HomeMy WebLinkAbout014-842-21-1109-LUP-1992-386 ` � Application for Land Use Permit �
County of Sawyer �
The undersigned hereby makes application for a Land Use :e�..�i,_.. ac��
�
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- � 1
lations of the State of Wisconsin.
PRINT - USE BLACK INK OR PENCIL + �
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Owner -�i3cle-r cxrc��1,FT �J uRs'�1.i,SF-(e 'j
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Mailing Address Mai�ing Address
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City, tate, Zip City, tate, Zip
B lding Land Use Zone District _�-� r �
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(/�) NPw ( ) Filling rt
( ) Addition ( ) Dredging Lot size m H
( ) Alteration ( ) Grading
( ) Moving On ( ) Acres 3�. 3� �
( ) ( )
New Construction t'r
Size a 0 ft wide ft wide ���
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`T � ft long ft long T
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Floor area �O 5 3 sq ft sq ft fi
rn
Total htg �2-� to peak to peak x
Stories �_ Stories �
No. of Bedrooms � � rear lot line or watetline c�
.o �
(yea�r_�round) or (seasonallS��``� � � cn n
Type of Bldg or Addition � 2 QD� Q' r'
(�Ct, Dwelling moou�� "' °
C• rt
( ) Garage (1) (2) car
( ) Storage Building �'�"� �
( ) Boathouse � I
0
( ) Livingroom �
( ) Bedroom `� -�.
�� 4''' I=-��� � =
( ) Kitchen-Dining ,�.�, �. ` `
( ) Porch - enclosed/roofed � �`
( ) Deck - open � �
( ) O � ��
( ) � +' �
Type of Construction N �� ���
(� P'rame ( ) Block -- ��.
( ) Log ( ) Concrete -
( ) Pole ( ) Steel r, m
( ) Metal ( ) � �
Construction Cost $ � ���. ' `
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Cer. Soil Test L 5'��^ �
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Sanitary Permit ��j- Q��� ----------CL Road - z '
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�V����� g� Zoni.ng Administra or
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Plb 67 State and County State Permit # 132
� % ,� Permit Application County Permit # _���,
�' for Private Domestic Sewage Systems County Sawyer '
�`' ,� CS� ,� _ O S 4-
"DENOTES STATE APPRO�(AL,�°REQUIRED
Date Approval Received from �fState if Required State Plan I.D. #
A. OWNER OF PROPE TY Mailing Address:
.. .
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d � ��-�- • � / > � .� ✓
B. LOCAT . ��_rY��_ Y, , Section , T/�� N, R� � (or) W Lot# ' City _ _
Subdivision Name, nearest road, lake or landmark Blk# Village
3� r�/�c !1�'� '�./� ,ri��*iri �. � TownshiP ,2 �
C. TYPE OF OCCUPANCY: *Commercial "`Industrial *Other (specify) *Variance
Single family _� Duplex No. of Bedrooms_�„ No. of Persons�
D. TYPE OF APPLIANCES: Dishwasher YES _� NO Food Waste Grinder YES�NO # of Bathrooms�
Automatic Washer �YES NO Other (specify)
E. SEPTIC TANK CAPACITY ?'�'� Total gallons No. of tanks _�
"Holding tank capacity Total gallons No. of tanks
New Installation Addition Replacement Prefab Concrete
*Poured in Place _ Steel �x� Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1 ) � 2)� 3) _�Total Absorb Area �sq. ft.
New� Addition Replacement "Fill System
Seepage Trench: No. Lin .� Feet �Width � t Depth Tile Depth No. of Trenches
Seepage Bed: Length �D Width � Depth � Tile Depth �� No. of Lines 2.,
e�
Seepage Pit: Inside diameter Liquid Depth_ Tile Size 1�
Percent slope of land a��/f-]�' Distance from critical slope O .-�
/J/.-�.� 13 �i
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 have sized the eftluent disposal system from the EH-115 prepared
by the Certifie Soil Tester,
NAME � ;��_a�:�� C.S.T. # � J �j/ and other information �
obtained from �— (owner/builder►. �l�i
Plumber 's Signature � C t, MP/MPRSW# ,��; ��.�Phone #,�3�� �3�_
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H6220, including well). �
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)o Not Write ' Space Below - FOR DEPARTMENT USE ONLY
)ate of Application 6 -3-75 Fees Paid: State 1 . 00 Cou y 10 . 00 Date June 3 � 1975
Permit Issued/�e�e�� (date) 6 -3 —�5 Issuing Agent Name — De ll ty
nspection Yes !� No Valid# ate Rec'd
I. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 �
2. state (pink� copy) 4, qlumber (canarv .�opv)
, Lepartment of Zonin� and Sanitation
Sawyer County
Inspection Report
Name of propertY �FI�O,@� �Ot'�p�
�
Description �F -i�rc., �EC, L��T-�z,J—�$�,.�
T
Owner Address
Builder Address
Ma,ster Plumber C�p��� /y,ET�,d�r Address
Inspection
� Private ( ) Public Property Sanitary lnstallation
Dwelling Privy
Violation Mobile home Setback - Lake
Garage Setback - Road
( ) Sanitary ( ) Zoning Setback - Lot line
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�ey
1�
9'
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�TE�t�.( /NssTAc.l,�� �qy Tr��K i�
�Et!'aR�i 1�' E�tT� lSZ4E� — �1u -
��t�$Q o� st-r� 3o/
A'c 1N sp EcT�o�-
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Discussed with Builder � � Yes (�� No
Discussed with Plumber Yes j� No
Date of Inspection �P � 3 ' 7�
Signature of Officer ��,��������
�
�.��1'i�..L.-� C_C:i�-f
DOCUMENT NUMBER AFFIDAVIT `
2 3 1 2 3 6 EXISTING SEPTIC SYSTEM .
ONE AND TWO FAMILY ����0°
Sew�at C'.rnvd'y � /
�ivai tor r�xd tb��dR i
If the existing septic system does meet the minimum re- A D 19y at�otio�
quirements for groundwater and bedrock depths and if it �-�rs�,,,d r.�oni«i ic,vd.�
is functioning, an addition to or replacement of a hab- d ;,,x�.d, a� p�. �m� .
itable structure can be made in most instances without � ��� �����1�- '
updating the existing system. If the existinq system g�
is utilized for the addition, every attempt should be `_ `�
made to locate and reserve an area which is suitable
for a code complying replacement system for when the
system fails. If the addition will substantially in-
crease the wastewater discharge, the existing system RETURN TO
will be replaced with a code complying private sewage Sawyer County Zoning Admin
system. P.O. Box 668
Ha ard WI 54843
Owner(s) Clifford E. and Juanita V. Poppe
. Mailing address Route 3 Box 3412
Hayward WI 54843
Property description Part NE� of the NE� SJ21, T 42N, R SW. Parcel .1.4.
WD Vol 71 PQ 517. 32.30 acres. Town of Lenroot. 014-842-21-1104
Q1ptj (We) Clifford E. and Juanita V. Poppe plan to
( ) Add onto existing dwelling
( ) Add onto existing mobile home
(�(j Replace existing dwelling with new dwelling
( ) Replace existing mobile home
The present private sewage system has been working satisfactorily as far as disposing
of wastes. If the present private sewage system does fail, it will be replaced with
one that is code complying.
.P.,rJL.d+ . ),� �! - �l ^`�f 2
Cli ord E. Poppe date
I � (
�i . � . L/�`. 1✓�` —�G
Juanita V. Poppe date
'��ROOQ�.
Personally came before me this \•,..••� .. �
.�v.. Q.y ?
�,3 day of , 19� 4� �P � U ,n
.i C , �. ;c
t-���� � ., i v o
I�Fi.c�1 �0.CIIC.�.4-C'� '�'. V� ._ .w
Notary Public �� . Q „
� 3 S 1w?C C4 .
—�
E/tJ County, Wisconsin
My Commission is expires -y���9�-
T�—
Existing seotic system - Sanitary Permit 75-029
Date system installed 06-03-75
�p�y� ZA or AZA
�Z — �.�—q3-
date
This instrument was drafted by 1/fl! ^ (3`z � 4(�5
v�ra. �3.7v
Susan M. Earle '"