HomeMy WebLinkAbout002-939-01-5225-LUP-1991-310 •• ' - Application for Land Use Fermit ��
- County of Sawyer
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- � t
lations of the State of Wisconsin. �,
PRINT - USE BLACR INK OR PENCIL
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�JJ�IPYL2� WdI��'�S Mo�t�n L��..� I�ilIGSZnC� ~ '�!
Owne Builder
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Mailing Address Mailing Add s
��r��l�a MIJ S�3o� C�,�„»P.�,�� . �'alls�wz
City, Sta e, Zip Ci y�tate, Zip 54'7�q-88o8
Building Land Use Zone District Rk'- �„i o �
(� New ( ) Filling rt
O Addition O Dredging Lot size �rj0� x ��04����� � n
( ) Alteration ( ) Grading
( ) Moving On ( ) Acres �j_13
( ) ( ) o
New Construction
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Size �_ ft wide ft wide �
10 ft long ` ft 1 ng �
i �
Floor area �I�I 1 O sq ft �-'--{0� sq ft �� �o� � ��
Total htg /a� to peak (to�_�a�c-� � <';
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Stories ( Stories ��
vm �a
No. of Bedrooms o i _ ,_.- �:�.. ar""wa erline c�
9" � �_ o
(year round) or (seasonal) " � � n
Type of Bldg or Addition � a o
( ) Dwelling r• ,�
O Garage (1) (2) car 2��� �
OC) Storage Building � ��� m� �9
( ) Boathouse � ��0� c,, c�C��'���,' - � �
( ) Livingroom i C\�t G�
( ) Bedroom — d'
( ) Kitchen-Dining �`� ; �1 �
( ) Porch - enclosed/roofed � �v--
( ) Deck - open �'�` �Lc« �� �
f � C�� �.�'lo�b 1: �2 I-k�. 4- �r\
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Type of Construction —' � ,� G
( ) Frame ( ) Block � q ,A,r�,
( ) Log ( ) Concrete f
(� Po1e ( ) Steel
�L Metal ( ) � �
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Construction Cost $ y3�9S6.00 �6 6
Vol �-�� Pg a3(pof deed �
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Cer. Soil Test ?+._ �- �``� 15�� � n
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TC�%1-C�'�1C_./ �-^��-�C L��P1 '% � �L� ��
b er Zoning Administrator
TOWN OF BASS LAKE
SEC.I TWP 39 N. R. 9 W
GOVT LOTS 2 a 3
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� �� w�scons!n APPLICATION FOR SANITARY �ERnAIT • �
' � ��4cJ y �2 C� NTY o
l (PLB 67) �
'_ aara<casm oePraarmenroF UNIFORM SANITARY PER 'T -1Lr �v
' �-'�+?�ID IflDUSTRV,IRBOR 6 HUTRfIRELRTiOf15� �^m �� _ O � � � �O � �
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—Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8Yzx 11 inches in size.
—See reverse side for instructions for completing this application. PLEASE PRINT
; PROPERTY OWNER MAILING ADDRESS
; . ES l,� r� N � E /oo �. i rcci`EL •�-��. �9P /T"�� Wi , ��
� PROFEI'�TY LOCATION /. p �pU� C..OT �Y:
� `�—,=cvt:
! /V[cI1 /4 N�1/4, S (n , T,3� N, R 8 �) W TOWN OF: � �SS [_�� C
' LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
I � � l�CTE��S 1�0/� TJ �,'OHD
', TYpE OF BUILDING OR USE SERVED
Ii�l os�E�nil� Number of Bedro�ms: � [� Pul,lic (Specify) :
�THIS PERMIT IS FOR A:
�. New System ❑ Tank Replacement ❑ Repair
❑ Replacement Soil Absorption System ❑ Revision ❑ Privy
❑ Altemate System L�� Reconnection ❑ Petition for Modification
� IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
�. Seepaye Bed ❑ Seepage Trench � Seepage Pit ❑ Holdiny Tank
�� System-in-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit # _ issued _
❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
ITotal -;='of Prefab. Site Steel Fiberglass Plastic
I Gallons Tanks Concrete Constructed
� Seotic Tank Caparity Qd�
� Lift Pump Tank%Siphon Chamber
i Holding Tank capacity
� Manufacturer.
�_.
� IF TtiIS IS AN ALTERNATIVE SYSTEPJI CO.VIPLETE THIS BLOCK: ❑ Mound � In-Ground Pressure
Total m of Prefab. Site Steel Fiberglass Plas; ic
Gallons Tanks Concrete Constructed
Septic Tank Capacity
Lift Pump/Siphon Chamber
i Manufacturer:
PERCOLATION RATE ' ABSORPTION AREA ABSORPTION AREA VUATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet�: PROPOSED ISquare Feet):
S �p � 5 �jZ � Private ❑ Joint ❑ Public
i, the undersigned, hereby assume responsibilit stallation of the private sewage system shown on the attached plans.
a e of Plumber (Print): (� ignat �_ MP/�do.: Phone Number:
I, �ta�yZ�' � � ���3 ►°+ t'Zt'�`r� �� `�' _ C-- c� �'s�tL.'�s�_ S7S<Z (7iJ" 1 �3� - 4�c�76
,
�Pluniber's Addresr. Name of Designer.
�T<o Nf'---�-I u� F-2 ,C , �1 S�/c3'�� ��c rL! G 2�i"��=r=
i COUNTY/DEPARTMENT USE ONLY
Signa re of Issuing Agent: Fee: Date: ❑ Disapproved
r
L� Owner Given Initial
� � 5 . � 0 7 - 21 - 8 6 '� APP�oved A�iverse Determination
Rzason for Dis p roval:
Altemate course(s) of Action Available:
�!LHR SBD-639£3 (R. 5/82) CISTRIBUTION: Original to Coumy, One Copy To; Eiureau of Plumbing, Owner, Plumber
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GEPARTMENT OF RE�O�� �� v�O�L E�3��I��J P1ND SAFETY & BUILGINC�
I N D U ST R Y, .__...._�_�_— ..__-_----__---�._,r� D I V;S I 0 '
LABOR AND PERCOLAT80� T'ESTS (�.15) P,�ADISON WI ��IJg
HUMAN RELATIONS
(ILHR 83.09(1) & Chapter 145)
LOCATION: $ECTION: TOWNSHIP/M ' i.TY L0�.: BLK. NO.: SUBDIVISIONNAME:
w�/ N w�/ � /T39N/R E � � W As.s 1. � �
COUNTY: 01Mtd'EFi�5/BUYER'S NAME: , MAILING ADDRESS:
S fJ +-✓ �' � � ni � o �' . N� � rc h �l.� v P �e Zo :� W �
USE DATES OBSERVATIONS MADE ,S'� �J
NO. BEDRMS. : COMMERCIAL DESCRIPTION: v PROFILE DESCRIPTIONS: PER(,0 AL TION TESTS:
I�Residence + � �� i �� New ❑Replace _ / _ " / �/S`� t/ �
/ (. O
RATING: S= Site suitable for system U= Site unsuitable for system
CO V NTIONAL: M UND: IN-GRO aPRESSURE: SYSTEM-IN-FILLHOLDING TA K: RECOMMENDED SYSTEM:loptional)
�S ❑U �S oU �"'S �U o S �U ❑ S .�`"U Y �:�'
DESIGN RATE:
If Percolation Tests are NOT required �f any portion of the tested area is in the
under s. ILHR 83.0915)(b), indicate: /�J/� Floodplain, indicate Floodplain elevation: ��
I �
PROFILE DESCRIPTIONS
BORING TOTAL ELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AfJD DEPTH
NUMBER DEPrH IN, OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
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PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE NINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD i PERIOD 2 PERI � 3 PER INCH
P- .3c� ' '� 3
P-
P- 3 �
P-
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PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the ho:
zontal and verticai elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the directi�n and percer
of land slope.
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I, the undersigned, hereby certify tha the soil tests reported on this form were made by me in accord with the procedures and methods specified �n the Wis or
Administrative Code, and that the data recorded and the location of tl�e tests are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETEC ON:
� ' � � .z� ' /� — S�'�
ADDRESS: -. CERTIFICAT O NUMBER: PHONE NUN'BER (opcior
1 � 3 � Cc.�.,�.,��. Cti�� '� `i � <o �` �lc-�-�;�G
CST SIGNA E:
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r.�n�-n�n� iTin��• ll�ln�nsl anci one copv to Lor_�I Authority, Property Owner and Soil Tester. /