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Home My WebLink About012-640-17-3207-LUP-1992-081 ,. Application for Land Us'e Permit ' County of Sawyer yo � 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- � lations of the State of Wisconsin. r j7 ��`� �� - � S �)'S�'I�a PRINT - USE BLACR INK OR PENCIL - 1'r A�a�/#l� ' �f G� -3 3-G,�.. � �a�.�n? e. .��d��J�' �./� rva�-e.::< C �: � �v = Z it ,. . ;. :;�; , � ac�ner Builder /� II �AcU Inl �ve . •ti•�� Mailing Address Mailing Address �- .S7- �.�1 u L, /�'� (J S��! F � �i:. �� ,!.,j .,f City, State, Zip City, State, Zip Bui ding Land Use Zone District F}Q-� o � (�New ( ) Filling rt O Addition O Dredging Lot size �oaf�p¢ �r 33a/339 N � ( ) Alteration ( ) Grading O Moving On O Acres . 7 a� ( ) ( ) �� New Constru�yion � " frn�aRt' VE��Fl:: ,�' '� � Size �_�_ ft wide ft wide �� 3 �o ft long ft long �� Floor area �i � '� sq ft sq ft =` m ' Total htg � 5� to peak to peak x S`= Stories � Stories No. of Bedrooms �— rear lot line or waterline c� 0 (year round) or (seasonal) U, rt G Type of Bldg or Addition o' t' ( ) Dwelging� �� r�r (�_ Gara e ( ar ( ) Storage Building N ( ) Boathouse o ( ) Livingroom � ( ) Bedroom ( ) Kitchen-Dining Z ( ) Porch - enclosed/roofed " ( ) Deck - open �' � r\ � � � �_ � . �.y� � �)�. Typ of ConstYuction ��- - — � (�Frame ( ) Block / { ��. ( ) Log ( ) Concrete LU ( ) Pole ( ) Steel �_; cn ( ) Metal ( ) G �D � n Construction Cost $ d GoO, Vol _3q5 Pg �'"� of deed �"} CS Vol � Pg �5 ,ti � w Cer. Soil Test -Q�`a � � m . ' r ----------C Road --------- Sanitary Permit 8`� -Q�� L -----,- ft� . , �_ '�� it 1- r7 0 ,z � Issued ��l�t� �� Denied —T � - � f ) U z-"�-" . ��u 1�-�0-��-��c� TL-� � � _ Owner Zonir.g Admini.trator ��ZE,ic.�,:..,. ..�..�-, ..�. . -._. S. %� �� a z -� �i /"?�l � � y z � � � � �� f/ � __ __ _______ __________ c�� -'�1��'d cd - _ _ �� i ' , qS � . a . � _ .��.� �C��( � , -s,,�.� .� g � �'1 C�'►'�� - . °�� - � ! � � _�> - - � . � ' � � , , ZI I _. � E � _ i _�., t ! / , o z � � J � �-' ZI ' I � � t �� g � � � i � z! , oz �\�(�1 �_ °Z 5 S '� ` �J'`��\ J��'(C, . b � � �� ' 8 ._ , � ,Z� � , Z� �---� v G' -� ' az N �G� 4 .r Q ; _ � -� �� . �_ � � z • , !�� __.. _,___-- _ _._ . _ _ .__ , ooi � �� . ---�,�, , - / ��. �;��-- `� , _ _ _-�- - � �3►�-b�M c�� cn�`�c� � � - � � . ,.�...,�: �, Whitecap Mtns. Re�creatiion Inc. � � BoX � Montreal, WI 54550 �r RIYENDELL � � , r? MOUNTAIN �fi� �E: RETREAT � � �7? �' ,,� I CHATEa�?' Q �' ROSOLO SNUGGERY ; � p / ' � ,,,r.✓ ? ' �'- SHIRE ~�-�'� � ' HIGH PQ�f T w, � � �";, n r•., � �I.J ,' KASTENBOLE WOODIAND v Z 1 � �' 1 HAN DER HAUS - LOFT VALKOMMEN � � ' ♦ � � = r�tyu�r' BRID(3Ec _ .� i �< . , . = CANTIN'Sa ;. � ��ROCKIES � � � =' THE VINTAGE '�� `PARKING �;� Y� 0 ^ THEO� ,< , �;_�, 6 CARR G TABLES BA� �.��TUNNEL h HAUS - �'` �` MOUNTAIN _ �.�• � ° � MEADOWS � :� �: � ..� "MVOS , ^\. - . � ,_____ ____ � \� ��WHITECAP LODGE - M�A1�R#M! � � � � � � " -�\```` �,_ ` `�-_'"-,�. �- CNP`��F� w � � a ST. MORITZ Z 1 � ^� SLOPESIDE COUNTY PARK —� � —�'—%"�� — � � � r, COU�TY ROAD E �_ -f-J_-� GRENOBLE � \ WEBER LAKE / \\ �°�^��^ APPLICATION FOR SANITARY PERMIT � DIL�HR � (PLB 67) SAWYER �;ourvry � UNIFORM SANITARY PGRMIT,""+N CST 81-052 52262 �' —Attach complete plans in accord with s.H 63.05,Wis.Adm.Code for the system,on paper not less than 8Y x 1 7 inches in size. —See reverse side for instructions for completiny this application. PLEASE PRINT PROPERTV OWNE/Rj / MAILWG ADDRESS �4 L( c1 d b.� �U 2 � .SJ7 P OPE TY LOCATION CITV: VILLAGE: !�J 1/4�u./1/4,S I 7 ,T�/U,N,R /� E (or)W r wN oF: r LOT NUMBER BLOCK NUMBER SU�B!DIVISION NAME NEAREST ROAD,LAKE OR LANDMARK STATE PLAN I.D.NUMBER �(� rwo�GKJ TYPE OF BUILDING OR USE SERVED � 1 or 2 Family Number of Bedrooms: � L.� Public(Specify): THIS PERMIT IS FOR A: L� New System �� Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System � Revision ❑ Privy i� Alternate System � Reconnection ❑ Petition for Modification IF THIS iS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. � Seepaye Bed ❑ Seepage Trench J Seepage Pit ❑ Holdiny Tank J System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing,For Which A Previous Permit Is On File,Permit� issued _ ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Sceel Fiberglass Plastic Gallons Tanks Concrete Consttucted Septic Tank Capacity p U Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacmrec � — IF THIS IS AN ALTERNATIVE SYSTEfJI COiVIPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure Total #of Prefab. 5'ite Steel Fiberglass Plastic Gallons Tznks Concrete Constructed Septic Tank Capacicy Lift Pump/Siphon Chamber Manufacturec PERCOIATION RATE ABSORPTION AREA ABSORPTION AREA �qIATER SUPPLY: (Minutes per inch): REQUIRED(Square Feetl: PROPOSED(Square Feet1: 1 615 615 � Private ❑ Joint ❑ Public I,the undersigned,hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber(Prin�: S'ignat MP/MPRSW No,: Phone Number: �IJ e,v lo � � ri �� a �'� l.t�� oa Y'�� Plumber's.4ddresr � Name of Designen S �r 1�1 W,�N �v w•� s�r�'9. �—.z�2-- COUNTY/DEPARTMENT USE ONLY Signa e flssuing Agent: Fee: Date: �Disapproved $70.00 4-30-84 �aPP,o�e� J ow�e�c��e�i�,�t�ai A�verse Determination Reason for Disap o al: i� Alternate coursels)of Action Available: DILHR-SBD-6398(R.SB2) DISTRIBUTION: Or'iginal to CountY. One CopY To; eureau of Plumhing,Owner,Plumber DEPARTMENT OF INDUSTRY, INSPECTION REFORT FOR SAFETY & BU14D�NGS LABOR & HUMAN R'ELATI-ONS pRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMB:NG MADISON, WI 53707 ❑ CONVENTIONAL ❑ ALTERNATIVE StatePlanl,D. Number (If asvgned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PEfiM1T HOLDER: ADDRESS OF 7ERM1T HOLDER: INSPECTION DATE�. � .�. �� -L�, ,v ,��e u�. � P.��L .�r,,�,J 6 -zs-- � y BENCH M RK (Permanem reference pomt) OESCFIBE IF DIFFERENT FROM P�AN: ��r/ri REF. PT. ELEV.: CST REF, PT. EIEV.�. a Name of Plumber. MP/MPFSW No.-. County�. Saniiary Permii Number. Q„� � � ec. �"Y- o a r SEPTIC TANK/HOLDIMG TANK: MANUFACTURER: I.IpUID CAPACITY�. TANK INLET ELEV.: TANK OUTLET ELEV.�. WARNING LABE� �OCKING COVER PROVIDED: PROVIDED: � /j'f{¢C �(140 � � � , �YES ❑NO ❑YES ❑ NO BEDDING: VENT DIA.: VENT MATL�. NIGH WATER NUMBER OF ROAD�. PROPERTV WEIL BUILDING �VENT TO FRESH L II ' A`ARM FEET FROM LWE�. �� AIR INLET�. ❑YES ❑NO / �• � ❑YES ❑ NO NEAREST DOSING CHAMBER: MANUFACTURER�. BEDDING�. LI�UID CAPACITV GUMP MODEL PUMP;SIPNON MANUFAC7UFlER WqRNING LABEL LOCKING COVEF PROVIDED�. VROVIDED: ❑YES ❑ NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPERTV WELL- BUILDING�. VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM ��"E "iR i"�Er: PUMP ON AND OFF) ❑YES ❑ NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing �eNcrH oiannerea roiareaia� allo nnnRKiNc or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVEiVTIONAL SYSTEM: WIDTH�. LENGTH NO.OF DISTR. PIPE SPACING. COVER INSIUE DIA. sbPITS�. LI�UID BED/TRENCH /� / � � raErv_ cHes � � roinrERir,�: P�T DIMENSIONS DEPTH: GRAVEL DEPTH FILL DEPTH UISTH. PIPf DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR. NUMBER OF PROPERTV WELL- BUILDING�. VENT TO FRESH BELOW PI�S ABOVE COVER ELEV. INLET ELEV. END � PIPES FEET FROM LINE�. AIR INLET�. �D / O� � t< � � r" L�C J QJ� � .3 NEAREST-► 7.�0 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 REVERSESIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. ❑YES ❑NO SOIL COVER TEXTURE. PERMANENI MAiiKERS�. OBSEHVATION WELLS ❑ YES ❑NO ❑YES ❑NO DEPTN OVER TRENCHiBED DEPTH OVEH THENCHBED U[PTH OF TOPSOIL SODUED SEEDED MULCHED CENTER EDi;ES ❑YES ❑NO ❑YES ❑ NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/YRENCH wIDTH LENGTH TRENCHE$ LATEHAL $PACING GHAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVEH DIME�NSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MAMFOLD MATEfiIAL�. NO DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. ELEV.�. ELEV.� DIA. ELEV.� PIPES O�A.: ElEV,4T10N AND DISTRYBUTION INFORMATION HOIE SIZE HOLE SPACING DRILLED COfiHECTLY COVER MATERIAL VERTICAL UFT CORRESPONDS TO APPFOVED P�nNs ❑YES ❑NO ❑YES ❑NO COMME�ITS: PERMANENT MARKERS: 00SERVATION WELLS: NUMBER OF PROPERTV WELI: BUILDING� FEET FROM ��NE. ❑YES ❑NO ❑YES ❑NO NEAREST Sketch System on Retain in county file for audit. Reverse Side. SIGNATU - TIT�LE. . ( DILHR SBD 6710 (R. 01/82) ,. � � , � �1 � �_1.�lf1 ��iul�1U ' ' � �� I _ ------- � �_ _-____ � � �� a�� I � a ;? ', �� 'h a �'�PW F�� `� � � t ��.r ` l�aroQ.a 1�� /; � i �` 3�' � �� .