HomeMy WebLinkAbout002-940-14-4201-LUP-1991-277 `�
1lpplication for Land Use Permit
County of Sawyer ,a �
0
1'lie undersiyned hereby makes application for a I,and Use PermiL- ancl ��qrees �
that all work shall be done in accordance with tt�e requirements of the Sawyer � �
County Zoning Ordinance and the laws and regulations of the State of Wisc�nsin.
PRIN'f - U5E ONLY 13L71CK 1NK/['litJCIL
v � c-.�-t�. k , a-r.��
�o�n_Y.i���t �''S7P r Sl1Na(.Q � ! aN� fptvS7l()C�� �N 5
Owner Builder Q _ �
�+-a �oX a Y3o,� �� � �_
mailing address maili.ng address
�ta)"`�(JUr� w-L' �y�y`� �v y,.�/a�� l.�- ��/,���
city, state, zip city, state, zip
f3uilding Land Use Zone District �,�,- �
( ) New ( ) I'illing S sq
f�.) 1lddition O Dredg3.ng Lot si.ze �+ �
( ) 111teration ( ) Grading m n
( ) Moviny on ( ) ncres /(� �. 58
( ) l )
New Conslruction '
L
Size p?� fL- wide ft wide
�(p f t long ' f t long
. +
Floor area ��� sq ft sq ft
v� •'
�
Total iigt �Y J to peak to peak x �^
Stories
� ) ,, �
�� t--g�t� �--�\'�
No. oE bedrooms rear lol- line or waL-erline
�
(year round) ur (seasonal} i_ �
'1'ype of bldy or addil-ion i ���� '�-r�'' �-�N�� i �o�,
( ) [�well.iny � I i � �
( ) Garage (1) (2) car � , � �''
i i N• �
( ) Storage buildinq � ' � � �
� ; > � �
( ) Bvatliouse i � �
� � N•
( ) Livingroom i � � �
� [leciroom � I �
i � �
( ) Kitchen-dinin9 i / ' �u � '7 �i �
( ) Porch - enclosed/rooted j -- f�� <�- ---�� a`�`� , �— J �
( ) Deck - open i —�"�r � � �
1�i I , �
( ) i ° � � � �
( ) i i O �
'Pype of construction i � i ( �lp'n•
py ['rame ( ) I31ock "
( ) I,og ( ) Concrete � � ' i � Im
( ) Pole ( ) Steel � � °'"
( ) t•tetal ( ) � i N
i ' i � �
nc
Construction cost $ iU. i � � �
� I
Vol �-52 Fg z� I of deed � � ,�
i i
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Csrt vol _�_ F'9 � (o s i i a
�"�" i i n s�
Cer. Soil `1'est � - �(.vs 1� x-Y1V�� j � � �
----------CL road ------------ o -P
------- z �>
Sanitary Permit g I -I4 7
F�C.C�55 oF� W►LL.I�Y'�5 ��-`�izT , z
P.��D ��
Issued •2,2 �p�(�I1if�'(�J� I l I I Denied '
� /A.L�C�iC�y�C'.� __ �.
owner. Zoning 1ldministrator
DOCUMENT �NUMBER AFFIDP.VIT �
2 � � � 2 � EXISTING SEP^1IC SYSTE�:', -
ONE AND TWO FAMILY na�Bae.r�e OtNce 1
r .
$av,va: �ounty 1
If the existinR se y °"� '��� r�� �b�
, ptic s stem noes meet th� minimum re- A D 19�� et '�iq�
quirements for qroundwater and bedrock deptns and if it —
is functionir,� , an addition to or replacement of a hab- —� *1 °1� ""O'�"j1° vd. ��,6
d :�-o:c; on F�9e _�7U
itable structur� can be made in most instances without ��b �� D
updating the e:xi.st:.ng system. If the existing system R��
is utilized for the addition , every attempt should be
made to locate and reserve an area which is suitable ��
for a code complyin� replacement system for when the
system fails . If ttie addition will substantially in-
crease the wastewater discharge , the existing system RETORN 'PO
will be replaced with a code compl,�ing private sewage Sawyer County Zoning Admin
system. P.O. Box 668
Hayward WI 54843
owner (s) Vickie K. and Donald H . Pfister
i�tailing address Route 2 Box 2430A
Hayward Wisconsin 54843
Pronerty 3escription Lot 3 bein� a part of NW� of the SE4 S 14 , T 40N ,
v
R 9W. P�rcel . 14 . 1 . Vol 452 Records PQ 249 and CS Vol 13 Pg 165 .
Town of Bass Lake . 002-940- 14 -4201
(� (We) Vickie K. and Donald H . Pfister plan to
(�cZ Add nnto existing dwelling
( ) Add ento existin5 mobile home
! ) Replace existing dwelling
( ) Replace existing mobile home
The present private sewage system has been working satisfactorily as far as disposing
of wastes . If the present private sewage system does fail , it will be replaced with
one that is code complying.
�-�.,-__> � � � - .S - %/
� onald H. Pfister date
i
--I��``-"`�' � • ��-t � A,. - 9
Vicki�Pfister �� e
• es,�
Personally came �efAY�� �
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���VJ�-(cG�. Pc;'�:i�"�o'TP�rv�Z'�i;.� ;� Wisconsin
'Y. eb
�:;.�, �.}/ S'�Y.'�',`�
hIy Commission is esoii'�3§�`� � �( �
Existing septic system - 5anitary Permit $1 - 147 _
Date system ir_stalled 27 AuQust 1991
�w� �..\J . �aJLa�.. �%xoo7��&X
Merton W. Maki , Assistant Sanitarian
06 June 1_gjl
date
This instrument k�as drafted by
Donald H . Pfister ��FL � � � P� x � o
C6K4�F1�0 hURV�Y MA�
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./ ADINA
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MURRY
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P L B � 7 State and County State Permit # 189 75 ^
� � � Permit Application County Permit # g 1 - 14 7
� ' for Private Domestic Sewage Systems County S aWyE' r :
' DENOTES STATE APPROVAL REQUIRED CST 81 - 168
Date Approval Received from State if Required State Plan I .D. #
A. OWNER OF PROPERTY Mailiny Address : � �
� � � :� �,ces�-� LV l f
�e�o �s � •. a - '�� `��� " 7 � � d+�3
B. LO ATION : ,j�Y4�Ya , Section ��! , Tl.�'ON , R ..�.�F) W ot # City
Subdivision Name, nearest road, lake or landmark Bik # Viliage
�S�Q�nd � a ��e , d ►1 W � � I � 4 /14 � ��PScsr"�" �C6 � Township �qSS � /�s�
C. TYPE OF OCCUPANCY : ` Commercial " Industrial � Other (specify) ` Variance
Single family � Duplex No. of Bedrooms Z— No. of Persons
�• SEPTIC TANK CAPACITY � ��_Total gallons No. of tanks J� '
HOLDING TANK CAPACITY Total galtons No. of tanks
Prefabconcrete Poured-in-Place Steel �_ Fiberglass Other (specify )
New Installation Replacement
Lift Pump Tz.^.!< ui iphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUE T (.� ; SPOSAL SYSTEM : Percolation Rate '� Total Absorb Area sq. ft.
New Replacement Alternate (Specify)
Seepage Trench : No. of Lineal�t. Width Depth Tile depth (top) No. of Trenches
Seepage Bed : �i.ength � � Width � Z- � Depth 7��Tile depth (top)�No. of Lines �—
Seepage Pit: _..lnside diameter Liquid Depth No. of Seepage Pits
Percent slope of land�-_�-6 � �� Distance from critical slope_ 1�A�
WATER SUPPLY: Private �I Joint ❑ Community ❑ Municipal ❑
Owners name as listed on EH 115 if other than present owner:
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 f�ave sized the effluent disposal system from the EH 115 prepared
by the Cert� �ed Soil -I ester, !
NAME G.� -r C.S.T. # J`�s � �/6 /r and other information
obtained from (owner/builder� .
Plumber 's Signat MP�MPRSW# b 7 Phone # 7(S`- ,�.� y- �( 2-53
Plumber's Rddress — d�
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca-
tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors
property. ►f well has not been drilled please indicate.
. �'�'
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Do ot Write in Space Ftelow - FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application 0 7 - 2 �! - $ 1 Fees Paid: State 14 . 00 County 36 . 0 0 Date 2 4 July 19 81
Permit Issued/F�p�t� d (date) 07 - 24 - 81 Issuing Agent Name (; avle Jorczak
Inspection Yes�iVo State 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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Department of Zoning and Sanitation
S�.wyer County
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Inspection Report �
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Owner Georgina Hopkins - *Richard D1agnuson (agent)
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Addre::a Route 7 Hayward, lUI 54843 �
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Name of b•��siness �
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Builder
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Address �
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Plumber La�arence Lamphear ~'
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Address 12oute 8 Box 163 Ilayward, 1VI 54843
Irspection
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(K� Private O Public Property Sanitary-instal o �
�( Dwelling Setback - lake <+ �
Violation Mobile HM Setback -•road o
Garage Setback lot lin '"'
( � Sanitary ( ) Zoning Privy
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' _l3rn�LV,loo 7,50 �
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Discussed ti,ith owner yes no �y
Discussed witl� bui.lder yes no
➢iscusscd with plumber r� yes no
Discussed witr yes no
Date � �f f.���� �'�
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S=�;natur.e of Officer ��'��r.,r� �A��