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HomeMy WebLinkAbout002-940-14-2201-LUP-1991-260 s Application for Land Use Permit F3 , County of Sawyer o _ The undersigned hereby makes application for a Land Use Permit and � agrees that a11 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 BLACR INK OR PENCIL � � l�reqor�l �.-. � .Tan�� �. Cc� �I-r ` � Own� Builder (z12� �..>cK Z�35 Mailing Address Mailing Address � a�;,:ard w� 5�}�s43 Cit , State, Zip City, State, Zip � Building Land Use Zone District �`��-� r � (� New ( ) Filling � rt O Addition O Dredging Lot size � n ( ) Alteration ( ) Grading " m ( ) Moving On ( ) Acres ��..� � � c � n New Construction Size � ft wide ft wide p G�;� ft long ft long m Floor area lZurO sq ft sq ft � td Total htg Z 3 �+ to peak to peak x Stories j %y Stories r No. of Bedrooms C% rear 1oL line or waterline c� 0 (year round) or (seasonal) �--�3 0 -> �, rt G Type of Bldg or Addition a o ( ) Dwelling ' C• rr (� Garage (� 2 car ( ) Storage Buil ing ~ ( ) Boathouse ���ti �� ( ) Livingroom �, � - ( ) Bedroom ��� I � ( ) Kitchen-Dining �P j ; p ( ) Porch - enclosed/roofed '1�2/ � pj � ( ) Deck - open �o � � 1 )� ��S '° G —��� � r� ( ) �---- -7�-- � ;_, Type of Construction � � � � £X � ', � � (✓} Frame ( ) Block �9'`r' � o �r� ( ) Log ( ) Concrete tio , - � � t ( ) Po1e ( ) Steel � - � ,���°` � .� �j � ( ) Metal ( ) _ � � Construction Cost $���'��aa = � � • Vo1 ��' Pg � of deed �� ����� � a8t� CS Vol Pg ro � w n Cer. Soil Test 7�-<a-�'�. _ � _ � ._ Sanitary Permit -7q•O Q�O ----------CL Road --------------- z - ����_ i,�._i� �� � o • z z Issued �g �pV�R- I�IqI Denied , _ .R_ m Z e �c�� ��� � � F�'�� Owner Zoning Administrator �� � � TOVI�N OF BASS LAKE SEC. 14 TWP 40 N. R . 9 W. ADINA � �AKE .6.1 .5.2 .2.1 .I.I MURRY .6.2 .5.i LAKE .4.2 .s,z WILLIAMS LAKE � 2 ILLIAMS ROAD .7.I .8.I 4.3 4. I s.i ISLAND LAKE ` . P TP � V' �p State and County State Permit # 5101 __ ■ � � � � � Permit Application County Permit —�- �� for Private Domestic Sewage Systems County �awyez'_ . 'DENOTES STATE APPRO`✓AL REQUIRED CST 8 - 29 � Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: . ,, _�-, �� _-� '7 ' � . r -7� }� � r 1�-JC���YI �' � / / L f�� ��"� B. LOCATION: �'1'' Y4 ;�� Y4, Section f /�. , T_�vl�l, R� � or) W Lot# City _ �.:�7 � Subdivision Name, nearest road, lake or landmark Blk# Village . Township � L�� ~ n 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 -�TTotal gallons No. of tanks *Holding tank capacity Total gallons No. of tanks New Installation Addition _ Replacement _ Prefab Concrete *Poured in Pla.^.e� Steel > Other (specify) _ —�� F. EFFLUENT t�ISPOSAL SYSTEM: Per ation Rate 1 ) f� 2) f,� 3) otal Absorb Area �/ ._ sq. ft. IVew Additien Replacement *Fill S�ystem � See ge Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length � (r Width� Depth �'_ Tile Depth .� No. of Lines �_ Seepage Pit: Inside diameter Liquid Depth Tile Size _ Percent slope of land� ,' �:y Distance from critical slo 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 siied the effluent disposal system from the EH-115 prepared by the Ce fie oil ester ]�j M NAME � r Q� � /S � �� C.S.T. #��� �and other information obtained from (owner/builder). Plumber 's Signature ' -� ^ ' _� _.., � p/ry�p.{�ay,.# - Phone # � �� �--�� �C� / Plumber's Address �� � " ~ PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H6220, including well). ,-- � ... . . . . V ��,,, I'� '� � .. . . .. . . . � �_ Jy^ � _ ` '' �( �l�'22 � / r ' ` 1 � ' - - � �/ � 2-� -- -- �- }-- . : , �� � " �� �1 .� ,a� � 4 I '�. . �.., _ _. . �. . . �. .. ... . . .. . ...��✓ ' S ! . . . .. � . .. .. / !.__. ... . . . ! , ". , ` !�, E� �� / ' . � . _ ; �-� �� �' , �J . . .. - ' ,�. � �ZG; ' '�..� : . - - _ _ � � � .--- � t� ` � � _ \ � ` ��'' �?'/� , i .. 4 i. _ _ ��� � �� �/ '�� _ , � r � _�� _ , ; . . _ , ,__ j _ 1v � .� Z. ,. � �� _�% � ; , ; � ---�- � _ . ___ ., - .-- . � �_ _.__ � _ ' ! ' ' ' { � � , , i , � : • ,. __ . , _..,. _ A ' _ _.. ; -_ f - --- - -.......1 _i_ _ _ , -�-- +- :.... � _�j. _ . ._. . .... , i � , `�/ , ` � ' I ( � � _ ' _ '---. ( - � - { � �...... ' - � i _G -�__ _ � _a.__--� -- — `_. --- �- -±._._.. _ _.___ ;... . i ` T , � � � , ( � i � , i ; � i � � � . � , i , _r� ��l_ _.--t :_.... �_ -;.. _. _; ._._.._.� -- — � - -_ i _ __ ; _. {_ _ , .. �� �.. �. i . � ; , �� �� �� ' . , , ' 7 '. _ -� , ! � _ i . � I ' � � � � � � i � ' � � ! ,. '� ------�--+ ._ �. --- . — , _— ., _. .__._._�_ _ ---- - - � - - ; � _, , .:, _� . ,_ � 1 __ , � r � ' � , � � ; ' j ; , , , , _;___ . � .._._� .._:_. !___i_� �__ �1...— L�_ ._ . _ — - _ ; - -__ �. �- i . � _. � _t_.._.�i : i i , �-� _._ .r . r -�. � I , � � � I � i � ` ' � � � - -*.____., � {__.. .� :- �� .�;_—�— �.__ :_�._�. �__. . �..�-� �- �--�� ...I.._-}_____t__... . / . .._ _ �,'_ � . � , . . . ,, ,. --- � ,, ��' . '... . . . ', , �.. i . I ' , �,� � � . . � ' _ _ __I.. "_ '_ . . . . ".�..� . � '. , i. . . ; .. _ ' ."_.:..._. . '. __ . . . . , � � ; , . Do Not Write in Space Below - FOR DEPARTMENT USE ONLY 15 . 00 29 June 1979 Date of Applicatior� 6 ' 2 9 - � `� Fees Paid: State 10 . 0 0 County Date Permit Issued/F���t�cl (date) 6 - Z9 - � 9 _Issuing Agent Name Elaine Nehrling Inspection Yes ,�• No _ __ 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. plumber (canary copy) . RPvised Date 6/1/76 Department of Zonin� and Sanitation Sawyer County � E � Inspection Report y Owner 3rent R. Aukema Address P.C. Box 587 Hayward, WI 54843 Tdame of bus�_r.ess Builder Address Plumber LaVern llennis �lddrees Vvinte: , 1VI 54896 Inspect.i_on r N (�1O Private ( ) Public Property �' Sani_tary-instal � � Dwellin� �etback -. lake �Tiolation Mobile Hm Setba.ck road °, Gara�e Setback-lot li_ne ( � aanit�,ry ( � Zoning pr;_vy w w ___...." '_ N N � 1 N C� IL� �'ENT � x' m �o!.D — =?loo'—�----y 3 h , �`�� w G�� _ P t,— _5�.,. �w��K � � s i-a r�r �% � I JV I� S/��/Y��- rl� ������I. � z I--� G i I� 4\ FI� � �'W�11lN& � � � m a m i � � I T � � �n � i � I ti. � � � I >���' i - I � y I � � --- V �. �Jf/.Llt?MS R D o D�scussed ?•�i_th own�r yes no � Discussed wi.th Builder yes no D�_scussed with plumber yes no I `D � ];_scussed wi.th yes no I DaLe ��_.���� 'ignatizie �f Officer �/��'�. �� a�. _��r.c-11_—------------- �