HomeMy WebLinkAbout012-740-02-1111-LUP-1992-369 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- �
lations of the State of Wisconsin. '
PRINT - USE BLACR INK OR PENCIL
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Owner Suilder
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Mailing Address Mailing Address
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City, State, Zip City, State, Zip
Building Land Use Zone District ��z o �
(� New ( ) Filling rt
pQ Addition O Dredging Lot size 2v5�zq��z,9� N n
(� Alteration ( ) Grading
( ) Moving On ( ) Acres 1. (D� n
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New Construction Q�Ck �=-. '�f:CI.C`<=(. �
G,�y,6� 0�:�.�-i�Ki d �� �t�c t} ('
Size ,�� ft wide �'-� ft wide ?rj
3� ft long � S� ft long �,�j �I
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Floor area /v�'� sq ft �S Z sq ft CD Z�
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Total htg �3�+ to peak �f� to peak ��� � b
Stories � U� Stories �
No. of Bedrooms _� Z��'
ear �ot 1' ;1,a�.�__ � o
(year round) or (seasonal) ` � y ' �, rt
Type of Bldg or Addition < �"��'�'�. n �' r
� II ,
/�O Dwelling �j�, �� _Q N I ' a o
/,h�(� Garage (1) �L2�-car p�(9 v L..,��s�.-� --� N.
�J( ) Storage Building� �5,� s� ,,,� �' �
,tw, n,, �hO i,.� r.
O Boathouse i4 p�cN� 5q_ _ - — o
( ) Livingroom Z����sr'�' �J, ��I iN _y-�• �
( ) Bedroom '�'—,�5 �'� 3�' �
�� ( ) Kitchen-Dining N �
Xj Porch - enclo ed/roofed—ys"u G�t � r� � N
(� Deck - open i`�x�3 � � ,,; {� r�
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�'�oS�� � Z D �
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Ty e of Construction � c�� �o
(� Frame ( ) Block � g �,t�'�„ O w
( ) Log ( ) Concrete
( ) Pole ( ) Steel °` 6 �'
( ) Metal ( ) � 9 �7'± `°
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GM �G e.:.
Cottstruction Cost $ �� y°a �
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Sanitary Permit � -U �
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TRANSFER OF PLUMBERS - - NO CHANGE 4�
� �����R FORM � '
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P L B 6 7 � T ' SANITARY PERMIT � �
State Permit # 15 36 9
Sanitary Permit # 81 - 044
County Sawyer
Sanitary Permit Transfer Date 2 7 July 19 81 Original Permit Issuance Date 0 5 May 19 81
A. Property Location : � '/Z /�/��/4, �ction Z , T,� N, R �� (or W Lot # City _
Subdivision Name, Nearest Road, Lake or Landmark BLK # Village
Townshi-p��
B. TYPE of Occupancy: .Commercial Industrial Other (Specify)
Single Family X Duplex No. of Bedrooms � Variance
C. SEPTIC TANK CAPACITY �d Q' Total gallons No. of tanks �
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab Concrete X Poured-in-place Steel FiY�erglass Other(Specify)�
New Installation � Replacement �,
LIFT PUMP TANK/SIPHON CHAMBER Total gallons Prefab Concrete Poured-in-place Other(Specify) _
D. EFFLUENT DISPOSAL Sl'STEM: Percolation Rate �Total Absorb Area sq. ft.
New X Replacement Alternate(Specify)
Seepage Trench : No.Lineal Ft. Width Depth Tile Depth(top) No. Trenches
�
Seepage Bed: X Length �S> Width �� Depth 3� Tile Depth (top)� No. of t_ines -3
Seepage Pit: Inside diameter Liquid Depth No. Seepage Pits
Percent slope of land —� Distance from critical slope
E. WATER SUPPLY: Private ❑ Joint ❑ Community p Municipal
Present Sanitary Permit Holder Phone No. ' Q Sanitary Permit Transferred To : Phone No.
Name lr�� ,1 i�E�� Name - � n ��USSc"/! � �/�.f� �7(,,
Address ��y�'/N'���. �i Address �'��/�f �V' �
�'�g¢3 Zip ZipSf�P2/
I, the undersigned, do hereby certify that I have reported all revisions to the sanitary permit and that all revisions are in accord with
section H 62.20-, Wisconsin Administrative Code and that I have sized the effluent disposal system according to the EH-115 prep�red
by the Certified Soil Tester nd/or any additi soil tests that may have been required.
Plumber's Signature P/MPRSW # �93 � Phone #�3r` ��"rZ
Plumber's Address �' v � �ii1s� •
Information obtained from �� '��r � r (owner or agent)
PLAN VIEW: Provide sketch below of any revisions to original sanitary permit. Include direction of slope and all distances in accord
wit H 62.20. Well location shall be included on the sketch. Indicate or dimension location of all wells, on the property or neigtr
bor ro ert . If well has ot been r'll
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Signature of Issuing Agent
1 . County (Yellow copy) 3. Owner (Pink copy) DIVISION OF HEALTH
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Department of Zoning and Sanitation
Sawyer County
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Inspection Report �
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Owner T�-eeland Cottages , Inc.
Address Route 4 Hayward, WI 54843 ,�
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Name of business i�
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Builder �
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Address �
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Plumber Joseph Kreyer �
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Address P .O . Box 365 Ilay�ward, W� 54843
Inspection
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( � Private ( ) Public Property Sanitary-instal o �
Dwelling Setback - lake � �
Violation Mobi�e HM Setback -�road o
Gara,�e Setback lot lin �''
( � Sanitary ( ) Zoning Privy
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Discussed with owner yes no � _
Discussed with builder yes no
Discub�ed with plumber yes no
Discussed with , yes no "
Date .`,�`'�3' �u-� �'1
Signature of Officcr o'f�/i,��r.�Y , �j '�,
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