HomeMy WebLinkAbout002-840-28-5406-LUP-1991-102 Ayplication for Land Use Permit �
County of Sawyer y
o �
7'I�e undersigned hereby makes application for a Land Use Pecmit and ayrees
d
tl�at all work sliall be done in accordance witli the requirements of tlie Sawyer °,
County Zoning Ordinance and the laws and regulations of the State of Wiscrnisin. 1
PRIN'f - USli ONLY 6L71CK INK/P1iNCIL
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Owner Builder �
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mailing address mailing address w `
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(?�t�2do,u�+41.SFZ1-�t�ct3 la�Hf¢- ' V
city, state, zip city, state, zip
Ouilding Land Use Zone District R�j-�
(�() New ( ) Filling � �/
O Addition O Dredging Lot size f�4 y ��ys��r7d s �
( ) nlCeration ( ) Grading —C/ T m n
( ) Moving on ( ) Acres _ ��f,ry
l ) ( )
New Construction ' �,
/
Size � f� wide ft wide
�
ft 7.ong ft long
' Floor area ,�Yj . , sq ft sq ft
� ro
Total I�gt %p to peak to peak x
Stories _�_ �
�L�
Ho. of bedrooms �'-� tw._ t�!!`c a�.`��rline
— '`_�. 7�a.�
(Xear--rflvnd) or (seasofial) j------ -- -ti_�` - —i
Type of bldg or addition � � `~�`"�-�..� i �
( 1 Dwelling � .. ! �� �C
(x) Gaza9e �) (2 caz � i n s
O Storage building � a i G n
( ) �oatl�ouse N � \ i v�i
( ) Livingroom � i oI�
( ) Uedroom � � i �
( ) Kitchen-dining � �
( ) Forch - enclosed/roofed i ,�__ i
i j Deck - open �� j/�} �/ � �
c ) �i 1% � I
/D� ��E�° ti — ;y�/ �
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1'ype of construction i �-- �- ♦ i �w
�) Frame ( ) Block i � 4� I{O' i
( ) i.o9 ( ) Concreke � _ '� � i �
( ) Pole ( ) Steel j �� / i Q»-
�
l ) Metal ( ) � .. ��� .,!. ��a ��"`
� '� i �
construction cost $ 3�.�pe,= � I,r I i n
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Vol �{3�1 Pg_q�� of deed i � i
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csM vol ��j Pg `'�� � � i ro
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Cer. Soil 7'est __%I_ -'✓N3 � i �d
Sanitary Permit _.�� ���� ----`----CL road�-'�--'-"'---'------- 0{�
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Issued 05 J�ti�.. �q�� Denied '��
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owner Zoning Administra or�
SAWYER COUNTY CERTIFIED SURVEY MAP �
Part o£ G.L. 4, Sec. 28, T. 40 `T.•, :i• 8 lJ. �
SIIHV�'YOR'S CiRTIF'ICAT�'
i, LYLL L. �LLICTT, registered land surveyor her=by certi£f that by �he direction of �3II, VI�S, I nave surveyed and mapped
the land �arcet :uhich is renresented by this Certi£ied 3urvey i?ap:
`?^.ze exterior boundaries of the land parcel surveyed and mapped is described as follows:
3 part of Government :.ot !y, Section 29, Township 40 ?Torth, 3ange 3 -,iest, Town of Bass Lake, Co inty of Sasryer, State o£ 'disconsin,
and aore �articularly described as follows:
Co�er.cing at the 3ast Qvarter cox:ier said Section 28, thence `7 99°�0'C1" ';! 2268.00 `eet to the point o£ begiruiing;
thence T.I 89°�0'K1" ',J 1�26.15 feet to +he shore of Lac Court Oreilles; `.hence V 62°�'Iy1" '_' on a meander line of said Lac
Court Oreillea '?4.oly °eet; �hence v ;1°�9'55" � on said meander lir.e 132.?2 feet; therce S 57°jF8'07" ^ (al+9.�1 £eat;
M thence : ��°10'01" ',d 205•89 �eet do the point of beginning, said �arcel contains 8.09 acres more or iess, including
� °, ° � � !3 � �11 land ;_om said meander line to the •.�aters edge, snd subject to any easements or restrictions of �ecord.
00 ° ° � ;
� a���� � I have :ully complied with the provieions of Section 236.jl� o£ the ',Jisconsin _evised Statutes and the
C\2 � ol o � subdivision ordinance of Sawyer County in surveying axid ma,pping same.
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o ¢ ° ' _ ?,. �LI.ZOTT, lG"_and surveyor
° '� ' i� f � 4lisconsin Registration 5-1300
� � °�-i%'✓� � w Date: April 9> >990
w 'q-�"�i j N I hereby certify that this survey is correct
= � u�y�i�! � a N 51�49�55'�E �� to the best of my ?rnowledge and belie£.
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K ..; i�i � . � 1 SCALE I"=200' � 132.72� / SS3,�6 �y��+�iy �
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(` �— `� �i sa. 933 sf. 49 nio r ti y+c� '1 \
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/ a 2H8,556sf. �ev S i3°1001"W 132.13�meo. •��.�� �+U7�'��� ' `-
/ �/�2 6.62 ac. �m l .p,� . i�
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�1 � APPLICATION SAFETY & BUII DiNGS
Yl'EPARTMENT OF � � o�
INDUSTRY, � � FOR SANRARY oivisiorvN
LABOR AND PERMIT P.O. 30X 7969�
' HUMAN RELATIONS (PLB 67) MADISON,WI 53707�
CS7 79 - 3`13
Attach plans for the system on paper not less than 8Y� x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal
and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter
H-63, Wis. Adm. Code, must beshown. An index page or each page must be signed, sealed and dated by the designec If designed by a Master
Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's.copy must be
included.
Elizabeth Jose h Koczka
Prope y Owner: Mailing Address:
�� v : '' �a`� o i'v�. G�'���P ,¢�..v �e�; ���/9 /
Pr erty Loc tion: ' City, Village or Township: County:
��< �/4S o��Y iT � NiR � �-�o�� W � �- ,_% .� ��r w � �.
t NV bec Blk No:: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Nur�bec
�� �� Uf assigned)
TYPE OF UILDING
Number of
❑ Public" ❑ Variance` ❑ Other (specify)` Bedrooms:
� 1 or 2 Family "State Approval Required.
- TOTAL NUMBER PREFAB POURED-IN STEEL FBERGLA55 NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE WSTALLATION MENT ISpecify)
SEPTIC TANK CAPACITV ,6F
HOIDING TANK CAPACITV
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER: L{/,�
EFFLUENT DISPOSAI SYSTEM
PERCOLATION RATE ABSORPTION AREA �
IMinures per inch): PROPOSED ISquare feetl: � New ❑ Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage� Pit
/ Y� � �/� Alternative (specify) ❑ Seepage Tn�nch
Water Supply: Owner's Name as Listed on Soil Test Report (If other than present ownerl: -
Private ❑ Joint ❑ Pubiic , �y vC- '�
I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached pians.
Name of Plumber. � Signature: MP/R7PRS�VNo.: Phone Number:
� I`�'s Y/.�I`� .�/' �.��-<,- �i . i . 9� 3�.�y�� y�
Plum6er's Addresr ' Nam Designer:
/4 � .S � �t-cC/
COUNTY/DEPARTMENT USE ONLY CST 79- 343
Signa e f Issuin A Fee: Date: � qppROVED Sanitary Permit Numb�r.
$60 . 00 8- 30- 82 ❑ DISAPPROVED 29500
Reason far Disap r val:
Alternate course�s) of Action Available:
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) m be submitted to the couniy prior to in-
stallation. Failure to comply will void the sanitary permit.
DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
DILHR-SBD-6398 (R.07/87)
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING;
LABOR & HUMAN RELATIONS pRIVATE SEWAGE SYSTEMS DIVISIOf
P.O. BOX 7969 BUREAU OF PLUMBIN(
MADISON, WI 53707
�.CONVENTIONAL ❑ ALTERNATIVE S�atePlanl.D. Number:
111 assigned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER ADDRESS OF PERMIT HOLDER�. INSPECTION DATE:
ocz S�5 3 �o� p�t� v� oz�a n � Cc I �' 31 ,9uG 82 �; �l5 a.�
BENCH MARK IPe�manent releren�e Do�nt) DESCRBE IF DIFFERENT FROM P�AN REf. PT. ELEV.: CST REF. PT. ELEV
5 � Co2n��n� � fi gRSk�1t� T T� P �F al.ock�, � 00
Namc nl Plurnber MP/MPRSW Nn Couniy $aniiary Peimii Number:
� , 1�CTC��F. �awY�-�' � �l�SOe�
SEPTIC TANK/HO�DING TANK:
MANUFACTURER. LIQUID CAPACITV. TANK INLET ELEV.. TANK OUTLET ELEV. WARNING lABEL LOCKING COVER
I UOO �IEJ(�1� / OO� PROVIDED PROVIDED
I$YES ❑NO ❑YES ❑NO
BEDDWG. vENT UTA. vENT MATL. HIGM yyn7FR NUMBER OF ROAD: PROPERTV WELL: BUILDING�. IVENT TO FfiESH
ALAFM FEET FROM LINE�. 1 AIR INIET�.
❑YES ❑ NO ❑YES ❑ NO NEAREST �Nk ��
DOSING CHAMBER:
MANUFnCTURF�4 BEDDING LI(IUID CAPnCITv PUMV MODEL PUMPiSIPHON MANUFl1CTUREN WARNING LABEL LOCKING COVER
PROVIDED�. PROVIDED:
❑YES ❑NO ❑YES ❑ NO ❑YES ❑ NO
GALLONSPERCYCLE: CUMPANDCONTROLSOPERATIONAL NUMBEROF PR�PERry WELI BUILDING IVENTTOFRESF
(DIFFERENCE BETWEEN FEET FROM ��NE AiR iN�Er
PUMP ON AND OFF) ❑YES ❑ NO NEAREST
SOIL ABSORPTION SYSTEM. Check thesoil moisture at the depth of plowing FORCE LF���sT�� °i"^'Ere�+ n�nreaia� nrvo nnnaKirvc
or excavation. (If soil can be rolled into a wire, construction shali cease until MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
IVIUTH LENGTH NO. OF DISTR. PIPE SPACING COVEH INSIUE DIl1 �PITS�. LI�UID
BED/TRENCH � THENCHEs / tiin�€a�n�: P�T oerrr+
DIMENSIONS p2o 3 y (j c�TIPAI�I
GfiAVE L DEPTH FILL OEPTH UISTH. PIPF DISTR. PIFE DISTR PIPF. MATERIAL NO. DISTR NUMBER OF PROPERTV WELL�. BUILDING: VENT TO FRESh
HFI_OW PIFfS„ AHUV�E/COVER FI FV INLf 1 ELE�/ END PIPES FEET FROM `WE� AIR INLET�.
(� 7U 93 P�G Y NEAREST-s lb , �N'� �/ 7 7s
MOUND SYSTEM:
Mound site plowed perpendicular to slope �heck the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
❑YES ❑ NO
SOIL COVER �E%TURE PEFMANENTMARKEHS 085EHVATION WELLS
❑YES ❑NO ❑YES ❑NO
UE ['T11 f)VFH iNENC�I BED DFPTH OVf H THENCH,BEU UEVTN OF TOPSOIL SnDDEU SEEOED MUICHED
CEfvTEH ED(;ES
❑YES ❑NO ❑ YES ❑ NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIUIH LENGTH NO. OF LniENALSPI�CWG GHr1vELUFVIHtlELOWPIPE FILLDEPTFIA80VECOVEVi
BED/TRENCH raerva+es
DIMENSIONS .
n;1nfVIF OLU PUMP MAMFOLU DISTFR PIPE MAMFOLD MATEHIAL NO UISTH DISTR. PIPE DISTHIBUTION PIPE MATERI�L & MAHKING
ELEV ELEV DIA E�EV. PIPES OIA.:
ELEVATION AND
DISTRIBUTION
INFORMATION H�LE SIZE HOLE SPACWG DFILLEDCnHREC1LV COVER MATEHIAL pLqNSCAI LIFT CORRESPONDS TO �PPROVED
❑ YES ❑NO ❑YES ❑NO
COMMENTS: PERMANENT MARKERS: OBSEFVATION WELLS�. NUMBER OF PROPERTY WELL: BUILDING
FEET FROM ��"E
❑ YES ❑ NO ❑YES ❑ NO NEAREST _
C� O(,L�.n �(C� T �UGp T"� (.(>ELL , CC�G�-� I� � E /NSiO� (ju , Ll» �I (,,',
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATUH TITLE
DILHR SBD 6710 (R. 01 /82) � ��� ��GYL�/1/ � ���'
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