HomeMy WebLinkAbout008-938-25-3401-LUP-1991-248 X
' Applica�ion .for Land Use Permit
Eounty of Sawyer o
E
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. �
PRINT - USE BLACK INK OR PENCIL
Lc°< ric� $ , �
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Owner Builder
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Mailing Address Mailing Address
City, State, Zip City, State, Zip I
Building Land Use Zone District (-1—� o �'
(�} New ( ) Filling r*
( ) Addition ( ) Dredging Lot size 1207 x 13z0 � n
( ) Alteration ( ) Grading
( ) Moving On ( ) Acres 3`f.oZ _
( ) ( ) �_
New Construction
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Size ��1��� ft wide ft wide
� �� ft long ft long �,
Floor area sq ft sq ft �
�
Total htg � to peak to peak �
Stories / Stories
No. of Bedrooms rear lot line or waterline c�
0
(year round) or (seasonal) ��,,,� ��-s,,� cn rt
Type of Bldg or Addition a� r
( ) Dwelling , a o
( ) Garage (1) (2) car ; �
G�) Storage Building m
( ) Boathouse ~'
0
( ) Livingroom ! �
( ) Bedroom
( ) Kitchen-Dining ��� ��
( ) Porch - enclosed/roofed �� c�
( ) Deck - open '
( ) ' rw
( )
LJ�
Type of Construction �
( ) Frame ( ) Block N
( ) Log ( ) Concrete (b `�
bQ Pole ( ) Steel -�
(X) Metal ( ) � ;
uo � i
Construction Cost $ �' �/: — � ,
�, C 7
Vol �t Pg Q 7� of deed _ � �� c"> '`�
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CS Vol n/ pg ��CH' ��' , � y
n i. %5 f ro �
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Cer. Soil Test h/;/� ���'o � �
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Sanitary Permit -]4..-2�2 ----------CL Road -------���'----
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ow �.,,-3�.� z
G� Ro�n o
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Issued l �
3 I��ov�vY��. I�9� Denied
I 7 ��
CLL�� �lt� E
Owner Zoning Administrator
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W II.I I2.I IS.I I(o.I
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.II. SCALE: I IMCH= 40o FEET FOR ASSESSMENT USE ONLY NC
e .a ...,...,A� r,v• /h. nw-rr•�i/9G,/R9 i��ac��ncn rs� cunw rns��ii�e��.
PI667 *S'�'�� . . . .
"`�` State of Wisconsin and Counzy
` ��' Uniform Permit Application Date 10 - Z I — �¢
for Private Domestic Sewage Systems
- County vja__ W`{��
State Permit `;
Num6er _L��� Permit Number 4 — Z�p2
A. OWNER OF PROPERTY
Name: � � � ! Mailing Address:
� � o cQ � �son� ��' �/ ,�rchwao� �cJ,"s, �-�, �>
B. LOCATI N OF PREMISE WHERE SYSTEM WILL BE CONSTRUCTED,ALTERED OR EXTENDED
LEGAL DESCRIPTION: Name One:
(Sec., Lot, Block, etc.) CITY VILLAGE
' TOWNSHIP
S u� % s-� 5�,J � S e�. as T, 38N- � .
C.$EPTIC TANK CAPACITY OQ Gallons NEW INSTALLATION REPLACEMENT ADDITION--
MATERIALS: Prefab Concrete _1�__ Poured in Place Steel Other ;No. of Tanks �--
D.TYPE OF OCCUPANCY
One or Two Family Residence Q�✓� �9�/ I � �No. of Bedrooms � —
��—
Commercial Industrial Other No. of Persons to be Accommodated —�_
(specify) ,
E. APPLIANCES, ETC.: Food Waste Grinder YES—� NO Automacic Clothes Washer YES �NO
Dishwasher YES�_ NO Other (Specify) —
F. EFFLUENT DISFOSAL SYSTEM NEW � EXTENSION ADDITION REPLACEMENT --
Seepage Trenches: No. Lin. FeeT Trer�h Width �De�th ��lumber of Lines _—
/ -/
Seepage Bed: Length . 3� Width —�� Depth �Tile Size � No. Lines _QS_—
Seepage Pit: Inside�iameter Liquid Depth
G. Percent of slope of land ' � % �E S� direaion
H. Indicate Slope of Land & direction of slope on sketch I. Tile Depth
�� �
PERCOLATION TEST
Indicate Soil map number _ And Soil Type � UP
Hours Water Test Time Dro in Water Level Inches Minutes
Test Depth Character of Soil Since Hole in Nole Interval Second to Next to Last To Fall
Nin�r Inches Thickness in Inches tst Wetted Ovemight in Minutes Last Period Last Period Period One Inch
�1 ;' P��4 ,� � �_ o � � � :�� —
.� �_
-� .3� . �' 30 ' � o � 3/ a 'l �y
-3 3��" s � �� � D �� � •� %� �
RECORD D:+l'A FROM MINIMUM OF 3 TEST HOLES IN THE AREA IN WHICH THE SYSTEM IS TO BE INSTALLED
SOIL BORIN�S -- Mi�imum 36" Below Pro osed Absorption S stem
Boring Tota! Deoth 4e �und W te De h edr ek �
Nunber Inches� Observed Estimated� bserved Estimated Character of Soil with Thickness in Inches
,, - - Je o sa,�� �� � nue � �i
� ,� " ' �" � r��e 3� „
-3 �2'' '' " 0 � su� '' ,� � '' ��
RECORD DATA FROVN 'VIINIMUM OF 3 BORE HOLES IN THE AREA IN WHICH THE SYSTEM IS TO BE INSTALLED
(COMPLETE OTHER SIDE)
Name of Owrrer N (� � � �S O 1V County � e r State Permit No. 0 8�7
� PERCOLA�'ION TESTS
I, the undersigned, hereby certify that the�Percolation Tests reported on this form were made by me or under my supervision in
accord with the �recedures and method specified in Section H 62.20 (3), Wisconsin Administrative Code, and that the data
recorded and�Jf�cation of est holes are correct to the best of my knowledge and belief.
NAME �LII./�_(1.�^ e S !QCY' TITLE ��uM �P r
(Type or Pri �I ���
REGISTRATION N0. J ' /or MASTER PLUMBER LICENSE No.
ADDRESS _-�,_�. � , Xe /,�/✓ LCl/ S , SY�3S
� �
DATE OF TES? _I� — SIGNATURE
.
PERSONMAKING PP�ICATION_ � eS ADDRES
SIGNATURE �6��_1 �o�. u,! 1,�J
MASTER PLUMB MAKING I ACLQTIb —l//�1PDA�,Z2 S 1 G L' �" LICENSE N0. MP 1�11��
�
SIGNATURE MPRSW
Provide sketch below of syste nclude rection and percent of slope and all applicable distances including well location and
lot lines) -
PLAN VIEW (Locate Percolation Test & ore Holes)
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Note: The application cannot be considered for filing until all of the above questions are answered r:���:; the ee paid.
----....--•----------------------'--------------------------------'------------------------------"--------------------------------------------'--'--------'----•-----------------`---------
Do rrot write in space below- FOR DEPARTMENT USE ONLY
Date of Application Fees Paid State �. (�C� County ��—
Permit IssuedfRejected (�iate��C� Z� �C��d- Inspection Yes_�No — Date � �q7
Issuing Agent Name �`'�N ��T- `��LT� Valid No. Date Rec'd.
OIVISION OF HEAL'fH, P.U. BOX 309, MADISON,WI. 53701 — REVISED 3-1-74
Department of Zonin� and Sanitation
Sawyer County .
Inspection Repor�
Name of property �, GoyJ� ('��'��
Description �r..� � — S�J �� - S �c . ZS - T3 � � - �`'1
Owner Address
Builder Address
Master F��umber �, �E3/6E� Address
Inspection
� Private ( ) Public Property Sanitary Installati.on
Dwelling Privy
Violation Mobile home Setback - Lake
Garage Setback - Road
( � Sa•nitary ( � Zoning Setback - Lot line
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Discussed with Builder � Yes (?� No
Discussed with Plumber Yes ( ) No
Date of Inspection �0 -� - 7�
Signature of Officer ��,vi,c���
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