HomeMy WebLinkAbout002-169-09-1700-LUP-1991-145 Application for Land Use Permit
County of Sawyer ��
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The undersigned hereby makes application for a Land Use Permit and - h�
agrees that all work shall be done in compliance with the require- c
ments of the Sawyer County Zoning Ordinance and the laws and regu- � `
lations of the State of Wisconsin. '
PRINT - USE BLACK INK OR PENCIL
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��uER�; C/aR�S onl Er �� �I o SEPly C. n10 r�,eG �
Owner Builder Z, � *
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Mai1ing Address Mai1ing Address
�oREST fAkK /�. C�Dl3o l.,i,tiyrvA�eo, t✓i. Sf�ff�3
City, State, Zip� City, State, Zi'p
Building Land Use Zone District (" — � r �
( ) New ( ) Filling �
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(7q Addition ( ) Dredging Lot size /���p7[ 020�X�o� � n
lT9 Alteration ( ) Grading
( ) Moving On ( ) Acres ,�Oo /a
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New Construction � � � '
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Size _� ft wide ft wide � � � � ��
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� ft long ft long � �"�
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Floor area o�`�Q sq ft sq ft o ;. O
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Total htg /(��/ to peak to peak � '
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Stories � Stories y �
No. of Bedrooms rear lot line or waterline c�
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(year round or (seasonal) �G,�,' C
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Type o dg or Additio o' r
( ) Dwelling p; rt
( ) Garage (1) (2) car g c
( ) Storage Building m, m�
( ) Boathouse ' r'
( ) Livingroom ' � �
(XJ Bedrootn� h) a'
( ) Kitchen-Dining r'�
( ) Porch - enclosed/roofed >
( ) Deck - open �
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( ) � ��.
Type of Construction ' � �� I
(Kj Frame ( ) Block � �
( ) Log ( ) Concrete (� •�b `�
( ) Pole ( ) Steel �
( ) Metal ( ) _ _ � �- > �/U'�a � Q�
Construction Cost $ 00.00 �,c '1 � � �
P K�; 4 ��x � . ( �
,�'DVol :.�:``' pg .' �" of deed � .�fl �"', ,�� i�� , j IO
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CS Vol �L A�1 P�-r : �:, � r y.,, _ r ._?�r� � y
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Cer. Soil Test 7S 3(2S , '�
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Sanitary Permit 7S_�3y CL Road � ~' Q
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�t A.�.�aa�jt S �_I,wrk c��i 1491 �ovivrY N4w; /t R� ° z
Issued 23 July 1991 Denied g S, �
C U Q.QE'lUT V/}G U Cj OL� STIZ uG�LG/C�� /�U
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DOCUMENT NUMBER APFIUAVIT —�
EXIS'PING SEPTIC SYSTEDI
2� 3U01
ONE AND TWO FAMILY qeyy��q� 1
Sew9x C.',rnmh �
If the existing septic system does meet the n�inimum re- � �o* �eco+d th ��dn� d
quirements for groundwater and bedreck depths and if it A C 19� et3'38'Joo1
is functioning, an addition to or replacement of a hab- M un�'. r�vorded i� �ol.��
itable structure can be made in most instances without d �'��a �n aase /3� _
updating the existing system. If the existing system �`G� -
is utilized for the addition, every attempt should be i al�a
made to locate and reserve an zrea 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 RE2URN TO
will be replaced with a code complying private sewage l� ' Sawyer County Zoning Admin
system. P.O. Box 668 ,
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Ha ard WI 54843 .3.3
n�;-,,,,-r,� T,�raina Rr�rkPr an�l Rn��nrlv C�rl �nn`
mailing address �ti7626 West Monroe
Forest Pa•rk IL 60130
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Property description Lots 17/19 , Block 9 . Rockford Beach S 90 , T 4f1N, _
R 8W. Plat Envelope 38 . WD Vol 435 Records Pg 210 .
002-169-09-1700 . Town of Bass Lake .
E�3J (we) Loraine Becker and Ravarl �r.arl �on plan to
(� Add onto existing dwelling
( ) Add onto existing mobile home
( ) Replace existing dwelling
( ) Replace existing mobile home
The present private sewage system has been working satisfactorily as far as disposinq
of wastes. If the present private sewage system does fail, it will be replaced with
one that is code comolvina.
� � 6 ��� � �► t
Loraine Becker date
� ' � � �- � r- y�
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Beverly Carlson date
Personally came before me this
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_day of ��L{� , 19 � �
�L�lr.�L�, � �A� ��'/!/1 �l/
,,.����������� ,, Notary PLlbl].0
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,���_""�'Yl•!�t `(/ County, Wisccnsin
� , '-�' wc 1� 1081.
- - Mp Cti:n[nis�:ibn is expires ��� � �
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�� L*�t2�sCl�ng septic system - Sanitary Permit _ 75-234 .
Date system installed 12-04-75
�l[�c�/ f�� ZA or AZA
� David Heath
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date
This instrument was drafted by
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� Beverly Carlson `V�L q. �i "� p� 13 0
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SAWYER COUNTY ZONING ADNIINISTRATION '
INSPECTION REPORT
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Owner Loraine Becker and Beverly Carlson^ _ �
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Address ''�626 West Monroe Forest Park, Illinois 60130 �„
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Name of Business
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Builder Joseph Notaro c
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Address Route 2 Box 2060A Hayward, WI 54843 ,.�
P lumb er ' ,_.�.3
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Address
Inspection ( ) Property ( ) Setback - lake
( ) Dwelling ( ) Setback - road
( � Private ( ) Public ( ) Mobile Hm ( ) Setbacic - lot line r, y
( ) Garage (�) �4�e�u,e. �ro�-d
Violation --� � �
( ) Addition ( ) s.�i-bQcl'. - 4dd,4-�h .-. �
( ) Sanitary ( ) Zoning v o
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C-1 V 435 P 210 . Plat Env. 3�3 .30 �cr�s
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Discussed with owner ( ) � ,�
Discussed with builder ('� ;_._, `
Discuseed with � �
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Pib 67 State and County State Permit # 2�796 �
Permit Appiication County Permit # ��1� �
for Private Domestic Sewage Systems County '��=�- ��='�- - -
"DENOTES STATE APPROVAL REQUIRED 4�� `� ��'�
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROP RTY Mailing Address:
��l �,F` ,
4'�//./_�._ i_� �:o� �T ,� /�.�Yl�• ���"il !� �� S�; � �J`��¢
B. LOCATION: Y4�'Z�Y4, Section�-;�_, T=-�, N, R��/ (or) W Lot#�'i ���C�ty_
Su division Name, `� nearest road, lake or landmark Blk# j Village
� � Township '� l�;%
�/Cs C�C.i7 .��Jd��!
C. TYPE OF OCCUPAJ�I2Y: "Comipercial *Industrial *Other (specify) *Variance_
Single family ;� Duplex No. of Bedrooms L No. of Persons ]i
D. TYPE OF APPLIANCE Dishwasher ��:YES NO Food Waste Grinder ��YES_NO # of Bathrooms -!
Automatic Washer �YES NO Orther (specify)
,
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E. SEPTIC TANK CAPACITY j_��' t' Total gallons No. of tanks �
*Holding tank capacity if Total gallons No. of tank�s �
New Installation Additi4n Replacement � Prefab Concrete
1 —
*Poured in Place Steel � 1 Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolatio . Rate 1) ��_� 2) , �" 3) •_f Total Absorb Area j'7� ' sq. ft.
New Addition Replacement � *Fill System __
Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches_
Seepage Bed: Length �S Width s7� Depth s�:r Tile Depth ✓% No. of Lines `��_
Seepage Pit: Inside diameter Liquid Depth Tile Size �
Percent slope of land fN�%� 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 Fiave sized the effluent disposal system from the EH-115 prepared
by the Certifi�d Soil Teste�,
NAM E � <>>a,� i 1 � � C� _�' C.S.T. # `�>�" "���" and other information
obtained from �'�i i� ��— (owner/builder).
Plumber's Si nature � � ^!�,_ MP/MPRSW# �j��> �-= � ' Phone # ✓`��s - ;��{-/
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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 11-24-75 Fees Paid: State .1.�0 County 1.�.�� �ate November 2�, 1975
Permit IssuedA�}�f�d (date) 11-2�-`T5 Issuing Agent Name Robyn Kephart - Deputy
Inspection Yes No „� Valid# Date Rec'd
..? l 4'. -�\.�_��/ �t�� ��� �+�/
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink COQ4') 4. plumber (cznary copy)