .3 � �4.5 :4.(, .15.5 / :4.g :4.� ��Q .15.2 �a,q f Q- �4.►v �' .5 .� :9.1� ��' :4.i� :4.11 � SCALE: F IF�CH= 400 FEET FOR ASSESSMENT USE �NLY N(�'T DRAWN BY: DATE : INTENDED TO SHOW GONCLUSIVE COLON (:) INDICATES GOVT. LOT EVIDENCE OF 04VNERSHIP OR BOl1NDARY LOCATIONS ..=,� 1 � � � � � ' State Permit # 3 78 6 - State and County � PermitApplication County Permit # 80 - 242 for Private Domestic Sewage Systems County Sawyer - "DENOTES STATE APPROVAL REQUIRED CST 80 - 29 � Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROP�RTY Mailiny Address: ROUt2 1 BOX 143 V� �' n o � -$� N �C.so �r ��/� l� , C e n-t"e Y , W � s S � � � / - B. LOCATION: Yd Y4 , Section �� , T�[ N, R $ � (or) W Lot# City SubdivisT3n"''�Vame� � 7 nearest road, lake or landmark Blk# Village Township � '(�U W �� C. TYPE OF OCCUPANCY: "Commercial ' Industrial 'Other (specify) "Variance Single family _� Duplex No. of Bedrooms � No. of Persons �• SEPTIC TANK CAPACITY 7s � Total gallons No. of tanks �_ HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel�_ Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM : Percolation Rate Total Absorb Area sq. ft. New Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (to ) No. of Trenches Seepage Bed:.�,�—Length�—Width 1 � � Depth�—Tile depth (top)�No. of Lines � Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land Distance from critical slope,/��-=� - �--�= � WATER SUPPLY: Priva Joint ❑ Community ❑ Municipal ❑ Owners name as listed 115 if other than present owner: 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 fiave sized the effluent disposal system from the EH-115 prepared by the Certified Soil Tester, NAME C10.Y ercC (� Q�ccr`��' C.S.T. # �J �' �7� and other information obtained from � � (owner/builder�. Plumber 's Signature � , Mp��g�p�#� �' Phone # 7�5 - � 3 �l-.� 3Y� Piumber's Address �' � Y � y PLAN VIEW: Provide sketch below of system (inciude direction of slope and ali distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. � , _.. _ �. _ ; ; � � : � � ? '� i ,: i i . � � � + 'f� � �W i � i /// M . ._�...F._..�i�.�_�.e.�.� _ ._. ..� e.---'—'� ---i----t-.v__;. ... ryryry {, .__...J.._ . . . . � i 1 � � /(1Vj�'1 / ___.,... ! , ; ; � � � ; , • � G nVG ` ._..._.}.,..„�_ .�....• ; —;_._.�..-'y .a. .;.� .. , __•—t._- /� j-_._�.. , } - ��. �.. w , � , ; � , , r , , � , ; � � ! � , _ � ' ��___.�.� } . _ ,_..,.�� _ _ — "__ � 1 ��I'(/G ..� � _ .. : � � i 1 ' � �,�',i , , + � 4 i ; 3 � __ :_ __ �„5G _ . t� . _�_ ,. _a .�-1--- -, �— �� a �..` ' .__ .S� % _ �_.� , , # � : 4 � � # , ��` `� e_.. e_.....�.�; ..,.,.s_.f�..... � .�-.__� �t_...w _...;._._ s ,.._._.._ . . i--�.____ .._ ,�, y. _..;__..__I._ ,.... . . �� ' �� ",.- ` �. � � I i � i + � i � i t , � E f ° . .�._.I _.!.._._aA� ..�._ _ .a ` ' .... __ _. � . _ � { , � , _ F -- ,__ _ .--�' � . + , . , ;� � , � _. �.. ! ' i ; ; ; � _ � � � � _e�.._.. ._i.w�....,� � . n ; ; _.�, ..�. . � � �,.� ., _ ' .e. � . �,y� ��J ,� t � , , .. gi. L�►"• ��'S�/� r . ; : , . , _ ��___a--�.�_.e - sw_a.. . ._ �_. _.. � _}�...._v. �... ._y.,�. E i t � ; s.,c,. ..._ � (....-. .e- { 3 . . . � . � f � � � { � f -.... .t, S� .._.......N'_ . y .. ..--J v«....---, �. ..�. .._ . . . . . . . . . � .. ...... . . _. . . � � ' f � I . . � � ._ ��.' _ � i � � i }1 p ! i C � y . _,l� �. �µ.« .5....�.. ._ , . �.._..e._-+r-'..e ...C... � _<...+1 e �.,E.....,.._..¢..._.�.._ . �� . � �... -. . . �� _ � ,.. . �� i 4 � i i � � � f � ! � ��_� _ _ � � ,_� �� a�F_ � p __ �e�_.� , ,, . _ __. , �� . . ; � -.+�--- � -!-_.,-�. ° _. '..:.� ... .- . ..,.-. . . ..._ .�_.�.. ,,... F_.._ W ...... e+�.._ _ ,,..� ....__t,.. _. �.. . . __ . ! �____�'.) � 1. ; i , . . .__� -t-�...._. , .... -_ . � .._ . � ._ _._.:._ ' �__ ` � , � . . � . . i� . . . � � � I . . ..C, .._ _ . . , ' . ' � / �� . . . . . .. . _ .. _.. . . �� . . � "_ " ,.s_.. . . . , . ... . . . . . �J_ . � � � I ` . � S � i , .� J, � $...,-_ ...._.._ �._.. .�z _.�_ . ' . � . . I i � � 3 k . � � � � . +_ _ L__._ + _ __ _ ' Do Not Write in Space Below - FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application 10 - 17 - 80 Fees Paid: State 14 . 00 County 36 , 00 Date 17 October 1980 Permit Issued/FZ?Ty1�r�f�'d (date) 10 - 17 - 80 issuing Agent Name Elaine Nehrling Inspection Yes XX No State Valid# Date Rec'd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISQl�l; 4V.L�37pp�, ; ,:, 2. state (pink copy) 4, plumber (canary copy) REPORT ON INSPECTION OF SANITARY PERMIT # 8C� �a�a. (1) Name and Address of Permit Holder Person/Persons at Site 2 Date of Inspection 'Ur�rvoN NeL�oN �u�2T M�7c��F l�s o� r �� .�I-�a t�-r�ten W�s, Time of Inspection ame, ress, icense o. o ns a ing plumber C 1.,��we t= G t�� 1�/ f a- t ( 1''-G $' 3;l5 P..0, 3 INSTALLATION CONSISTS OF: �Septic Tank �Seepage Trench �Dosing Chamber ❑Seepage Pit �Seepage Bed ❑Holding Tank ❑Fill System BEN ermanen re erenc�e oin�lSescri e: l`�" �Cokw✓3Y� P�ut� �o' (,u o� �°,/�t'. ��Ev R� k4ASE Elevation of vertical reference point: 1�j p � Slope at site: Q-� �O (5)MATERIAL AND DEPTH OF SEWER: �3 O �S (6)SEPTIC TANK: Manufacturer: 7 i.,�G- Liquid Capacity: S cJ Tank Inlet Elevation: �j� Tank Outlet Elev: �7� /O # ft to lot or property line: >�1,5 # ft to wedl: >�S (7)DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute horsepower brand name of pump and rtrodel number Is the warning device installed? ❑YES ❑NO Wired? ❑YES ❑NO II HOLDING TANK: Manufacturer o ga ons construction ; depth to the cover ft; If septic tank is being used are baffles removed? � YES ❑N0; ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? ❑ YES ❑N0; Wired? ❑YES ❑N0; Locking device on cover? ❑YES ❑ N0; Diameter of vent and material Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth; ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe-elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: 2 ft width; ft length; _:� tile depth; �Q_li.neal feet tile; ��2� ft to residence; ��0 ft to well ; �,5 ft to lot or property 'ine; >%_5o ft to ordinary high water mark of lake or stream; N�_ ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed _Q'�'� ft. 11 SEEPAGE TRENCH: Total length of seepage trench ft; width ft; tile depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage I trench _ ft. � (12) Has system been installed in area indicated on EH 115? �YES �NO (13) Nas system been installed in floodway? �YES �NO Floodplain? �YES �NO DILHR-SBD-6095 N.05/80 Signature of Inspector: r��,�� /fjti�,;� �v,.�_ .>�rJ Department of Zoning and Sanitation Sativyer County � � � Inspection Report y Owner Crystal F, Vernon Nelson c 0 Address Route 1 Box 143 Alma Center, WI 54611 � — o y Name of business z � Builder '' . N 0 Address � Plumber Clarence Dletcalf Address Route 6 Hayward, WI 54843 Inspection H O £ (� Private ( ) Public Property Sanitary-instal � � Dwelling Setback - lake Violation Mobile HM Setback - road �-°y Garage Setback lot line ( ) Sanitary ( ) Zoning Privy .,. w t � `To w n� /1 C. � y , x a � � I3 � J �� 3s, Vh�7 proi � o � C I I� n i h N i � � r �25z� � o -y c.�. al«-r+ a M, � !3"NoRwAY -�.� �\_ 750 •• � � %r �r�c � � ' � �[_�C,i, , � ' � � No 6�pG 1! r� �0 �U6L� ��`'-r• a � m I � � a � r• c > I50� a �' I � �. W , o �, � H £ ___ -- __ _ � ------ . . _ . . . • __--_--- - I ��-�-_--- ----- - � � (,J�TL� Rounio l�(3k� �- Discussed with owner yes no x Discussed with builder yes no Discussed with plumber yes no Discussed with yes no �° Date /`S" 0 G��p __ Signature of Officer j��„,� � �h,�,�