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HomeMy WebLinkAbout014-941-02-1304-LUP-1992-031 Application for Land Use Permit y County of Sawyer � o � The undersigned hereby makes application for a Land Use Permit and � agrees that all work sha11 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 BLACK INK OR PENCIL � N\�r� E � �� �o�.����r�s � Owne � Builder ���s.� � y.3�� �0�.3 � Mailing Address Mai ing Address ����\�� ����.��,`��i �0.����.���� . Sv.�`\3 �■� City, tate, ip City, tate, ip Building Land Use Zone District �`L � r' � ( ) New ( ) Filling � rt �9, Addition O Dredging Lot size )287 x 1'3Z�i ' �n n ( ) Alteration ( ) Grading O Moving On O Acres yQ �`�,C)7 ( ) ( ) New Construction 2 t�lD STb�� �1 Size � ft wide ft wide � ft long ft long Floor area �3�- sq ft sq ft m Total htg 14, to peak to peak x Stories Stories No. of Bedrooms _ — rear lot line or waterline o (year round) or (seasonal) I ?1)' G r�-r Type of Bldg or Addition � r' f ) Dwelling a o ( ) Garage (1) (2) car r. ( ) Storage Building I �' r• ( ) Boathouse � (� Livingroom ij�l Bedroom �\����v.o� �"� -� .n (�1 Kitchen-Dining — U ( ) Porch - enclosed/roofed � '� ( ) Deck - open � ��Q� r\ � �' _. � ) . �. hv — r 2y , � � Type of Const�uction p_ �, � ( ) Frame ( ) Block (� � � (�c) Log ( ) Concrete � �_ _. ( ) Po1e ( ) Steel -' � _T ( ) Meta1 ( ) 7;-_._ -3�2 �'� , � � �2� Construction Cost $���C�, ---�' e�� �pf Vo1 ���+� Pg ��/3 of deed �$� � �E-, _r.�,� . H cs Vol � — Pg -" � � ' K Cer. Soil Test �q' t � m �i W� � �1L �2b�ard�---Y'_-4�------ ~ �� Sanitary Permit `'�': - ��C!`7 --'�`y�1 I z o z z Issued Z,'�j 111{�'��\ ���2 Denied •{N _� ( I ��t' � K�UT�r £ Owner Zoning Admi_nistr tor OF LENRQOT � TWP. 41 N. R.9 �!1/. 35 36 i .5. 1 . � \ � �� .2.1 .I.I .2.2 � �L vJ k � ' � .3.1 � .4.1 J W � � � 14.1 ,13,� .I�.I .t6.t h r�".'`,z ; . �.� REPLACEMENT DRAINFIELD ONLY I � U �` 10312 L � � � State and County State Permit # g��ggX _ � Permit Application County Permit # � coU�c awyer , for Private Domestic Sewage Systems Y ' DENOTES STATE APPROVAL REQUIRED CST 80 - 299 Date Approval Received from State if Required State Plan I .D. # A. OWNER OF PROPERTY Mailiny Address: �i�7[.T�� �YTCNE�.Sv/�/ �'T. 3� /�AYy1/pitd, k//. 54 8 ¢ 3 B. LOCATION : �Y4 N� Y4 , Section �2 , T N , R � (or) W Lot # City Subdivision Name, nearest road, lake or landmark Blk # Village Township C�Y/�AOT C. TYPE OF OCCUPANCY : "Commercial "` Industrial `Other (specify) * Variance Single family X Duplex No. of Bedrooms .3 No. of Persons L SEPTIC TANK CAPACITY Total gallons No. of tanks EXISTING 990 GALLON HOLDING TANK CAPACITY Total gallons No. of tanks SEPTIC TANK Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E, EFFLUENT DISPOSAL SYSTEM : Percolation Rate �� Total Absorb Area �g� sq. ft. New Replacement X Alternate (Specify) Seepage Trench : No. of Lineal Ft. V�(idth Depth Tile depth (top) No. of Trenches Seepage Bed : X Length SL � Width �� Depth��Tile depth (top)�No. of Lines �' Seepage Pit: Inside diame1te Liquid Depth No. of Seepage Pits Percent slope of land �% Distance from critical slope WATER SUPPLY: Private � Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I , the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I fiave sized the efftuent disposal system from the EH- 115 prepared by the Certified Soil Tester, NAME /qRNOL� CiqtZLSG/1� C.S.T. # ���'�GS and other information obtained from i7j� �/L�S (owner/builder) . Plumber 's Signature Mp�gZg�# 393� Phone # L3 ¢- 875�► Plumber's �`.ddress 1' PLAN V I EW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. 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S .�..,__-!.,_ ,. ._.. __� . �_ ��_._... y.., . . ,.... ...._ � .�, . . , .A ..r_ _. . ,_;... .__� .� ,. _ '__..k_ ._.. ., . . �� _ . �_. ,_�.,. -�—'�-_ � ' i ( ) ; I ; ; ; � i , , t � j � ; r ; , . , ; , ___._ ._ __._ e _.. _� m.._ n-. �_� , � ___ „ __ �_ _ , � . � -� � ._. � . .__ � ---� _r-=_ : � , � �� t � �.� f . t i �. i i i 4 � � ._._1_.__�. . _; . . ...4__ �_ _ . , - � _" � _.. . _.a_..�. � __A_— -_„ i-- � � i _ -, �._.,.�_ ._ f __ .. � _ . _a_ .__� ._.d. � . } _.��. . � } � . � � f ` � ' � ` � � , , . , : _ ,_ _ ; ; Do Not rite in Space Below - FOR COUNTY AND STATE DEPARTMENT USE ONLY Da e of plication 10 - 30 - 80 Fees Paid: State 14 . 00 County 36 . 00 Date 30 O �tober 1980 Permit Issued/�t� (date) 10 - 30 - 80 issuing Agent Name Elaine Ne�1T11I1g Inspection Yes No State Valid# Date Rec'd 1 . county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4 . olumber Icanary co�v1 - ' '- ' . , Department of Zoning and Sanitation Sawyer County 0 Znspection Report � � Owner Mary �, Walter Eytcheson � w Address Route 3 Hayward, WI 54843 � � Name of business � rn Builder �+ � � Address � � 0 Plumber Andry Rasmussen � Address P.O. Bx. 66 Cable, WI 54821 Inspection H ( � Private ( � Public Property Sanitary-instal � � Dwelling Setback - lake Violation Mobile HM Setback - �road o Garage Setback lot 1in H' ( ) Sanitary ( ) Zoning Privy r c� � ---- --- ,� �;�c �'a� bj o t-� . o � r+ � F-d � � K � � 1�,�- m � ��j.��'1oe` ��d�`�Tln�� lo/sa �r�7 `�r��a��c N � � jo`{:�si �K.tSr,r�G �,��, f�1N, 30 `fr �,, _,�5�NV�- �, '�`�' tzri � , F��� $F��� ���; �� Q� ��� � "�� � m c-r n � ¢ N• � �f'/L�� � � �v�y u��r �� N 1�' o j � � y E � .p N Discussed ti,rith owner yes no � Discussed with builder yes no Discussed with plumber p� yes no Discussed with , yes no � I)ate —_ r� r���7- �G' Signature of Officer o��-�'�o.✓,,, �,�i.�_