HomeMy WebLinkAbout012-739-01-1101-LUP-1992-422 d,� D+��.�. 8��. Q�so�.-�
- 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 requirements of the Sawyer County o
Zoning Ordinance and the laws and regulations of the State of Wisconsin. � �
J�A►�t n[� L, � ��::,/��,�-.� ;,,4} PRINT - USE BLACK INK OR PENCIL
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wner Builder
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Ma'�ng Address Mai�g Address
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Bui ding Land Use Zone District �� -.�
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(l�New ( ) Filling � �
( ) Addition ( ) Dredging Lot size � �
( ) Alteration ( ) Grading
( ) Moving On ( ) Acres /'� � �
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New Construction r�"`-��
Size � ft wide ' wide � ' wide
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Floor area � C�i sq ft sq ft )�_ sq ft �
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Total hgt %� � to peak ' hgt =�,.� ' hgt :��` �' �i
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Stories �
No. of Bedrooms �_ rear lot line or waterline o
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Typ of Bldg , Addition, Use � r
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( Dwe 11 ing - �`�ti��`-�t-- �' '�'�
( ) Garage (1) (2) car �. N•
( ) Storage Building "`�,�3�-��, o
( ) Boathouse �
( ) Livingroom ���'..� ,� ,` � .._- �..'.��
( ) Bedroom �"``
( ) Kitchen-Dining �
( ) Porch (enclosed) (roofed) � ��
(�Deck - open
( ) Fw
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Typ of Construction �
(�Frame ( ) Block
( ) Log ( ) Concrete ' F�r
( ) Pole ( ) Steel \
( ) ( ) Pole/Metal � �
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Construction Cost $/�•�
Vol .�.�.. (,� Pg � of Deed
CS Vol Pg �
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Sanitary Permit C" `<"'_ "�' ��i C ~ �•
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INSP�CTION RI�PORT
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Name of business �4„� �4�. {�.Qso��- -
Builder
Address p�
Agent/Purchaser �
Address _ �
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Inspec�ion ( ) Proper�y ( ) Setbacic - lake �`
( ) llwelling ( ) Setback - road
(� Yrivate O Public O Mobile Hm O Setback - lot line o y
( ) Gara�e (� yV�„�K� So;(s �evi�. � �
Violation ( ) Addition ( ) �
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( ) Zoning ( ) Sanitary M'
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Discussed with ; c-�� � s`� t�3 c -_ '_� �) `�� `;� �
Date �- l�l-4 2
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Signature of officer -F-F=yi_�-`. � s"
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-� SANITARY PERMIT APPLICATION � N
�DILHR ���Nn �
In accord with ILHR 83.05, Wis. Adm. Code �
'�'�,..o,•,..,.^.�..� S a e r ' °°
C S T 9 2 - 2 61 STATE SANITARY PERMIT# �
-Attach complete plans (to the county copy only) for the system, on paper not less than 17 9882
834 x 11 inches in size. ❑ Check if revision to previous application
�ee reverse side for instructions for completing this application. sra,TE P�AN i.�. NUMSER
I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. S 9 2 - 2 O 7 7 6
PROPERTY OWNER ��d rj PROPERTY LOCATION
j � /a a, S T , N, R E (o�
PRO TY OWN 'S MAILING ADDRESS LOT# BLOCK #
CI , TATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
�
II. TYP OF BUILDING: (Check one CITY � NEAREST ROAD y
� State Owned O VILLAGE � U� � `� � �D � �
Public ❑ 1 or 2 Fam. Dwelling-# of bedrooms — PARCE�TAx Nu BER(S)
III. BUILDING USE: (If building type is public, check all that apply) 012 - 7 3 9 - O 1 - 1101
1 ❑ ApUCondo
2 ❑ Assembiy Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11� R�UBar/Diw�ng
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 � Other: Specify � � �TTif�Ges
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1. ❑ New 2. �teplacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ 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 ❑ Seepage Bed 21 �Mound 30 ❑ Specify Type 41 ❑ Holding Tank:
12 ❑ Seepage Trench 22 In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
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 GRADE
/� . REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
6 D U � - -- �� . � Feet �Feet
CAPACfTY
VII. TANK in allons Total Site
INFORMATION # of Manufacturer's Name Prefab. Con- Steel Fiber- p�astic Exper.
New xistin Gallons Tanks Concrete structed glass App.
Tanks Tanks
Se tic Tank or Holdin Tank �� a /�Lt�
Lift Pum TanWSi hon Chamber 60
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plu ber's Name (Print): Plum Signature: (No St hips MP/ o.: Business Phone Number:
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Plumber's Addre treet, Ciry, State, Zip Cod . �
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IX. COUNTY DEPART ENT USE ONLY
❑ Dlsapproved Sanitary Permit Fee (inciudes Groundwater a e ssue Issuing Agent Signatur (No Stamps)
� Approved Surcharge Fee) .
❑ Owner Given Initial $ 2� 5 . 0 � -2 7 - 9 2
Adverse Determination �
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety& Buildings Division, Owner, Plumber
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�' CHIPPEjrA FLOWAGE
� Dan-Bar Resort ��
(high �ater mark is approximate) � Dan Seibert, owner o '
(distance to tanks is 50'--70' ) iJWl/4 El/4 Sec.l T39N R�i
Town of Hunter -�'�
��--'� Sawyer County `�J �
CS'�
NORTH
*Scale: 1•=40' , unless other-
wise noted. �
*The existing failing sewer
Private interceptor sewer to ,�� �aill be pumped and removed
septic tanks is ex�_stin . and the neta tanks installed
Bar � Rest. in the same spot.
2BR 2BR 2BR � � a� � 19 Bar Stools
CAB. CAB. CAB. y 1250 g• 8 Rest. Seats "All tanks by Skaw Precast.
1000 g• 1 Emp10.+ee =Soil Boring
�10' � �OGO g. /
� =B.M.(nail in oak tree,l2")
' ell (above grade; tree isj
(10' from edge of blacl
toP)
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2" F.M. o
�75' O �i U
P �
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RIVEwAY � This area to remain � � � � =o Z
D � UNDISTURBED. i Y � 7 ,es a
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CJ'L" o�F�owage Road �
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