HomeMy WebLinkAbout010-941-22-4437-LUP-1992-439 Application for Land Use Permit T �
County of Sawyer y
. og
The undersigned hereby makes application f.or a Land Ose Permit and agrees that p ^ `
a11 work shall be done in compliance with the requirements of the Sawyer County o 1 V
Zoning Ordinance and the laws and regulations of the State of Wisconsin. M �
PRINT - USE BLACK INK OR PENCIL -
�(�.r���� L. ���c � �
�occ�,�,.).�Jo_.�czr� �-t e_nc�d-�
Owner Builder � r ``
�� ,�� ��ox a8�- L��� �vt �--. �..,,�_�
\.� ,
Mai ing Address Mailing Address ^
� , �t �
�'.i:��'� , � , � h a c,, _� � , , - �� ' � �1/
City; �tate, Zip � City, State, Zip
-� o �
Building Land Use Zone District C. rt
( ) New ( ) Filling Se,E� Jll_ `� ��
(k) Addition ( ) Dredging Lot size �' �.' �
( ) Alteration ( ) Grading v �.
( ) Moving On ( ) Acres �
O t ) �, `5"
New Construction �
Add�}:tx�'• y
Siz�o ft wide ' wide ' wide
3� ft long ' long ' long
O
Floor area , .�'�� sq ft sq ft sq ft
cz� �
r ;�
Total hgt \ '��� to peak ' hgt ' hgt x' :i
Stories � /
No. of Bedrooms "�- rear lot line or waterline o
C
(year round) or (seasonal) G rt
Type of Bldg, Addition, Use a o
( ) Dwelling �• rt
( ) Garage (1) (2) car N•
(. ) Storage Building � r.
( ) Boathouse °
( ) Livingroom �
( ) Bedroom � C
s
( ) Kitchen-Dining �'
( ) PorcFC� (enclosed) (roofed) 3��, �, � ��
( ) Deck - open '
(X) Comm�-c-���o� ����\ ,P S o�
\ )
( ) AUFv 3n-�'=r��E�,���� �6j ' ,,,
Type of Constructi�, �` � \ � �;
( ) Frame ( ) Blo�lc �'s `°' � "
( ) Lag ( ) Concrete �� �' ,�•�+� � I��-
( ) Pole ( ) Steel ` ,�v '�^ -
( ) (� Pole/Met��� —_ � �°o' —� �n
� � � � T '"� -i nr�k ..�
r
Construction Cost $ Ip�vprj� pQ ,
. ��
Vol � ,=_, Pg 3;�,'l af Deed �
CS Vo1 i":,. Pg ro �
�M; `- ` H
Cer. Soil Test ;���, �
" , r I �_
Sanitary Permit J�'� - L road
---------- � -------------- o
z
�-�: —��.1 . z
Issued 2-^( �1,JC�'(��GFJZ_��Z Denied - �
� � s�
�i
� t`�(��' l,��c�� �2c�J� f —�y��v �� 1 W.-K.E - Es�Jwr" E
2T —�Zoning Adminis rat
ll0.9 •"�
• a-_ T USED :.�Q
I�d.ID�-� ,. v ' .
, ,
(b:l r_ i.. ..
162 ��= �M ., ' N
.►b2 ,- .. , nr
! N�
.16.3 P1
16.3y N \
�
n
16.¢0 . �°' u
N�
- s
� � �
� z
� D,%G
16.33
16.3S
3 � C
V �,
16.41 f
. ,7 Z�
-- Q • �
- 16.'5 Q „�
� .�b O ' �
.I6.y2 � ;
- - .16.I � 2 �
. U �
2 2 �
Q �� - ._�
`
\ •
.16.F;� .16. '
16.6 ' +y;
J �
.16.7 .
� ,',�
r6.e '�
0
. � o
'` i,�� '� �C�
. j �va
�
.16.2 8 � ... __ �-
o , --
o � ,
.►6.20 3 .�� ---1__
.w.2 i i �
` if
� 16.22 _i' '
�
,
; /, _ �_
ITY�� ��Q"��- H.AYWAR � I
. _ _I_ !
� �
__�
reo-er
CERTlFIED SURVEY MAP
m PART OF THE SE 4-SE% , SEC. 22, T 41 N, R 9 W,
; TOWN OF HAYWARD, SAWYER COUNTY, WISCONSIN.
N
P �/1
n
m n
N � � m I
w ..
4 b O
— 2 2
o � � ` �
i
O y y 1j A
i O =
^� � 0 r- �n iD r
V1 � C � p �p p
a b o m n � '�
O"� � o •L „�t4 �
A' 't o AE�
o � b � A �-L �.'�i'�
� m z � -'N" n so. �t
�n � 2 p O
\ ^1 m � m `! �o
� m m "' � m
� • o �no \ Z y ' y
m
� � � ° z "� 1~ � r � 3 -S I'01'12"f. 165.17' -
�p O �� V y m
� w C r e N ^ ��*1 / � 'A
� m r �' � � �+2 / p
� V ~� a A � m / g
m « n �, /
A \ � uf
� y / �
o � m �
z� �. �
� •� 0�"� m m
� / j �'I� m m N
/'� ,%' r�2,,? `\. � ��/v�'�'2y�y � O O o �
� � ��
���� � ,r "��f � �g�'y� ,' 2 z
�,,� '� \ (� 4. ''s� m
-� �: ` := N ; 0 .�� / �'L y r,<,� uU
� Np
"��, �' = � v� r . . \� 3e:. , a�
"�,.. p U � ! ?s. /y S l'04'45"' W. 29233' .
. :!� . Z C' '� / / � � E '
t .�,� ' / � u �
O•� �.�._•� � :/ >b`o N
.'� � / n`^'y p N
.:\\` <_ / y<� 4 V
!
� �
� 00� i o �
`/ � <
J3
/ , N :
� m m 1� 4 N
� � 0 = �1
� p y � �
» � N A v
/, . �. o
/ �
p� T
o� i
� '� •� Y
/ N !'01"06" W, 20 7.34' "� pEN[f:NE � �
� °' O'S0'45" W, 99.9y8'
mm m 1 N 0'SY24' W. IOO.Op'1 ��6r•IBSE.�E, 172.43' '-
/ � �
N (�i�
• �i 2
/ N �
m t �
" W � I \ . � • N
!� i„ ,., u
J "�
' '"- � I -'' '+ '
. :�? _ u; I _' �` �
om ' :'� - 'a
r�.� e
,J o ` . u b m
�A n
�A
c�if1 � y -
� T
V N'� �� __-- _ ' '— _ __—_ �i
__� EAST Lh SEG 1$ T�I K R f M. _.� T--- �-- .�f h
N 0'S17�' W, IJ26,4J' �
� W
h ���O PAGE f OF E PAGE$
C'`.^.�lllri� FiUfYi'�: 4�_..y.__ .. /�
� .
J
I , Ronald L . Peterson , Wisconsin Registered Land Surveyor hereby
stdte that in compliance with Chapter 236 . 34 of the Wisconsin Statutes
I Y,ave surveyed , divicied and mapped the land herein described , and
that to tt�e best of my knowledge and ability this ma� is . a correct
representation of the survey made . I further state that �his survey
has been made under the direction of HAYWARD GAKES REALTY , INC , owner .
This land is located in the SE1/4-SEl/4 , Section 22 , T 41 N, ./ �
R 9 W , Town of Hay�rard , Sawyer County Wisconsin , described as follows :
Comrnencing at the Northeast corner of said SE1/4-SE1/4 , Thence
N 88° 55 ' 15 " W , along the North line of said forty, 199 . 09 feet to the -
actual point of beginning , Thence continue N 88 ° 55 ' 15 " W , along the � • :
ilorth line of said forty , 522 . 07 feet , Thence S 1 ° O1 ' 12" E , 165 . 17
feet to the Northerly right of way line of S . T . H . " 77 " , Thence along
said Northerly rigtit of way line , S 97 ° 22 ' 24 " E , 623 . 23 feet to the end
of said ri�ht af way line , Thence N 1 ° O1 ' 06" W , 207 . 34 feet , Thence
S 88° 53 ' 58 " E , 35 . 75 feet , Thence N 0 ° 50 ' 45" W , 99 . 98 feet , Thence
N 6° 17 ' S7 " E , 272 . 43 feet to the point of beginning .
Subject to all existing easements and reservations .
� � �+ � ; �
�.. r � .!
F._;7:?c.'s Cfiice �
. �
.C..l1i':i:: :,C._�tY -/+
�:e�c:ved fa* record tYie �� aaY oE
��t��i'c1_A D lB�'7 at 5 >'�clxk
;.i cr,c recorded in vol.�_
ctC.��� on pcne�S '?C � �COj�j �
�. C7`CftC.c.��Ti�r.%-+�"` Fcriste: /� / ��—�����f\\
/_n., j ROIJALD � , ., .`�
A�,;,y 1�t �' P;�Tc.:,�:�N �• `
i c.�:��3 �
7� �.�;' ,::.nC ,
\;15. % ;
'� ., • ` �•
`., �,,� `� ,
\ ' _ . - `
.� I �`� � � ����; � .
This instrun�ent dr3fted by •
Fonalc] L . Feterson � `�
Nov . 9 , 1 �?87
I?�.' .��r� � ��
, �
Approved thi � day of , 1987 , by
Sawyer County Zoning Admin .
Fage 2 of 2 pages
7�
SANlTARY P�RMIT APPLICATION °°�"T`'
�DILHR In accord with ILHR 83 05,Wis.Adm.Code SAWYER
� � STATESANITARYPEfiMIT#
CST 88-043 104233
—Attach complete plans(to the county copy only)for the system,on paper not iess than STATE PLAN I.D.NUMBER
8%x 11 inches in size. ��— �p d 8
�ee reverse side for instructions for completing this appiication. PEririoN
I. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR vnainNee ❑ves ❑No
PROPE�2T OWNER , PROPERTV LOCATION
� C• 1C �- SL Ya,>L�/a,S �, T S/ ,N,R = E(or W
PROPERTYOWNER'S MAILING ADDRESS LOT NUMBER BLOCK tJUMBER SUBDIVISION NAME
r �' 1 �.�
CITY,STATE '/ Z�IP CiO(DE PHONE NUMBER � CITY : NEAR/EST ROAD,LAKE OR LANDMARK
t.'�( --�Y .y� I�l.S'�/� �VILLAGE: _ . i� �T/.,.i 7 L.;..
11. TY E OF BUILDING OR USE SERVED:
Number of Bedrooms if 1 or 2 Family OR �Pubiic(Specify): � ���.
III. PURPOSE OF APPLICATION:(Check only one in#1. Gheck#2,3 or 4,if applicable)
1. a.�New b.❑Replacement c. ❑Replacement of d.0 Reconnection of e.�Repair of ar
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 CoFy.
IV. TYPE OF SYSTEM:(Check only one in#1 and only one in#2)
1. a.�Conventional b.❑Alternative c. �Experimental
2. a.OSystem- b.❑ Holding c.❑ Pit Privy d.❑Vault Privy e.❑ Mound f.❑ IGP
In-Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
t. 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): REQUIRsE�D(Square Feet): PROPOSED(Square Feet):
3 /G�� %LCJ �7 Feet Private ❑Joint �Public
CAPACITY
VI. TANK Site
in allons Total #of Prefab. Fiber- Exper.
INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel 91ass Plastic APP
Tanks Tanks structed
Se tic Tank or Holdin Tank /Zf.� � F��y r� --
Lift Pum Tank/Si hon Cham6er ❑
VII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans.
Plumber's Name(Prin/t):1 Plumber's Si na ure:(No Stam MP/�v}PR59PAb.: Business Phone Number.
��Vf� V ��.L�' ZC�� %/ � �S%�Si�
Plumber's A�dldress(Sireet,City, ate,Zip Code): Name of Desiqner
�� Z� `� . �i �J,+.-�� T•
VIII. SOILTESTINFORMATION
Certified Soil Tester(CST)Name . CST#
�:�.1 -< /"��Cu��d�.�� - �7ic�
T's ADDRESS(Street,Ciry,State,Zip Cotle) Phone Number
6 !✓� .� [ i i `S �s�- i•�� ,� - y7���
IX. COUNTY/DEPARTMENT SE ONLY
��isapproved SanitaryPermitFee Groundwater ate Issui AgentSignaWre(NoStamps)
�Approved ❑OwnerGivenlnitial SurchargeFee
Ativerse0etermination $90.00 $25.00 5-16-88
X. COMMENTS/REASONS FOR DISAPPROVAL:
SBD-6398(tormerly Plb-67)(R.03/86) DISTRIBUTION:Original to Counry.Une Copy To:Bureau o(Plumbing,Owner,Plumber
► 88 - 2 � R �
� �
�
�
� �
r � _ �
\ 'i /
� —__.1 �� �Jl.� .�. _...-._._�_.....___.�
�
If `,_—____—_.__"_._'_"_
� �+
� i
�.. �
\ t '
� '
t
� j I
' � ,
\ f '
�
� �• �.s _ �'` , � �C. �
S -
� �____.-- � �
I � � s� �' �°�C„�
1 � � ``''
n r'.i
� � .. �,
:; ��� , � -
\J �
f � , ,
� ���� � ��
. � � '� � T � �
, �
� � , P �
� G, ,
.. : � � �� � � �.� `�� � s�
� � �A � � � Q � �� `�
, � � � �
l.'j � �\ � .
;' �. '�; �,� � �` �, �
� �
�v� � .� � y� .--� :.�
i � � \ ` _ —�.. �I` r
� \ � � � � � \
� �: - - � �
\
� �/f�.:-.x� � �
� � k
. ��{� / � �� e
' V � �(�rY, !
\ ` � f
� ' � , l;
; r, �
�' �f� � � �� � �
r f � `� \ G� �\
c• �, \ " �^
PRIVATE��SE�,�G�'���� w
.ti � . ,:
co,��t�Q����� � � ,
_ � �
.. ___ � �
x ____
._ ., �,. , r j � ,., r� `a � �e
�___-- �'tr G=� t YJ� y�'t''{ fi '� �,�y,�� �"�i::a } .'
�;� ! E'��i:���r � �;'ti:v '.�:� � � �. �T��"
�, f � � 4•� ���•, ��' �) �� �` V � V
� DEPA�iTMENT G: Itii?:lSTf;�'. l_Af.CiR �!�4 � ,.-::���,� � +��cLA?tG�,� �
, .
� Q�VI�{�1lV Cf .�i,ai C�Y �.i`d�.; �71�i�.L::ir�iJ � � � �
r
�l �
� �
n ' �
(' , ' Cro. � �• � �, ` \ �
i
S CQRR��;�,:. :� �, ._ ;��; ,� � ��
l� � c.
( ; � r � tY
� �. _ . , � _
—_ ____�-----__--- _ _ . r
- - � _
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY& BUILDINC
LABOR & HUMAN RELATIONS PRiVATE SEWAGE SYSTEMS DIVISIO
P.O. BOX 7969 BUREAU OF PLUh'BIN
MADISON,WI 53707 .
� ❑CONVENTIONAL ❑ALTERNATIVE s�a�eP�a^i.o.N��,�e�.
(II assignetl�
❑Holding Tank ❑ In-Ground Pressure ❑Mound s'8�= a c�o�'6
NAME OF PERMIT HOIDEA�. p�u��yy A(�� � ADDRESS OF PERMIT HOLDER�. INSPECTION DA7E�
� � .t'r . /zf �o � �v,�rr/wi - .s-s��y3
BENCH MARK(Permanent reference po�ntl DESCRIBE IF DIFFEHEN7 FHOM PLAN REf.PT.ELEV. C5T REf.PT.ELEV.
Name ol Plumber:� MP'MPRSW N�i Cnu��iy Sa���tary Pe,m,�Num!�er:
�!i/�✓ � c�O� Ci�'� _ 7 ' fy—��
SEPTlC TANK/HOLDING TANK:
MANUfACTURER�. LIOUID CAPACITV IANK INLET ELEV TANK OUTLET ELEV W�+RNING LABEL LOCKIVG COVER
PROVIDED PROVI�ED-
. / .Z� �'iCj-� /a+SC `/ ; /�9, J�v Es �',N o ❑ r Es ❑N o
eeooirvc: vervr oia.. veNr r,r.�i. �+ic��vanrEvt NUMBER OF Noao aaor�er�Tv w=_�� ei_�i�owc Ivervr ro caesN
n�ar+�n FEET FROM ��"E r 7�S_ �S aia irv�Er
❑YES ❑NO ❑YES L�NO NEAREST .� /
DOSING CHAMBER:
MANUFACTURER �EDUING l I(]UII)f_.1Vnc:llv 1'11M�'ht(�I)El �'i;\tV SII'r�t)N MnNU�nf;ttlfltfl WaRf�IN(�L:.BEL LOCKI�G COVER
PROVIDFU� PFOVI)ED
❑YES ❑NO I_�YES ❑NO ❑�ES ❑NO
GALLONSPERCYCLE: aunnanNocoNrHo�soveRarion.n� NUMBEROF ''''"nE�+ry ;���� eui�oinc verv*TocaesH
(DIFFERENCE BETWEEN FEET FROM ��Nf 4iR�v�ET
PUMP ON AND OFF) ❑YES ❑NO NEAREST—�
SOIL ABSORPTION SYSTEM.Check thesoil moiswreat thedepth of plowing i'^�����, i��na,� rrr� •.•�art fa�:.;,�tio�aakrc,N��,
or excavation. (If soil can be rolled into a wire,construction shall cease until FORCE
the soil is dry enough to contin�e.) MAIN
CONVENTIONAL SYSTEM:
wiorN �ENa1ri �v�i o� oisnv Nivi sr�n�.irv�, rovew �,,_;�ir ui.: _� , uouio
BED/TRENCH � � nvervc��Es � � r.�ntE,r+in� P�T oer�rr�
DIMENSIONS `o? �,_,S � T .�r '
GFiAVELDEPTH FIL�DEPiH I�iSil� �'I�'1 U1514{ Vlf'E DISTR PIPF MATEHInL Nf) i�if+ NUMBER OF �'HOVEHTv IYELL BUILDING VENTTOFRESH
' BEL(1W PIPES AB()VE CnVEf7 E I k v INI 1 I EI_E Vn!NU �'tl'I ti IINF � AIR INLET.
6 �r /.� �ve 9'8� l Q• 5�_��LJ — 3 NEARESTO—► 7 � 75,� 7ZS 7Z.�
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHOW E LEVA-
meets the criteria for medium sand. TIONS MEASURED.
aYEs ❑No
SOILCOVER TEx�u�te ��EirninN�n�t�inr�K�i+s i�;ssti�van�rvwF��s
❑YES ❑NO ��YES �NO
DEPTH c7VER iRENCh1 fiEU DEPTH()VCH ifiEN(;��HF It I�f f'il�()F i�lf'S��IL S��I�I)!I1 )Ff I)f I) �1ULCHEf7
CEN�EN ED6ES
LJYES. L�NO C�YES L_'NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
--� -- ---—— ---
wioi�� i.tN<,t�� No o� inii�tni srnciN��, <,unvii uirn�ntiuwrn�i iiii nr��r�+ni+ov� cuv[w
BED/TRENCH r�+En,cNFs
DIMENSIONS
MANII�OLU Nt1M1' h1AN11�)LIl UISiH VIVE MANI�()lI)���n1f�11li1 N(1 1115711 UI$71i f'll'f I)1;�1111L{l1iIt1NV'll'�MI�T�IiIAL$M11llHKIN(�
ELEV. ELFV IJIl� ELEV �'IPES L]IA
ELEVATION AND
DISTRIBUTION
INFORMATION "o�Esize �+o�esr�ncirvc uwi��Euc��i�F+ecriv covF�aMnlEwin� vEFencni urrcoHHFsvorvosl�onaaHovFo
1'Lr".NS
❑YES ❑NO ❑YES �NO
PERMANENT MARKEHS: pBS�HVATION WELLS PHOPERTV WELL BUI�DING�.
COMMENTS: NUMBER OF �iNE
FEET FROM
I ❑YES ❑NO C�YES i_-JNO ____ NEAREST __ _
�-P P f��i�YaU�r/ �/�/L��11• �/✓S/,� �!P d �'�.? f��-L
/�� AP/�ro�� �`i��v-
Sketcn Syscem on Retain in county file for audit.
Reverse Side.
sicNnru - — nnr �
�
DILHR SBD 6710 (R.01/82) �GGG� � �