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HomeMy WebLinkAbout006-440-16-5214-LUP-1991-181 Application for Land Use Permit '" . County of Sawyer o The undersigned hereby makes application for a Land Use Permit and � agrees that all work sha11 be done in compliance with the require- o� ments of the Sawyer County Zoning Ordinance and the laws and regu- M I lations of the State of Wisconsin. PRINT - USE BLACK INK OR PENCIL ` ` l//9v��� �O D/.✓ J E � � awlll4/' � Owner Builder 3 3 3 �✓�f���- �►� Ma' ng Address , Mailing Address ,�LA i,�� i L G ooG 7 City, State, Zip City, State, Zip uilding Land Use Zone District G'� � o � New ( ) Filling � � ( Addition O Dredging Lot size l�j� .� /�d d m n ( ) Alteration ( ) Grading �. ( ) Moving On ( ) Acres ��� � ( > O � New Construction � � Size � � ' ft wide ft wide � / r/Z y ft long ft long �I -� b J F1oor area � sq ft sq ft w � Total htg ��r � to peak to peak � �� Stories l Stories No. of Bedrooms � �Qar�-6t�ine-o� waterline c� 0 (year round) or (seasonal) � n ' G Type of Bldg or Addition Q' r ( ) Dwelling a r°r � Garage (1) 2) car ( ) Storage Bui ng `'� �• ( ) Boathouse o � ( ) Livingroom � ( ) Bedroom , ( ) Kitchen-Dining C I ( ) Porch - enclosed/roofed ��x I ( ) Deck - open .,� � �� �� r\ � � � � � � T —_ a`� . � �� Type of Construction ` � (�.Frame ( ) Block • �'� ��.�.� '�� � ( ) Log ( ) Concrete ` n�`'' - i � r� ( ) Po1e ( ) Steel �� ( ) Metal ( ) � � or, Construction Cost $ �� � �`- �C'� - Vol �� Pg �� of deed CS Vo1 — Pg - b � w n Cer. Soi1 Test �(�-,-'���.^ � m r � Sanitar Permit '"'� '.�i� ----------CL Road --------------- � Y - z 0 ,'��rx k �' � � - , • z � Issued 29 Ju1�1991 Denied � " r. d�-�C QG-U"'"'�- ^ ��r.� I� ��ur� � Owner Zoning Administrat r � � - - ----�-- ------- ------- - --- �` - �� \ --- ------— ----- ------- , ,!'` ✓�-� ��` � .� � \ , . � � - �, ,��� \` - , '� _--_ . � `_ - =�---_ ` . , �i ` ' _--J` ��� \ ;; s�, _--- - � ��� ; ';, � ,; � ' . ; �� ���` ! . -� � ��j%� I �. , �_ /% _ , I -l; i 1� .�� ��/ . �� % � ^ �'i� �'j ' (\ ` , i � \ � O � \l'` \` I W -�`,\� �� ' .. '\��. \ � �', � i \ ` � I r � _ �� �,�,.� 1 \�\ � --- � \'��, , ,`` _ _-- __ -_--_--i`;, �'�- ------ ,�t, ,,, - � , ,�, ��„ � ;�` � � ' ' �n ( _ ,��\ � � i � �������_ -�. I '� � � �i \ I i � � ��_; � i � � i � � \ ' �� , �.. . � � --- �P �, � ; � ; ��' ���� i � C>> , �,�� .� � '� i� � � \�= i j �..; L� ;,`, ' I � - -- � j . • iJ � � I I . � j � . '; , �, --� '- � � � , � , . ..�� ��., ! 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' ''-�-�� ------------------- �� �a.\ �> - il_•-'-- ------------ . . ------ � .�_ ./ �;� �_, ��' ' �� E,_,1 C:1 � ` . : _...� -� �' , .'��'� • -i �) � � �� �-� " 1-�-�=• - ' -- --- ` � � h cy ��V i _ , \ �t -r----- - --------'�� (��- _•�, .,�\:,` �.. �'v;; .ti � , � -- .�. . - -i ----- -_ :-_---- _. . --`�-,�-;�-- ----.---- .-� ', \1\ '� _ \\\ �--�----- � � \\ ,� � I � � � � � �-� � �A i•J Cc. . , �` � ,�v 3=� � i \� . �/j ,� J � �I. ��/ I I I , �. , � ,_ I ,,� , � � � , �`��'' �:��- I .� - _- ��\\ �+ 1' I ���� ��(�\ • , j / �:= / ` -F= ` ��`. I.� I � � �.✓ ` ' i �='1 ��' ' ;i� i I � �-r�, ,r.�f! t � r_.., � _. � � i � /\ \ \�\'. � i �. I _ � � '„��,,�, � � - �1`;;� ; ; �� � `� �� - --- _"\ __----------- . -- V�� Plb 67� State and County State Permit # �'�'6� � � •� Permit Application County PErmit �-2�— for Private Domestic Sewage Systems County Saw,yer "DENOTES STATE APPROVAL REQUIRED CST 6-308 Date Approval Received from State if Required State Plan I.D. # _ A. OWNER OF PROPERTY David Jo Tobin Mailing Address: p/3-� i D �c !��� 3 3� N, t���,r�' _� r� `' �}�� l i,'U�- .�l,L�, 1rC�l�(o�1 B. LOCATION: Y4, Section �, T� N, R� E.�-(er) W Lot# _�.__City Subdivision Name, nearest road, lake or landmark Blk# Village_ Lot 1 of Govt Lot 2 7ownship �;�'��`_�_�� 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 ��i0 Other (specify) E. SEPTIC TANK CAPACITY Total gailons No. of tanks _�_ *Holding tank capacity Total gallons No. of tanks New Installation Addition Replacement Prefab Concrete *Poured in Place Steel l Other (specify) _ F. EFFLUENT ISPOSAL SYSTEM: Percolation Rate 1) � 2)�3) Total Absorb Area sq. ft. New Addition Replacement *Fill System Seepage Trench: No. Li . Feet��Width � �Depth Tile D�pth No. of Trenches___ Seepage Bed: Length�Width ��Depth �Tile Depth � �� No. of Lines _� // Seepage Pit: Inside diameter Liquid Depth Tile Size�_ Percent slope of land� � 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 Certif�ed Soil Tester, NAME ���� � .5 �p�� !�j C.S.T. # , � -- t _ and other information obtained from , (owner/builder). Plumber's Signature ��'�j�-�? ( i` A„�.i�_Mp� �///�/�� Phone #�(p[, - ��� FT ��� ----��` �'—T—T�— PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). t � � ' �i�� �-��� , � � �C� _: _ , � � __. � _. � �_.._ _.i._ � --- � ._; ;._.__ ' _�.. _ _ � 1 i • , � � , � ; � � , i , , , + � ,___i _..._ � . i_ _i. 1 __ , �__ : _ � __ _ _ __� r { _. _. :. _1 : T ,_... , . � � ; � ; � � � � _i ;_.._._ : 1_ _ ! �r __ T _ ; i i ' 1 ; � i _ _ �.. _. ___ _ .... . . � �.. !�. (� � + i ;. , . , � � � � � , _ , __ ' __ _ _--�__�..._� � � :._ �-- -.... t . �.._ �.._� —'..._ ._ i � � ' � � ' . i . � , , . . I . , ; I � � }� �.._.... .. . . ..� ..t.__ ,.._ .. . _ . . . �._....... � � � � � (_ . � _i _ __ � 3 ��r'�i� � �l�' � 0� _ �� �f 1� � � ����,���a:�--� . ��` --- -�- � � �3 ;��� i� � � �n - .�; � _ r � 3` .?i �� t.� � �' �--i:,,?a.��' V � � . _ _ _ ._ 1 . , ; i _'� ___._�. �f �' r i `( � . , 3j � ' ± ' � _. ._, ,__ _,__. .., , � ' ; � ' � �� ��, _ � __ , ; _ - � ._ .� _ __ ,_. , I � , ; , , t �.. , !" I + j! , . ."__'___�..."_�__._...�.. _-.___...�.. ...J._'___i_ ._...__ ;_�......;_ ....�...._."'_ _ ..i"_.. � ..._�... J._._......� _�y.._._ ± . � f ..' .._._. , .__ '...._ ' �.....� � }�. ; � r �� � f : ' ' , i I � � � ' ' ; � I . ..i. ,.__...__ _'l..._. .. _...1 . ..___'�.._. .�....._ : ...,...� . �_._. . 1.. .. ..... _ i .. { .�..... ' ..._. . !... � � ..l.. .... _ l��, i Do Not Write in Space Below - FOR DEPARTMENT USE Of�Y Date of Application 1.0-22-76 Fees Paid: State 1,00 - County 10.00 Date October 22, 19'T6 Permit Issued/�DEDC (date► 10-22- 6 Issuing Agent Name Robyri Keph&z't - DZA Inspection 4`�"'No Valid# Date Rec'd 1. county (white copy) 3. owner (green copy} DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 � �rara I�i;'.c coo��) 4. olumber (canary co4�r)