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010-158-00-0300-LUP-1992-079
Application for Land Use Permit X y ` County of Sawyer o s 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 BLACR INK OR PENCIL �I'Rti� T. �- <1 ��a���.� LZ S c�"U�����, ��_��,�1;,��.� C�,..�_ Owner �— Builder ` �• � 21�1`�0 �civ�c�z�� �ue �1/�J�' S�JfC��4�6cL� �,L-Z`E � Mailing Address Mailing Address �o¢�z-.i� �.�.C� V'11 n�_ SS�2`� - >�� ���. � C`"z�..1� �R�, I'�1 )'1 ��`�� �,> City, State, Zip City, State, Zip Building Land Use Zone District }�� - � r � (�y New ( ) Filling rt � O Addition O Dredging Lot size �C�(�� 3C���3��, m ( ) Alteration ( ) Grading ( ) Moving On ( ) Acres � _�.3 v ( ) ( ) � New Construction � � Size 3 Z, ft wide ft wide �� � 4.c� ft long ft long Floor area �Zg (; sq ft sq ft � � Total ht � \ g �p�- � �� to peak to peak x � � Stories � Stories �, No. of Bedrooms �j c�t�� L�,��//�'-�::. �_r,�; � . rear lot line or waterline c� c s��a� — _ _ ._ ._ ° (year roun3) or (seasona]_) '— — -- — �, rt Type of Bldg or Addition a o ( ) Dwelling n C• rt ( ) Garage (1) (2) car t (r�Storage Building ` I �. � ; ) Boathouse ti ,�G' i � ( ) Livingroom ( ) Bedroom � `d�� j � ( ) Kitchen-Dining F--- �Z�—� � x � I ( ) Porch - enclosed/roofed � M � �� ` � ( ) Deck - open ;z a � ( ) i � ° c ) �. a Type of Construction 1 ( ) P'rame ( ) Block ��,qi� � � �,. ( ) T�og ( ) Concrete ie�p r.. ( �Pole ( ) Steel I � cn ( �Metal ( ) � � � , . J�� � Construction Cost $ .SDOC.,� (`} � "� � �J�' ��.i Vol �-���� Pg � ,�%;� of deed � £x � �' �� � �^��_�1��'�1 r,p z --�`� � �- rl���.,� � �-I Pg -��- w � Cer. Soil Test �� ��-��� '7 H m �C Sanitary Permit 1�� �`7�� ----"'--� --- -- ------� z � C+E1�F L�� , o° z ��� � Issued _�G/�,(� l9�J� Denied �p_ O W 0— �.wv�:7�� � � �E�-I1�� � I� ��-1 �� £' er Zon.ing Adminis rat�p 0 . _ 3 �� t � � AKE SHORE S :�� �� ���� , . . �1 O � P� F�� � O� � O V T ��T � . -� ��`��,, �taT +��c� !A s�+ W �► 1 T W P 40 f�•l. FZ. 8 W . �.uS� ���� :���� ra�, . . � OR �AUNt�AIl1► �,r���. • J. � . :..:r.�,� f•I�� ' .s ,_ _. ..__ � , -'.'- / � _� �- .._-- ---_ . .�-- ..__ - ._ ----� .i � '� '' �� ' I� .__:_._..�--�---_...__�-_ �_.____�-� .�' � _./ — � � 1 � I 4 13 I � I I I � -i,�a� ` � : ; : l_� K �.iy,� -�,�3, i.r2, � �---.. 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OPi 1 .f:. : . �� b . 0 0/ y ,o � y . �. � 3n i aa-3aoH � « '��' •�o. •`P°'r,,.a..` yt.�_ d•r ,o ` �, o 'y �a y�� . F�s�� ,4 --�f-1 a-O N zF�r— . �n o k• "�- "' • 1,� � a.♦ ;� "�', _ � , . s 4f . � M � � � �. � O � �z: � ey. , , � Qa , ^ : � (� �9 �,�9 . � q ;�+ p, \S p .o� y �, , , � - ;- � � � ,�v'� ��� . _ _ � �,� � � _ ���� � " ,_ �/ u •�a„_ � • .� a. . Y . . �p, . ;� —� ` .1`.' . . f)� . . � - , N � —„`h • Vl y� �r /� \''�• ��� i , � •j� Q� .�• ; �� � b9/�•�N � � i r=, \ - W ^ ' � � �� � �•, � i m � � �' DILHR SANITARY PERMIT APPLICAYION In accord with ILHR 83.05, Wis. Adm. Code couNn � �" � SAWYER � �`�_� CST 9O-LHZ STATESANITARYPEflMIT# r� -Attach complete plans(to the county copy only)for the system, on paper not less than 138 0 72 � 8f�x 11 inches in size. � Check if revision to previous application -$2B f@VBf50 SICJB/O�If1SffUC210f15 fOI COfT1PIBtIf19 ShIS BPPIICfltlOfl. STATE PLAN I.D.NUMBER I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION 3u ' c ' �' Y< Ya, S (p T �/U, N, R �' E (or� PROPEHIY OW NER'S MAILING ADDRESS LOT�j BLOCK# _,[. a! 7� � C'4 � �av ��'/ � CIN,STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR GSM NUMBER ro a ' G�a , C� fp- l� o a-� II. TYPE OF BUILDING: (Check one CITY NE REST ROAD 1 ❑ State Owned O viu.nce �Q d �✓ ❑ Public �1 or 2 Fam. Dwelling-#of bedrooms 3 PARCELTAX NUMBER(S) III. BUIiDINGUSE: (Ifbuildingtypeispublic,checkallthatapply) 010-158-00-0300 1 ❑ ApVCondo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ RestauranUBar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B it applicable) A) 1. � New 2. ❑ Replacement 3. ❑ Replacement of 4. � Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit# — Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 � SeepageBed 21 ❑ Mound 30 ❑ SpecifyType 41 ❑ HoldingTank 12 Seepage Trench 22 ❑ In-Ground 42 � Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Filt VI. ABSORPTION SYSTEM INFORMATION: 1.GALLONS PER DAY 2.ABSORP.AREA 3.ABSORP.AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL�3RADE REQ/UIRED(sq.ft.) PROPOSED(sq.ft.) (Gals/day/sq.ft.) (Min./inch) q�/ ELEVATION �/'� d (p � � 36 � _S / /. Feet Feet VII. TAIdK CAPACITY Site in allons Total #of Pre(ab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manutacturer's Name Concrete Con- Steel 91ass Plastic APP Tanks Tanks structed Se ticTankorHoldin Tank �4U �� •-7.e- LittPum Tank/Si honChamber VIII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name(Print): Plum r's Signatu;e:(No S ps) MP/M�P $JN1Jo.: Business Phone Number: N � ,�n� � �� � � �rs -� _ � Plumber's ddr (Street,City,State,Zip CoCe): f � � '�— y IX. COUNTY/DEPARTMENT USE ONLY � Disapproved Sani[ary Permit Fee (Incluaes Grounawater a e ssue Issui A ent Signature(No SfamOs) Surchar8e Fee) �Approvad ❑ Owner Given Initial AdverseDetermination $11$ . 00 8-29-90 X. CONDITIONS OF APPROVAL/HEASONS FOR DISAPPROVAL: ' SBD-6398(Vormerly PIb�7)(R.11/88) DISTRIBUTION: Original to County,One Copy To:Safery d Buildings Division,Owner,Plumber � n � � o, � . , �� � ,� ,S 0 � ��� �� s�� a h; v� _ J � _ . • , a5 � � - � �'F: - F � /�. � � ♦ ��y �p�� �� '�� • � � �Xi 8/ "�� S , ,e < � \�8 , r ,�rc� o� - � -� �-� � �,. `'"�S � " a �- � p - �r a- � � �,� — y•t t�n�i��fj/ — m d c�// /y'�iS/ 7� ��S 7[ � n °'� _ Q J� �C d�-1,0 a/�� (Y� -,�-'� b �.� /I� � � � ��Yl��� y. 5 �-ly