HomeMy WebLinkAbout002-145-12-1200-LUP-1991-030 Application Eor Land Use FermiC x �
County of Sawyer y _
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The undersigned hereby makes application for a I.and Use Permit and ayrees
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tliat all work sliall be done in accordance witli the requirements of tlie Sawyer M
County 2oning Ordinance and the laws and regulations of the State of Wisconsin.
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�Owner Builder �
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�alling ac res mailing address O
ity, ta e, zir city, state, zir
Building Land Use Zone District (�'4�. `
(w New ( ) Filling � s
O Addition O Dredging Lot size 2..,(�� X ? �Q n �
( ) Alteration ( ) Grading --� in ti
( ) Moving on ( ) Acres Z�
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New Construction � ' � Q
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Size �_ fC wide ft wide
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Floot area 7dC�J sq ft sq ft
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Total hgt � to peak to peak x'
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Stories �
No. oE bedrooms —�' rear lot line or waterline
(year round) or (scasonal) � ��, �
Type of bldg or addition � � , � N �
( ) Dwelling i. ��jD � �y �
( ) Garage (1) (2) car � I � a S'
(vM'Storage building i � � C n
( ) [3oatl�ouse �� ! ��/'�"��� � N
O Livingroom � i G� � j � 7 I
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Sanitary Pecmit '77_J�J_ o -
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� � State and County State Permit # 20�26 _
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� Permit Application County Permit # --�1�—
for Private Domestic Sewage Systems County Saw,yer _ _
csT 7-058
*DENOTES STATE APPROVAL REQUIRED
Date Approval Receivecl from State if Required State Plan I.D. ,#
A. OWNER OF PROPERTY Norbert G . F�uard Mailing Address: ROUte 2 BOX 286
A 1 � � � �
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�Lois�.�3�u�.`t' �:�. • I-� l) 4� �•.'_-� ``- � =-- 1'� � l� t') bC' l� ; a�`I- �'t '.z
B. LOCATION: _ Y4 '/4, Section ' �`� , T N, R `",i� � (ar) Lot# _ �City _ __
Subdivision Name, nearest road, lake or landmark Blk# Village
�..07 • L(c> "µ��„ � • y���y c�_• :� �,~,( tq Township �-j;��3 �
�� 'VY h �� "�I�N� .� �I�f� l r� ��y5._ .
F,3 tZ�V7
C. TYPE OF ' OCCUPANCY: *Commercial * Industrial_ 'Other (specify) *Variance
Single family _�_ Duplex No. of Bedrooms r 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) �;_j� 3) �_Si_Total Absorb Area � I� sq. ft.
New� Addition Replacement *Fill System __
Seepage Trench: No. Lin . Feet ,`� � Width � Depth__��Tile Depth 4' No. of Trenches _�_
Seepage Bed: Length Width Depth Tile Depth No. of Lines
Seepage Pit: Inside diameter Liquid Depth _ Tile Size _
Percent slope of land �L�3�' = Distance from critical slope _
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 t�ave sized the effluent disposal system from the EH-115 prepared
by the ified Soil Te�ster,,� „� .
NAME iY;�rw�Z,� '� • �-}�sjh]ty�, �� IZ. C.S.T. # ��" � ���� and other information
obtained from =� (owner/builder).
Plumber 's Signature ti.- � ��t '� ` MP/fo4p.R�M.# �74� Phone #���` — � -d � � ____
Plumber's Address t � - " ���
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
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Do Not Write in Space Below - FOR DEPARTMENT USE ONLY
Date of Application ca�� —'� Fees Paid: State 10 0 00 County 1F . 00 Date l� September 19'7'7
Permit Issued��¢$� (date) �-1F -77 Issuing Agent Name Lori Ca rr�,�
Inspection Yes�_�II= �q Septerr�ber I977 Valid# Date Rec'd
1 . county (white copy)�„� �� 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
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Depar::::ent of Zoning and Sanitation ` �
Sawyer County
Inspection Re�crt
Oumer �Git�'�i�� lr �IU/}2CL Address � �. /�,'/�•/+2c� C�JZ�
Description ��T /2 ��k !Z �e c 30 7�ia nr � R :Y ��
Narne of business
Builder Address
Plumber /�U�e�i� �/+/J/+RRE Address �T� �iL1 l��/f/Zo� 4�-Z.
Inspection
([�}�Private ( ) Public Property Sanitary installation
� ellin� Privy
Violation Mobile home Setback - lake
Garage Setback - road
( ) Sanitary ( ) Zoni.ng Setback - lot line
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Discussed with owner ( ) yes � ) no
Discussed with builder I 5 yes S no
Discussed with plumber t j yes j no
Date - � - �
Signature of Officer �,,,,� ,�1z,�1 i