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008-118-14-0013-LUP-1991-353
Application for Land Use Permit County of Sawyer o � 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 o£ the Sawyer County Zoning Ordinance and the laws and regu- M lations of the State of Wisconsin. � .}- PRINT - USE BLACR INR OR PENCIL 6��� I R �- �- � �. - 1 ! ; ,. , W Owner Builder �- \ � 1 / Mailing Ad ress Mailing AYidress' '/ 1� � � � � ! � �: � :'�t L; � �� '�� �J � City, State, Zip - . City, SCate, Zip Building Land Use Zone District (Z�-� r � � 0 (�- New ( ) Filling rt O Addition O Dredging Lot size �n n ( ) Alteration ( ) Grading , ( ) Moving On ( ) Acres ---- ( ) ( ) �,�� tt New Construction "'i6G`�S�'� Z. -- Size 2U ft wide � ft wide 7- Z4- ft long �J� ft long Floor area L,-(�� sq ft 7z0 sq ft ca . Tota1 htg 's, to peak ��j � to peak � ', Stories �_ � Stories No. of Bedrooms �-' rear 1ot line or waterline � o (year round) or (seasonal) G rt Type of Bldg or Addition a o ( ) Dwelling � rt ( ) Garage (1) (2) car N. � Storage Building(Z) `� -- ( ) Boathouse � ( ) Livingroom � ( ) Bedroom ( ) Kitchen-Dining o : C � ( ) Porch - enclosed/roofed - _ � ( ) Deck - open �� ��� — ( ) �-�': 6 So, ��p a ( ) s � Q� Type of Construction 1 ��Frame ( ) Block � ( ) Log ( ) Concrete 179- Pole ( ) Steel � � ( ) Meta1 ( ) � �s.� Spb. Construction Cost $� � . Vol �� Pg � of deed �� ���-'� CS Vo1 — Pg —' �y� w � � � � Cer. Soil Test —' � : , , � r ,, Sanitary Permit '7t"j - I$� ---------' Road --��-------� z ` ' � o • z z Issued 23 December 1991 Denied ��. � �.' 1.�,��' �' � � � N`- wner Zoning dmin trator � . . � � `� � � � A \� � � n m �� �� � � --� ... D � � ��\ c ,,J � m �.� \, � � __--\ 1 ���� � \ I �. ., AKE .ST. � � ��,N � � � N__.� \-/ \ ! � � ro � p N N a i 1 W 0 � N N ' � w � LI � m N .. W .. �� 'ti' � � � ° . I1i W p _ �-- _ . � � W - _ ��� � � ����� " _ ��W J �� °�`�, � � _ _: �� �`�� V i,; _� — =- MW ~ J �4 N W � P \ � , � - � �, - � N �l CD A -- ro '- . �.- � � � rn A _ - � .. W � �h.�'rr4 G� SY�cver ---- \\�j ,_� . ....--- ,7\ � N - - � � � � ��/ N � \ '� � I — \ ;j} � � � � � W ' ' I A \ A �� N I N ;�a' -i �' 1� '-� w m `i � � � ' a � +"� � � CLOVEq STREF7 � � �, T+� - � — - �i � � � I _ N N m _ ;� ' O J �!i l� - � � j +'_ _ � y R — W o --w F.� (� k !�3 ro N N �� \ : N , � � - W 1 � � � \ _ "' '� � N � A � � � Z` � 'sNc � �+ MART/N STr?EE,T R� -� � _ ; 3 1`Q� O�� 1� � w N ! r .,� C� �s � �� �` I �. �J ( �-9.�,� f':;o . I, �I � T� �` '�� � �1 � � 1�, ; �'y ���. -li i,•`1 � s� � � I � � w b � �os j�o z�_,;,- '� >� ��r,,.. �� ` ��`__ a� -o� _— ---- � _... �� ✓ � � : y J�, c-p .R' ozn7�,� ,� F'r\�,.. Rj .L� b N y . I\ � { . '�. a. , � ...... Plb g7. . State and County State Permit # �1�—._ . �, - � �� Permit Application County Permit # _���__ for Private Domestic Sewage Systems County Saw.yer _ " DENOTES STAT� APPROVAL REQUIRED . L' S7 � — 2 � � Date Appro I R ceived from Stat:� if Required State Plan I .D. # A. OWNER F PROPERTY Mailing Address: �� i �.� '� � r- �3 ti�-�6� � ����d. � J �� , �T � � t � B. �OCATIO^� :� •� Y4� ', , Section � , T� N , R � E (or) Lot# .. City _ Subdi:�ision PJ�-ne , nearest road, lake or landmark Blk# �e � . Govt Lot 1 - j Township � ��� j= ----_ - C� � �:� �. - C. TYPE OF OCI:U�'ANCY : Commercial " Industrial "Other (specify) 'Variance Singlr family _��� Duplex No. of Bedrooms =�_ No. of Persons_�_ D. i YPE OF APPLIANCFS : Dishwasher _�_ YES NO Food Waste Grinder _ YES�NO # of Bathrooms�_ Automatic �Nasher �YEa NO Other (specify) E. SEPTIC TAiJK CAPACITY � OCat) Total gallons No. of tanks �Holding tank ca�acity Total gallons No. of tanks New Installation 4- Addition Replacement Prefab Concrete -�� J - - - - - *Poured in Place __ Steel � �� Other (specify) _ F. EFFLUENT DISPOSAL SYST �M : Percolation Rate 1 ) � 2) _L3) _�Total Absorb Area ��,;` sq ft. New�_ Addition __ Replacement _ * Fill System Seepage Trench : No. Lin . Feet Width Depth Tile Depth No. of Trenches See a e Bed: Len th ` � ' ' ' '" p g g �Width _��_ Depth � Tile Depth �, No. of Lines _�_ Seepage Pit: Inside d;ameter Liquid Depth Tile Size �_ Percenc sl�Fa of land � : � Distance from critical slope �� " I, the ��ndersi�rie::, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin �,dministr�tive Code, and that I Fiave sized the effluent disposal system from the EH-115 prepared by the Ler�ified S�,i� T?�ter, � ) NAME __��•• �>k % C.S.T. # �S` %�`7 �C, and other information s�'�— -- . obtained from _ �`_�� _ !" (owner/builder). Plumber 's Signature _� a. . �'��... _ MP/MPRSW# ��� � i Phone # �« ..� �"���iv`t � "�s�`'' . / ; l_�.I r N � L.! N DA�.� � =--- PLAN VIEW: Provide ske*ch below of system (include direction of slope and all distances in accord with H62.�i�, incluaing we�l) . ----------�— ; � ' �r�c �i � i�t i�i � � _ . : ; _ � , , . � -=--- ' � '--_ .: . _.� `-1 t T CC'�: : � , - _i.._—i--..._ . . .. 4 � � i . � ; ; � i__-�--�— �_ , . • � --� _ __. _�_ __ , � , r � � ; • ---.. i i ; I � , i � � ' � ' � __} _ _ __, _ : .-- ,.._ . _ . . . 1 __ _. __ . j � �.- : , , ' . i . ; ' � � i � �,�� i � ' �- —t----�--�----•-_ _ .. __ :_ 4 ' . \ __.. _ . __. -:... ; _ �_. . � � � � � i � � i � I : i � ' ' �_ _. , _ ?__ . �_ . �.._. _ _. . .� _ �__._ � ....... } _� � i f � I � i � , , � f. f � � � _ . -. _.�_ �_.....--1 — �.�.. ; - --:_ _ «.. � - - t.._ _. _ i..__ � �, _ � , � � � ' ; � 9� � �. _ �__ �_.:_ _1_._ ._� ;._ : __� _ _ . . : ;_. � , ( + � , � ► ,. ,.1� _ � ` : ! � � �_ � _�_ �_ ._ __ '. _ _ ;. � �' � _ i � � �� � . � � � i ; i � � ' , � � � � � � �r � �` � I __ � :_ '__ ; f , � , , � � , � � ,�n F—.. • 1 � . ,_ _� .__ �___ : ,��� '� 4tt�� _._ . a � � ! � � �_ i ���� 1 _ . , � 3 �' � ; I � -__--i--- -� -. _. _ � _� _ __ .__, _ � { , � � �-- _ __! ._ __ � _- ' � �d i— ;- - —{ - , _ _;. -- { . __ _ _ __.j t� : ,I �, �i��� ' � � � i � � � � , � � i h , � < . . i .. �.. f ..._.- '-t---..... _ .:- 'A S. . �.. ... _.. . . . ... . ._._ "" __..q __ ._r..�... ...y. ! . _ Y .._ ... .... . . . .. . ._.._ � � ,, �i � 9 � � I + __ _ . , � , � i ' 1 -- �- -- _ . N � � , _ � � � B ' , , , . � _ - -- �_ ,_ - -. .__ � _._.�. � f �jb � � _ _ , ' _ . , - t� � ; � � � � P ; � i __ . _- ;---�-- _�-_ (- _ � _ ., - _, 1 I ' , �,� � i `. r7� " _ . __.,--_._ � - . � � � __- . � _- � E � - , � { I � I ; ,-- 5 -t. --r _-_.•_ . � � , - _ , . -_ . . _. _.. 1 _ . � 1 � �--- ��'� � � � � � 1 � , � � � � � � Do Not Write in Space Below - FOR DEPARTMENT USE ONLY Date of Application 09-10 -�Fees Paid: State 1 . 00 County 10 . Date e ember 10 1 `T Permit Issued�,ic:a� (date) 09_10 —`_�_Issuing Agent Name — Deputy Inspectio� Ves_�R'o . Valid# te Rec'd �� .- � - z � - �s� . 1 . county (vrhite copy� 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copY) 4. olumber (canary coovl