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006-440-33-3112-LUP-1991-340
� 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- '-^ lations of the State of Wisconsin. ` PRINT - USE BLACR INK OR PENCIL � � • �. /V�ck ��e rv? c zU � (�-�Ie Maq�,�nS�M��. � Owner 7�/6 W SCG�ti"�v1C rG�t?•.: Bui er � ToWm �c�acl %l5`123L�KeW;Mfer�lZ<< -y Mailing Address , Mailing Address Ch� ag� 6!>, ,;; . � .. Lo.�e�ta �v��s�v�»s;m �n/�m�erl�, sc�v�s,�y, Sy39�; City, State, Zip City, State, Zip � Building Land Use Zone District ,�/Z_ j o � ( ) New ( ) Filling rt {>0 Addition ( ) Dredging Lot size m n ( ) Alteration ( ) Grading ( ) Moving On ( ) Acres �. _S' - ( ) ( ) New Construction � g�C�'Yf� — L�VINC�R��M �;,� � ,-, Size _� ft wide � , �^ ft wide � ,a�C' ft long �� /� � ft long / , . ,f-liE e�le(.��l--S Floor area ��j S..r `��-f-t---�-`-- sq ft td Tota1 htg ,, ,7� to peak to peak � Stories � Stories No... " �-- rear lot line or waterline c� (year round) or (-S�^�nn�y. -�s�� ��nJ � � � rt Type of Bldg or Addition � a' r ( ) Dwelling ; a o ( ) Garage (1) (2) car Y. ( ) Storage Building �n ( ) Boathouse ~� 0 (� Livingroom � ��tJ Bedroom �'�����ti�j �� ( ) Kitchen-Dining ���' � � ( ) Porch - enclosed/roofed , � ( ) Deck - open � � �v � ) ... v..`sJ�1.�,�'� -- ' / -C lh , � S /'S �/ a � o U d T pe of ConsCYuction � � r�sp `���yy�r=� `.'�� � � i � � Frame O Block � v�"� 5�,���,oP�R � y�. � W cw ( ) Log ( ) Concrete I �''� � � ( ) Pole ( ) Steel - %�-___ 1 � � ( ) Meta1 ( ) '�m'�l,C�l" r � � ��' Xa� "v �h N Construction Cost $ �� G��� �j W / Vol ��Pg� of deed�� � � ,.ti,� � i CS Vol Pg ,�:I ���� ,ti � i Yi w Cer. Soil Test -j`� - ��'��- I V.o�►/ � .�- m �C n---------- J///��� ~' `J Sanitary Permit -1�j-��j� , CL Road --�------------ %�1�:'>3,� fZ7b�.,(�l�I(;�5���n c � Z � 7y Issued 23 December 1991 Denied � � .�^-��c ����C�� l-GC.t.u��,,�l�a-Z� [v �- � � Owner Zoning Administrator V � - � C1>.J�, . � � . \ �� , � ' �, ,,. . � � ��;,� � -;; 40 �` ''� , � l„. �; A � _ .. � ..� � •5,2 � __ _ _ ---- - -- � _ . � �� p , , � i \ ` \\� ,. _� � n� _ � 1 �� Tr� _ � �_ �t +�- �n �{� � - . , � . �; � � 1 �f ��,� ' �,,, ��t ,�\ � I � , �3.�•, ��:' r � � �.�..A � , = � Al (ll� � � 'l �� � r `�r'" .4�. , �;, �� � ; M I� )� / _ �g I 3 � � ' . \' —_'_ _ ._ . d 0� 1 — _' __" __'_'__—__-_"____ r \ �, •,.�_ /% �� �l� �4� .4�1� nl q � J � / � �\ ' �✓ �\ ia �9 10 -.�:.(1 � � < ��_ �' ��p �4q rm4 `l \ ��`��. � m � � �� �r, � �, �g (� �� , '.r'"�` ✓`� _� � ,��, � , .: � ��- �I �,�� �� _ ,,, � , . , /� i�s�� , �� 1 _;-���✓���\ '� J��, ,�,, ; M f � �, /��—i � ����,i \ / �+ �\ �.\ l�.Q, � �-r—�— 4 J��a� . � %/ � o�<"�� � 1� :,1 � , � ;'r/ c��� � � � � � , ..__ � ; -, � __ ��-:f , � � � �� � , � -��� � �� ,., �- I _�:� ' /�-� i , «, i� ����;� . � '� �� i- �� P , y�,�, l�\ j. . � � � -------- ------___ _ - -- -- -- ;— - , _--- _ _ . - -- _ � ; SH T / oF 2 - - WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVECES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HERLTH P.O. BOX 309 MADISON, WISCONSIN 53701 J'lJ l.^ ��. REPORT ON SOI L BORINGS AND PERCOLATION T�STS � `� �/- i2- LOCATION : _'/4, ��j Y4, Section �, T�Q�I, R �'�' P�r) W, Township or-f�rree�Ly �_��_—i�_ � � Lot No. � , Block No� , County S� L'�✓ �' � /� U � � �� Subdivisi ame �� � �� O�vner's Name : �� j�/� Mailing Address : y � ,� ((�_�r � P 1?�` / J� /�i �`�i'� � � � fl i �.� .� ��-� �oL-� TYPE OF OCCUPANCY: Residence �� No. of Bedrooms 2 Other ___ _ EFFLUENT DISPOSAL SYSTEM : NEW 1� ADDITION REPLACEMENT _ — _ DATES OBSERVATIONS MADE : SOIL BORINGS ?- � �- 7 � PERCOLATION TESTS �'2-� � 7/� SOILMAPSHEET `�YnJt' �l_ �}.j. � c � � /�+�1�S01LTYPE �1- �� C � /'� � �;J•,T 5h �' E' � l/j / � � pERCOLATION TESTS ��� -�� '�n� - •f TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM— �NCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL BER 7ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P- j � � ' S � � k34 � � �� � ,� � T l �"� � � ,.,n.,.;,.. I / ' � � / ` .� P- � 3 � " f, 1 , ; , � + L�' � ,��yu.,,., % l % ! %`L �- P—.� j /l �� , / I � � ��. �� � J l t. � � SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNrSS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF UBSER\/ED1 B— / / /� / � '..?�+t� / // � (o ��z � �0 6 � , SG � — �N ��-� L � B (., � ' .rv�.,.,� � � � � ..� . ,,L'T .��' �- �,__ � �. � B �3 7� " ' � 7 i� " �S � � S�C io " ,� r a,� .�� � S d- . � n � , PLAN VIEW ( Locate percolationtests,soil bore holes and suitable soil areas.) indicate on the plan the locationand square feet o suitabi. areas. Indicate number of squa�rj f et of bs,�rption ar � ,�c � needed for building type and occupancy. y�� � 8�'� / •�v �►r5di�at�°�a� or distances. Give horizontal and vertical reference points. Indicate slope. 5/ � ; / _ _ _ I----+ .. -, 1 _,C c � % - -� � l - -- -- '- "� s� i _. � , - " � ' � • � d •,. i I ` � �` ; �-,: O ! �� � ' � i � �� ' 0 � f'. �1 r-- =;, i ! � �, i G� Q � � Y N � ; � �' ( � I • � i� ' � ' � � �� y 'k � '� c { 1 � � , I � � \ ( � � � � � �« i , ` � -�-,� � � � _ ___ _ ; ; - � --- - -�-� • � � - ' � . , _ �-t-- - _ � '__ q _ � � l R �_ _ �_ � . ,� � ' ; 5 ?`� o �3 � � ' � � ' � , _a --- - - -- -�---- , ---- t-__,__ _ _ , i i - � -t---{-- -�-- ` i � � �� � I � I ' G N�`' � �.} � l I , the undersigned, hereby c�fy that the soil test r e this , made b _ in accord with the procedures and methods specified in t e sconsin Administr � e o e, and that the data recorde and location of test holes are correct � 4 to the best of my knowledge and belief. � Name (print) �� � � � p S �'v � � �X-� Certification No. ��'� `�' C� ,/ _ Address� ��3�''� D %cJ t hJ �" ' ' _ Name of installer if known L-^- -- �1� - CST Signature 2�"�-�" ��'' �"L`�'^-� C�i'Y A - LOC�L �.UTHC�RlT�` � ��� � State and County State Permit # 5134 � Permit Application County Permit # _�30 for Private Domestic Sewage Systems co��ty __ Sawyer _ "DENOTES STA.TE APPROVAL REQl11RED � CST 9-182 Date A�proval i�eca�:�ad from State if Required State Plan I.D. # _ A. OWrJER l;F PROFERTY Mailing Address: � � ,� �///� '�' <° ��`�__�-�-� C�-GL �' `�� �� � � ' '�-�� �%��,C%�,� =� B. LOCArtION: ��Yo��J Y4, Section �, T� N, R�` E (or) W Lot#/�_City_.: �c. — Subdivision Narne, nearest road, lake or landmark Bik# Village � Township �� C. TYPE OF OCCUPAiVCY: Co m rcial_ "'Industrial *Other (specify) � *Variance Single family _�___ Dupiex No. of Bedrooms_� No. of Persons D. TYPE OF APPLIANi:ES: DisF,washer YES NO Food Waste Grinder YES NO # of Bathrooms__ Automatic Washer __YES ___fV0 Other (specify) E. SEPTIC TANK CAPACITY___`,?�'�Total gallons No. of tanks / "Holding tank capacity _ Total gallons No. of tanks New Installation � Addition_ Replacement_ Prefab Concrete 'Poured in Place Steel_�( Other (specify) _ F. EFFLUENT DISPOSA� SYSTE:�: Percolation Rate 1) � 2)�3) �_Total Absorb Area %%�� sq. ft. �!ew� ,^-,ddition __ Replacement �Fill System �sepage Tre���,ti: No. Lin. Fe�t Width Depth Tile Depth No. of Trenches___ Seepage Be*+: I_ength�(' Width ��, Depth�Tile Depth /c��' No. of Lines � Seepa,ye Pi*. lr.side diameter Liquid Depth Tile Size �,/ " _ Percent slo;�e c; land d Distance from critical slope �J�� _ I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin :�dministrative Cod•:, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soii TPste!' NAME _���j�r'� ����_ C.S.T. # J�- and other information obtained firom .( i�e � i n� (owner/builder). L-_ o C Z� /i c,� / p,�� ` Plumber's Signature_ '� � (�p�/MPRSW# ��� / Phone ���.(� � o 7 c�-� Plumber's Address-.._ __ �=��s��-- U�_.`� . . PLAN VIEW: Provida sketch below of system (include direction of slope and all distances in accord with � H62.2G, including well). � , � . ; . , , E . : � r_. ; ; , � � _ _..____ ._ _ -_ !-. -1 i .._� _i 1 .. _ _._... _ . ..__ _ , , } , � ; �-- . _ . . . i � ' , � � , i . _-�--__�...__�._�_..._.. j . _a_ !_.__'L --�-..._� 1 __ - .._ _ � - : , . � ( � , i I , � - ' � f _ ._ . , __:__ . � !_ _ � _; i__ . � _� __!___ _a� '__. _ _ _ ___j _ _. rt_ r._.v , �__ , . . � f_ i I i , � � I _ _�._. _ _____ . �.._ _ �- ---- __f _..._ _ _._ . � . . � _. " 3 .___., __ ` . . _ �_ , ; ; ; � ' � j i , 1 1 , � � • _� �..__.� _. �_. i —1 ..- - -- ' _--� -{...._ , _ �_ _� �-_ -- ; � i ; � E f , ; , __�_ _�._�_.._; ._... . ;. 1 . _._ . �__. i 1..._ ' _ , ( --- � f . .f _ 1 � i � � , 1 � � i __ __� � �_ T _l __;__._�-- t__ _-�- -�-_ _ � . � _ � . < i� � _. .�___ _-- .._._ . � . � � , . , : , : ; . _. � , � I ' ; ; ' �f .�_... _-�--,- --- t _. __._ _.. , , r___� � � ; y� ; , , , , --- --� _ . _�-_.�__ � � � -��---- 'i � , �_ ;- -= p� ; . � ��, �� � �-� -� � � �- -� � ���j . _ �� � __� _ �__ _ . _ i , , . , , � � � l�'',r3 �" \ ' � ; _: L� � � �. �. �, �._ � I � __� ._._.. � _. _. 4 _.___. _ �1 � � I ' � ; � I i , __._:___i__: _ �..._ ;_._ __. w__ _ :� _ __ �-._.. _ i - '•_ _. ' � I � � j , (,(� , , ' i �vF,r,�( � � ' ' � ; { . � -t _ _..- - -- • Z __ � __ -r-._ -- •. � . ._ _t.___ � _ _._ _ �_ , � � � , I ; � I � � I _ � �..�--�-----� --- {-- _.._ _: --,. ._. .-----� - - _ �_._._ �__ .�...-- - - _.... � . , � , , _� � , , , - , , i � • I ' ' i ( � ' � � j � i ; ° ' F ) { ( i 1 ; i � � � ._.� . _.__. . � . _. ' � .. . . . . � . � . � .... ` -�,, _. _ � ._._ . .. . ' " _..f___,_'_ __. .. . _. .. .. ._. ._...._. .. . ._� � ' _ .._ _._ . ._.. .,- � i I � � t � �, . . ��, ' . �. . : � ' \ ��. --- _ ��� _.,.. :. ._ _ T (\tn '�-�-�- / _ ._�-- _�__ ,_ J. ; L _ ___— -__...� _- --- - ----- . . . - - . _ _--� - -_ - - --— _ : - �-� �' � Ss /�c� � ' Do Not 1NritP in �pace Below - FOR DEPARTMENT USE ONLY Date of Applicat�on 8_0 3-7 9 Fees Paid: State 15 . 0 0 County 15 . 0 0 Date 0 3 Augus t 19 7 9 Permit •Issued!f3eJ�3Lib.�C 1�a�e) _ 8-03- 79 _Issuing Agent Name Elaine Nehrling Inspection Yes�iee ___ Valid# Date Rec'd 1. county (white cooy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 _ . . . � w ._i...YL.... 1..,.�..�•. .......r�