HomeMy WebLinkAbout010-841-36-5514-LUP-1991-078 X
11��plication for Land Use Fermit
County of Sawyer y r
o �
1'he undersigned hereby makes appiicatioti for a Land Use Permit aucl ayrees
�
that all work shall be done in accordance with the requirements of L-he Sawyer ° t
County Zoning Ordinance and the laws and regulations of �he State of Wisc�nsin.
PRIN'P - USL ONLY I1L71CK 1NK/L'L•'tJCIL
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Owner Builder
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mail.ing address mailing address
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OU1� r�E, i�i1� �1� •I'�'�,�5�5//� _ � G(�l S $C/,3
city, state, zip city, -ate, zip
D"�u�ilding Land Use Zone District RR`�
W New ( ) Filling �
( ) 1lddition ( ) Uredgi.ng Lot size � �
� �o
( ) 111teration � Grading v� �i
( ) Moving on ( ) ncres �, ,� S I
( ) ( ) vl�
New Construction ' �
Size �y� r f l: wide f t wide �z
i I,
_� f t long ' f t long �c..i
Floor area �_� sq ft sq ft
! N
Total I�gt � to peak to peaY. :�'
, �,
1 f'T j'
Stories �'' �`x�'"�1
No, of bedrooms � rear lot line o w
iyear roun�) or (seasonal) i � r �
i
Type of bldy or addition i '� i o
( ) Dwe 1]i i�g i � � FjCs�fi j UG' ;}
(� Garage (1) � car j � ��'�` i a S
O Storage building � / i Q �*
( ) Doatliouse � 1 : / � � �n
i ; � i N.
( ) Livingroom ��� :' o �
( ) [3edroom 1� � � �
g .. _ _.� _ - f's i
i
( ) Kitchen-dinin � i O
O Porch - e►iclosed/roofed + � `' I i �
( ) Deck - ope�i ' �� ' �Z� i
( ) �` �� �' i t
( ) '�` '� � i ,
/ �1, i
N . /SZ L` I �O.
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Ty of construction � F / i '
�E'rame ( ) Ulock 1 �
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( ) Loy ( ) Concrete , i (J�
( ) Pole ( ) Steel � 7 �
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( ) t•1eta1 ( ) � j
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Construction cost $ � ps70� � �� � t� i �
;/�,� , 36 i
Vol _��,�,�'a_ pg 4`f� oF deed i 5s � ��
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CSF1 Vol _�_ pg _�_ � r, i �
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Cer. Soil 1'est _�Q-31�J j i m �
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E. Louis Lindholm
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I, Ronald L. Peterson, Wisconsin Registered Land Surveyor, hereby certify
that in compliance with Chapter 236:34 of the Wisconsin Statutes and under
the direction of Dr. Van Gorden, owner, I have surveyed, divided and map-
ped the land herein described, that said map is a correct representation
of the survey made, to the best of my knowledge and ability and that said
land is a part of Lots 4 and 5, Certified Survey Map �k1428, Volume 7,
pages 193 and 194, located in Govt. Lot 5, Section 36, T.41 N, R.8 W.,
descrobed as follows; j
Commencing at the Southwest corner of said Govt. Lot 5, being a meander
corner between Sections 35 and 36, on the Northerly shore of Little
Round Lake, Thence N. 0° 26 ' 15" E, along the West line of Govt, Lot 5,
505.72 feet, Thence S. 89° 32' 21" E, 300.00 feet to the actual point
of beginning, Thence S. 89° 32'21" E, 158.69 feet to a meander corner
on the Westerly shore of Little Round Lake, Thence along the meander
line of Little Round Lake as follows, S. 35° 53'03" E, 158.92 feet,
Thence S, 73° 54' 15" E, 198.40 feet, Thence S. 61° 06'21" W,
175.97 feet, 1'hence S. 49° 26' 15" W, 154.78 feet to the end of said
meander line, Thence N. 29° 33 '45" W, 102.54 feet, Thence N, 0° 26' 15" E,
100.00 feet, Thence N, 89° 32'21" W, L00.00 feet, Thence N. 0° 26'15" E,
200.00 feet to the point of beginning, and including all the land between the
meander line and the waters edge of Little Round Lake, between the parcel
lines extended.
Subject to all existing easeme k�Sa� _ O� s.
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This instrument drafted by ,�J. . �� RON/U.D L �
Ronald L. Peterson 1t PE7'ERSON
Ju 21, 1980 SA00
� jJ '� NAY�IAPD
/�-%r/d�c CY. ,��A..�) p�g,
A roved this �da of ����� $ Cu�18��� � �U ���
PP '-'�."" Y U Y C�c<-� � e2
�---._- � Sawyer County ZOning Admin.
7ak�rd ��
l'-/
Page 2 of 2 pages .
3aa
;DEPARTNlENT OF � APPLICATION � SAFETY & BUILDINGS
� INDUSTRY, � FOR SANRARY GIVISIONcc
LABOR AND PERMIT P.O. BOX 7969�,'
HUMAN RELATIONS (PLB 67) MADISON, WI 53707�
0
Attach plans for the system on paper not less than B'/z x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. kiorizontal
and vertical elevation reference points must be shown. All appropriate sepxrating distances and physical characteristics as specified in chapter
H�63, Wis. Adm. Code, must be shown. An index page or each page must be signed,sealed and dated by the designer. If designed b�� a Master
Plumber,the date,signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be
included.
Property Owner: Mailing Address: ..{�.
� 0 6 /!� 5�,, '7�S/� /� � O ,u %�! .S G
Property Location: City, illage or Townshio: ounty:
• � '/oy✓'/<S3 �T Y/ N�R C-�er) W YG. d 5 �s—
Lot Number: Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: State Plan I.D. Number.
� G! � /� / (If assigned)
LG /( UN CT 4 E-' —
TVPE OF B ILDING
Number of �
❑ Public" ❑ Variance" ❑ Other (specify�" sedrooms:
7 or 2 Family "State Approval Required. �
TOTAL NUMBER PREFAB POUFED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OP TANKS CONCRETE PLACE WSTAL�ATION MENT (Specifyl
SEPTIC TANK CAPACITY r
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUPACTURER: '
EFFLUENT DISPOSALSYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square fee0: � NeW ❑ Replacement ❑ Experimental C� Seepage Bed ❑ Seepage Pit
/ /� i � ❑ Altemative (specify) ❑ Seepage Trench
«� �l
Water Supply: Owne%s Name as Listed on Soil st ReFort Uf other than present ownerl:
C� Private ❑ Joint ❑ Public JJ j; j f/ � (�'�r-�n �
I, the undersigned, herebY assume responsibility for instal io f the private sewage s stem shown on the attached plans.
Name of Plumber: i . MP/MPRSW No.: Phone Number.
/ �..� "{�,— i��� .� f .� ���n G J Y-YLs.
Plumber's Address: � Name of Designer.
C� P� � �G ..r�Cr� S '
COUNTY/DEPARTMENT USE ONLY 80- 315
Sig of Issui A Fee: Dace: �qppROVED Sanitary Permit Number:
�60 . �� �- Z- $2 ❑ DISAPPROVED Z944Z
Reason for Disa oval:
Altemate coursels)of Action Available:
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to im
stallation. Failure to comply will void the sanitary permit.
DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
DI LHR-SBD-6398 (N.03/81 I
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DEPARTMEP�T OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVIS'ION
P.O. BOX 7969 BURFAU OF PLUMBI�:G
MADISON, WI 53707
L� CONVENTIONAL ❑ ALTERNATIVE StatePlan �.o N�mh<<
Ilr a:signedl
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PEHh1iT HO�OER. ADDRESS OF PERMIT HOLDER� INSPECTION DATE�.
f�M E S SG a�tit � � I°%. , v� � (J��„ ��
BENCH MAHK (Permanent relerence po�nU DESCRBE IF DIFFERENT FROM P�AN�. REF. PL E�EV.: C5T FEF, P1', ELEV.�
I � 0
Nam�� nl Plumber MP/MPFSW No. Cou�ny�. Sanit3ry PermR Number
�W t� A� �C !vt !��i+��. � A W �( C
SEPTIC TANK/HOLDING TANK:
MANUFACTUHER LIQUID CAPACITV. TANK INLET ELEV. TANK OUTLET ELEV. WARNING LABEL LOCKING CO�'ER
) /�, PROVIDED�. PROVIDED-.
� ''� lV� L,I �YES ❑NO ❑YES ❑ NO
BEDDING: VENT DIA. VEN7 MATL. HIGN WATER NUMBER OF ROAD�. PROPERTY WELL�. BUILDING� VE�T 70 fRESH
ALARM FEET FROM A//� LINE� � �� �O AIR INLET�
❑YES ❑ NO ❑ YES CJNO NEAREST '"
DOSING CHAMBER:
MANUF ACTURER BEDUING LI(]UID CAP�1C1Iv PUMV MODEL PUM�P,SIPF�ON 11ANU�r1CTlIHEH WqRNING LABEL LOCKING CO�'ER
PROVIDED�. PROVIDED�
❑YES L� NO ❑YES ❑NO ❑ YES ❑NO
GALLONS PER CYCLE: PUMPANDCONTROLSOPERl�TIONAL NUMBER OF F'F�(iPEHTv WE�L BUILDING VE�TTOFRESH
(DIFFERENCE BETWEEN FEET FROM ���`E AiR iN�Er.
PUMP ON AND OFF) ❑ YES ❑ NO NEAREST—�
SOILABSORPTIONSYSTEM. Checkthesoilmoistureatthedeptho( plowing � f '��,��� ��nrnE,E�+ h-iarEH�a� nn;� Ma��KiNc
or excavation. (lf soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
IVIDTH LENGTH NO Of pISTR PIPE SPAGN(V COVER INSIDE DII� rp1T5 L �UID
BEOlTRENCH TaENc�Es / s�nTEaia� P�T o_aTH
DIMENSIONS , sEj w�
GHAVFL UFPTH fILL DEPTH UISiH PIPf UISTH PIPE DISTR. PIPE MATERIAL NO. D�STR NUMBER OF � PROPEHTV WELI. BUILDING�. VE�T TO FRESH
BEL�1W PIPCS ABOVE COVEH ELEV�j NLE � ELE�/. END PIPES FEET FROM LWE � � / AIRu INLET�
�j �� p�Z � 7� � NEAREST—s �O �� �C� V �
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
❑ YES ❑NO
SOILCOVER tExruNE PErannaNENrnnnHKEHs otisEF+vATio�� wE��s
❑YES ❑ NO ❑YES ❑ NO
UEPTn OVFH iHfNCN 8ED pE�Tu OVf H ?RENCH.BED U[P7H OF TOPSOIL SODDED SEEDED n.1ULCNED
CFNTFH EDGES
❑YES ❑ NO ❑YES ❑ NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
b'JID�ta LENGTH NO. OF LA7EFiAL SPACIN6 GHAVEL OEPTH HF LU1^J VIVF FILL DEPTH ABOVE COVFH
BED/TRENCH rRervci+es
DIMENSIONS
MAMFOLD PUMP MAMFOLD DISTR PIPE MAMFOLD MATERIAL NO DISTH DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MAHKING
ELEV. ELEV DIA ELEV. P�PES DIA.:
ELEVATION AND
DISTRIBUTION
INFORMATION '�OLE $IlE NOLE SPACING CRILLED COHHECTLV COVER MATERIAL VERTICAL LIFT CORRESPOND$ TO APPROVED
PLANS
❑ YES ❑ NO ❑YES ❑NO
COMMENTS: PERMANENT MARKERS� OBSERVATION WELLS: NUMBER OF PROPERTY WELL� BUILDING�.
FEET FROM � �"E
❑YES ❑ NO ❑YES ❑ NO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNAT E TITLE
DILHR SBD 6710 (R. O1/82) d�/,Lrn� / +(.�Y/Iv�S � IT �r! �