HomeMy WebLinkAbout008-937-30-4303-LUP-1991-315 Application for Land Use Permit � , `
County of Sawyer ° =,l
The undersigned hereby makes application for a Land Use Permit and �
agrees that a11 work shall be done in compliance with the require- o ~�
ments of the Sawyer County Zoning Ordinance and the laws and regu- M
lations of the State of Wisconsin. `
�41,�:,� - 3 S`(-�aSS PRINT - USE BLACK INK OR PENCIL -•; /' ' 1
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Mailing Address Mailing Address
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City, State, Zip City, State, Zip
Building Land Use Zone District A - l r o
( )/1Vew ( ) Filling � a
(��j Addition O Dredging Lot size �n n
( ) Alteration ( ) Grading ,
( ) Moving On ( ) Acres �, �j_
( ) -Co �� �.t�. ( )
M(�rr��i�F_. 41r�rAt-.
New Construction
n �
Size -� � ft wide ft wide -
ft long ft long
Floor area 'i sq ft sq ft ��
w
Total htg �� to peak to peak x `�_
Stories / Stories 1.
No. of Bedrooms _� rear 1ot line or waterline o�
Q}�r roundl or (seasonal) T �
� rt
Type of Bldg or Addition � � � r
� Dwelling a �
Garage (1) (2) car I r•
( ) Storage Building �'
r•
( ) Boathouse o
( ) Livingroom � 1� �
( ) Bedroom -' (fl
( ) Kitchen-Dining �
( ) Porch - enclosed/roofed '
( ) Deck - open � �`�
f ) ' � � E"r . �8 I`69 � r�
( ) -O _ao'_: I� j 3e ci
Ty e of Construction n ��� '
� Frame ( ) Block r�
( ) Log ( ) Concrete
( ) Pole ( ) Steel �
( ) Metal ( ) �
s I
Construction Cost $ �7��'� • �'
�s' �%
Vo1 .: ,'� Pg (� � of deed
CS Vol Pg I �
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Cer. Soi1 Test C' ��.�' �
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Sanitary Permit -'--------
Road -------------- �
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_ �S��q i473� - 3 bd .}�,',irr
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Issued 23 December 1991 Denied j�;
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� �� � �/ r � �
-� � Owner Zoning A ministrator
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DOCUMENT NUMB�R- . � APFIDAVIT �
� N� �`A L � EXISTING SEPTIC SYST�M
- � ONE A.'��D TS40 FAPIILY �� � , �
If the existin se ���°T "'� �0��' i
g ptic system does meet the minimLur re- �-;�,,�,e A L 19�, et�'�,, odo;.
quirements for c�roundwater and bedrock depths and if it —�-�
,,./? H �ssrl :e:o;�;zc ln wL �l��J
is functioning, an addition to or replacement of a hab- a �3x � _� � �
itable structure can be made in most instances without �_ ��;.�+_2Z"'t`, '- ..s
updating tne existing system. If the existing system y�*
is utilized-for the addition, every attemnt should be „
made to locate and reserve an area which is suitable
for a code complying replacement system for when the
system fails. If the addition will substantially in-
crease the wastewater��d3:scharge, the existing system RLTURN TO
will be replaced with a code complying private sewage Sawyer Crsnty Zoning Admin
system. p.0. Box 668
Hayward WI 54843 �
owner(s) Lori and Louis DeVries III
Mailing adc',ress Route 1 Box 67
Birchwood Wisconsin 54817 .
➢roperty description � Part SW4 of the SE4 S 30 , T 37N, R 9W. Parcel
. 15 . 3 . 1 . 30 acres . Vol 473 Records Pg 167 . 008-937-30-4303 .
Town of Edgewater
(� (We) Lori and Louis DeVries III plan to
( ) Add onto existing dwelling
( j Add onto existing mobile home
! ) Replace existing dwelling
�� Replace existing mobile hon�e with new dWelling
The present pri✓ace sewage system has been working satisfactorily as `ar as disposing
of wastes. If tne present private sewage system does fail, it wi11 be replaced with
one that is code complying.
- � .�� � ���� . -� io - 3�- �l
� Louis DeVries III date
�,� ��� Ib— 3/— �'/
Lori DeVries aate
Personally ca;r,e beiore me this
,.au.nu
a�9'�` taN D t/'�f"�
� day of � 19� s�°��-�` ���.. �if?,�+�
�= tvr��.. •.,���,,f'.���
:
� = t�C�'A�t 's'�? ?
Notary Public Y�, ,� ��` �
County, Wisconsin �� �gp��i.�Ci o �
• �
..0.pd��0�,.. ..••'�g���.'
My Commission is expires ^ � �'O�P��f,�l�I;S����a°`�
Existing seotic system - Sanitary Permit 72-46447
Date system installed 1�-26-�2
�� u �O � �L. ZA or AZA
� _ � ��/ �— �l �
date
This instrument was drafted by
Louis DeVries III � �. � � � � � �
�""'L rC:l'I.?;l FOR SAfJYEi2 CO U"1T7
��, I�� : :i:v_Ii'l�hY PFHI�'I1 ,
-T
`s' Rpplication �:� Date J� ��-� " �2
� Fee o f $Z0. 00 received 1C—�� �v.r '� �7�i�t�-✓
Date County Ci:erk
� AppZication is hereb�;� made for a Sar�yer Courty Sanitary
Permit for worK to be done on tiie premises described herein,
, f / p ,
G� C.II ; �Vj�i� � �# U/�C'� uJ[;o�Lr�. �S
O�n�r Ad re� 1'ele�hone
x. Lc.%
The ;��_ o f t1�e i � Sec. -i0 _ Tv�. =1��'I✓ ��
or
Lot Bloc: Sub-division Z,��r=��LsJ{�'r�.�.
-- ---� —
q � �
� �W � �,I:CJ/�1 C' ? u �7Pivl �/;'1f'011� /� .� 1��F'✓'
G✓ork conte Zate To "be performe� by
tdumber of �edrooms � Num"oer of Bathrvoms
Dis?au�asher ��m Gar6age G-rinder /,(�t �
Automatic Washer• /JL?
So•il Description � �/�(,� � '
Sentie TanY, Size �� gaZ.
Seepage Pit HeiSht D�.ameter ,%,
Seepage Trencn _�_ Length _ ) Uidth _IG�Depth 1��
Septic Tank. Perr,�it ;� �����
Percolatior Test Forn PLB 43 attached _�
Yes No
Contemplated corpletion date /p ,� ; ��
App�zeation Appi�oved Perr,7it #
� " , . � ?
Sani tarian .�` � C — —� � � �
O��acr Agent i�lot ftiea Date
-�,
Remarks
Final Inspect�on /
� /, / /
Sanitarian � :;�i�C �C,' /✓/�T� !�' /'i, ,4',�=--
O�raer%Ane'nt IVotifiad (Date)
i`• F.
RL'1,',C.Y'F;S � ._ jZ�
*** Serzd origina2 a.nu t'hree copies �ith . * **
fe� of :'Z0. 00 to Coa�2ty CZerk
F� �i ihi
- Wisoonsln Departnent of Health and Social Servioea
� Division of Health -
SEPTIC TANR PERMIT APPLICATION
TYPE OR USE BLACK INK - PLEASE PRINT
A, 04MER OF PROPERTY .
Name Addresa (Str�aL, City� Zip Code)
r i �/ � �
I f� # . 9 �"' ) ���' J -
n
B, LOCATION OF PROPERTY HHERE SYST F'ILL 6E CONSTHIJCPED, ALTERED OA EXTENDBD COUNIT ..J , L.�� � %^
Cheok Onet
CITY YILLAGE LEGAL DESCAIPTION
7'OWNSnIP (Block� Lot, Seo,� � ; , ,! �- ," ��'� � � iy 7
--� Y� _� 'l�� �� O /(� � `� � !/�
C, IS IACAL PnAMIT REuUIRED FOR THIS NORKY YES No� PERMIT NlP1BER
D. SEPTIC TANK CAPACITY � �� GALLONS N&W INSTALLATION_ REPLACEMENT� ADDITION_
MkTEPIALSi PREFAB CONCRETE PO D ZN PLACE S?EEL� OTHEFi
NIMBER OF TANKS TO BE INSTALLEDt t_ 1�
E,. T1PE OF OCCUPA."1CY
Check Onei One or 'lro Fami�y Resldenoe Commercial_ Industrisl_ Other_(Specify)
�
Number of persoa9 to be Accovanodated� Number of H?dFooms �
F, APPLICdNCES, ETC� Food waste Grinder YES �NO Automatic Clother Washer Y'c5 �:JC
Dista`asher YES r'�'NO Automatlo Potato Peeler YES �NO
OTfiER (specify� YES ay';70
"T'
G, MASTER PL ER NIAKZNG INSTALLATION .{�
, ,�1 /; � ,�¢��l'�
Namef �!/�U � ��5 /C �fn Addresat /1. /
/ �
� � .�/� /!,a!'il� ��J / 5
SIGNATURE OF APPLICANTs � � �' /(� C� � � i
/ License Number� riP �
AD�AESS s �1 / MP R547
H, (TO BE COMPLETED HY ISSUING AGENf�
/
Date of Applloation ��� �L�� ��' FesPaid ��'�
- � _ '77i 'r1'/ �� �
lL'°---,G
Per�it Iesued (date . P�rmit Numb�r � 1+
�/ �1L J � �: '7�'�
Agent (mme� `, .>'W, � �1�"� For� .�'?w'yGL' L�-U'�Y _
tam� vil •, aity, co y� eto, epeciry)
,/
NOTEs The Applioation eannot be oonsiderad for filing wrtil all of the ebwe questions ars anew�rad
and the fee pald, Agenta xill Porward appllcation� the fee of $1.00 for eaoh septio tenk and
the third oopy ot the pe�it (canary) to the DSvielon ot Health. Cheoks end money ordara should
be made peyaDl� to the Divieion of Henith,
C01'�LETE OTHER SIDfi
NAh�t
COUMl'Y t
SEpTI� TANK PEAMIT NUMBERt
REPORT ON SOIL PERCOI.A2ION TEST
AND SOIL SORINGS
TO
DIYISION OF HEAL75i — °UJIIBINC SECTION
P.O.BOX 309� lfndieon� Nls, 53701
Pureuant to H 62,20� Wia, Adrolniatravive Code ,
P E A C 0 L A T I 0 8 T E S T -
TEST DEPTH CHARACTEA 0� SOIL HOURS ilATER TEST 47M? DROP IN HATaR L&VEL INCHES MIM7TE5
NUIiBER INCHES THICISNESS IN ZNCNES SINCE HOLE IN HOLE IN'tERVAL SECONJ TJ ERT TO LAST TO FALL
� � lst HE'I'TE� OVERNIGHT IN MINUTES LAST PERIOil LASP PERZOD PERIOD o:JE INCH
EXAAffLE
P - 0 36^ TOp SOIL 10" CLAY 26" 25 YnS OR NO 30 60
1 • � � � � �j' — .�
2 '.r.. . . ., �� , � � . . �, ' "�',l
�,
3 � ' �' . . � %" — � � -� - �'
R@COAD DATA FROM 'Ii3IL�IIJM OF 3 TESP HOLES
COh�UTE SIZE OF ABSORPTION AAEA IN ACCOfiD WITH H 62,20 HIS,, ADMli�ISTRATION CODE.
S 0 I L B 0 R I N G S - MINIMUM 36" BcLOF! P�O205EU kBSORPTION SYSTEM
aOAZNG TOTAL DEPTH OEPTH TO GROIMD WATER DEPTH TO BEDRWK �
NUi12EA INCPCS OHSERVE➢ ESTII1ATED 035r",RVED tSTIt1:.TED CHtiAACTP.R OF SOIL HITH :HICIQ7E55 IN INCi3E5
EXAM�
g - 0 Z° B CK 0 OZL " C Y 8": SA . 8° p 4"
1 ' � � .. .- � ! . . ;f�" �
2. . . � . . . . , . i -,.
3 . , � . - . . . . � / ,' . . // ..� � . .
� � RECORG DAik FAON NiININUM OF
TYPE OF CCCUPANCYt
RESIDENCE: NU[1jEA OF BEDROOMS -"� QTHERt (SPECIFY) NUlBER OF PERSONS `�!
FOOD HASTE GRINDER; YES NO '`� DIS1WASh�A: YES N0 �'� AUTOMATIC CLOTkiES HASI'.ERp YES NO 1'
� EFFLUENT !IISPOSAL SYSTEM; NEF' �\� EXTENSION ADDITZON REPLkCEMENT
TILE SIZE N0, LI�, FEET TRENCH WICTY: DfPTH Mtt�".tiER OF LINES
_ %, / �
S�E.PAGE BSD: L..RJGTH ' � � HIOTH/ �EPTH� � �.�� TILE SZZE '� N0, LINES--;
SEEPAGE PITi INSILE DIAN.ETER� LIQUID DEP7'H - --�
I� the underslgled, hore6y certify that the percol�tion tests reported on Lhis form xere made 6y me or under �y Super-
vision in accord aith the proceduros and method specified in Chapter H 62,20 (3 �, �'Ssconain Administrative Code� snd
t}�at the data recorded and location of test holes are correct to the bast of my Amwledge and belief.
�
%. \/ % /
NANu. - �%�;� //�l .. ( ., ! .. :� '�, TiTLE ����'��;�L !i
� � � TYPE on.�RINTJ � � i
AEGISTFATION N0. , OA MASTER PLUMBER LICENSE F0," ''_�j -' �
` � �7 '
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ADDPESS'. , . � . .. .
/, <!i.
DATE�'.•i . � �' !i�- SIGNATURE
-? DO NOi BRITE IN SPACE BEWW - FOR DEPARTTIENT USE ONLY
CATti RECEIVED FCCEPTED BY RETUi2NF.li
FEE AECe NE� YALLG h0. PF.RNTT N0.
REVIEvlEU BY � APPRCVED DATE
PiITIALS 7'65 CR NO � �
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SGALE: IINCH=400 FEET FOR ASSESSMENT USE ONLY Nt
DRAWN BY: DATE:7-10-84 INTENDED TO SHOW CONCLUSI\
COLON (:) INDIGATES GOVT. LOT EVIDENCE OF OWNERSHIP OR
BOUNDARY LOGATIONS
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