HomeMy WebLinkAbout002-133-02-1600-LUP-1991-261 Application for Land Use Permit
- County of Sawyer o y�
The undersigned hereby makes application for a Land Use Permit and � ��
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- � �
lations of the State of Wisconsin.
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Building Land Use Zone District _�R-a r �
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( ) Alteration ( ) Grading �
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New Construction '-t-
Size �N ft wide ft wide
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Floor area // D � sq ft sq ft �
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No. of Bedrooms rea�-iot-line or waterline c�
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Type of Bldg or Addition 'I` o' r
( ) Dwelling ,, °: ,°Y
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(�Storage D g � � �
( ) Boathouse x
( ) Livingroom _ .iW/��m e �_�; . �
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� P L B 6 � � State and County State Permit # 18908 --
� Permit Application County Permit # _8"'151-
for Private Domestic Sewage Systems County Sawyer _
CST 7 -115
"DENOTES ST,ATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan t .D. #
A. OWNER OF PROPERTY philip J . Allemani Mailing Address: P . O . Box 391
� �
� � � Minong , WI 54859
B. LOCATION : "----V4-----�6 , Section � , � N, R � E (or) W Lot# __City _
Subdivision Name, GOV't L 1 nearest road, lake or landmark Blk# Village
, / c. Townshi�'„d �' � ,� y��X,�
C. Y E OF CCU ANCY�o mer�t�1 L-C� ustnal f �L'2� *__���� * _
(specify) Variance
Single family _ �� Duplex No. of Bedrooms '� No. of Persons Z--
D. TYPE OF APPLIANCES: Dishwasher YES �_ NO Food Waste Grinder YES NO # of Bathroom�
Automatic Washer YES �IVO Other (specify)
E. SEPTIC TANK �APACITY � - � Total gallons No. of tanks l
*Holding tank capacity _ Totzl gallons No. of tanks
New Installation _�_Addition _ Replacement _ Prefab Concrete _
*Poured in Place Steel Other (specify) __
F. EFFLUENT DISPOSAL SYSTEM : Perc ation Rate 1 ) � 2) � 3) Total Absorb Area ! sq. ft.
New Addition Replacement " Fill System
Seepage Trench: No. Lin . Feet �g � Width �_ Depth ��Tile Depth ,� / No. of Trenches _�
Seepage Bed: Length Width Depth Tile epth No. of Lines _�
Seepage Pit: inside diameter Liquid Depth Tile Size �1- _
Percent slope of land Distance from critical slope
I , the undersigned, d� hereby certify that the information � have reported is in accord with Section H62.20,
Wisconsin Adminisirative Code, and that I fiave sized the effluent disposal system from the EH-115 prepared
by the Certifi S i_ Tester *
NAME � �_�� C.S.T. # -j� L}' � `j and other information
obtained rom _ �-- �
. (owner/builder).
Plumber 's Signature �Aq,R.�-# ����-�4� Phone # ����/
Flumber's Address � � — C
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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) . �j�
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Do Noi Write in Space Below - FOR DEPARTMENT USE ONLY
Date of Application 9-15 -78 Fees Paid: State 10 . 00 County 15 . 00 Date 1S Sen mh _r 197A
Permit Issued �Ai�� (date} _Issuing Agent Name F. 1 ai nP M _ NPhrl i nd� ,.r
Inspection Yes�No _ Valid# Date Rec'd
1 . county (white��) 3. owner (green copy) QIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
� crate loink coov) 4. plumber (canary . copy) , , , _ � , , � . ,, ,� ,�,,
Department of Zoning and Sanitation o
Sawyer County �
. �
�s
Inspection Report
ro H
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Owner _Irene G. & Philip J �llemani � �
Address P.O. Box 391 Minong , Wisconsin 54859 4 u�
Name of business y
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Builder ~
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Addre;, o
— �.
Plumber I,aVern Dennis
AddP2sS __ ;�inter. Wisconsin 54896
H
Inspection. o
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(�O Pri���te ( ) public Property Sanitary--instal °,
� � Dwelling Setback - lake
Violation Mobile Hm Setback - road
Garage Setback-lot line �
( ) Sanitary ( ) Zonin� Privy N
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IMS�'Faon cond�c+t�� nO �e e "`� �o�...�-Vtl)
Discussed with owner yes no�y�u ���0 �
Discussed w9.�h builder yes no Sab ca�-PI��� �'0P`�'�� f�
Discussed wi�h plumber yes no q.15-�$ `
Disc�assed with yes no �'''"" _ I
Date �1 ��- '�Yj
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Signature of Officer (�