HomeMy WebLinkAbout010-941-17-4201-LUP-1991-087 x
npplication for Land Use Fermit
County of Sawyer ,a ��
d
7'he undersigned hereby makes applicatiou for a Land Use Pezmit and ayrees � �
that all work shall be done in accozdance with tha requirementa of the Sawyer �°
County Zoning Ordinance and the laws and regulations of the State of Wisconsin. �
PRIN'1 - USE ONLY BL1�CK 1NK/Plit1CIL `�
��.mes y � hir�euA �nUl� lcZmeS Qoy ��_ �
Owner 8uilder ����
� 8 �o x S3 '� ��N ��,- � R<>x �`�/a'� �' �
mailing add�ess mailing address
�c�i,U�.�/d.rr-� , l c,���. �5�`/ri h'.� N d �/1�'d r� �tJi• �7'�r�y.�
city, state, zip '9'
city, state, z p
Building Land Use Zone District �.�.'-1
( ) New ( ) Filling
O nddition O Dredging Lot size s �
.- m
( ) niteration ( ) Grading � ��
�) Moving on ( ) _ Acres �n . �°� �� �
( ) ( ) _
'�O'-c-�� --�-eo�- �
ew Construction _' �
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Si e fC wj�de � ft wide � � `t
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� ft��long � ft long j
C �
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Floor area� � ' sq ft �� sq ft -
Total hgt , �� � to peak �� / to peak x�
Stories / ��
No. oE bedrooms � rear lot line or waterliue (Z
(year round) or (seasonal) �
� f �/`/O� i c�
Type of bldg or addition � 1'15� � �
( l Dwelling �� � Ao�ws Hr Di � � `�
( ) Garage (1) (2) car i 5 � �
� a�x�s�� i� � �S
(� Storage building b ��. � `z. � i r �
( ) E3oatlwuse � � �'
( J Livingroom , ���� �, i yI
O Bedroom i I A i
( ) Kitchen-dining j ._ � � � � p
' i �o.;�..¢ o � O
( ) Porch - enclosed/coofed �
O DecY. - open ; � � i i I
( ) �i 300' '�' � ��
( ) ;�.i � i�5= i
;� 13Y'r � I � �+-
1 ? I£y�� �
Type of construction �+� ...��, n� �
( ) Frame ( ) Block i ��-� z�+'� � �I�
r` /) Log ( ) Concrete � '��a � i -0�•'
(� Pole ( ) Steel - j � �`�O' � N""
�x� Metal ( ) i 2 5� � o
i �
Construction cost $ �S�Q, j , ��-- � �
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Cer. Soil 1'est �,5- 13'� i 459� 3vt�' � 6G� � Y�
' ---`-----CL road ------------------- z \
Sanitacy Permit � - ��9 �j.4�j U D �0 1�1.� � �
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Issued y=�� m� I�C� ' �enied �
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. � owner �- Zoning Admini trato
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I ,' �� N89°38�46��E,33.00 - -- - - N89°38�46��E , 955.78� ---- --
� � _ � ROAD EASEMENT � �
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cD • — SW Cor. NW I/4 S E I/4 — � FOUND MONUMENTS
3 � Set II(4"Dia. Iron PiOe • SET I-V4 ��X 30��IRON PIPE
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p Ih BEARINGS ARE BASED ON SOLAR OO
� OBSERVATIONS .'�lCjCONsj O
' . co SEPTEMBERG, 1983 SCALE 1��- 100� \\� � �
� _ � :tONALD L �C
— ��/� � p � � PETERSON � z �
�Gtq c[.[c7. � ���—,� ��' �� '� .
. ' I _ .+ � �\ � � P ..
;' � SI/4Cor, Sec. 17,T41N,R9W ' ��.0 �.�Q �
� Fd. 21/2��Brass Cap Iron Pipe SUR
(County Cor Rest. Index N-71
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I, Ronald L. Peterson, [di_sconsin Re�istered Land Surveyor, hereby state that
in compliance with Chapter 236 .34 of the Wisconsin Statutes, and under the
direction of Sames Boy1e, owner, I ha•�ie surveyed, divided and mapped the land
herein described, that to the best o_` my kncwledge and ability, this map is a
correct representation of the survey made, and that said land is located in .
� the NW'�-SE`�, Section 17, T 41 N, R 9 W, described as follows :
� Commencing at the Southwest corner of the NW�-SE�, Thence CI 0°38 '0�" W, along
the West line of said N[d�-SE'�, 568.24 feet, Thence N 89°38 '46" E, 33.00 feet
to the actual point of beginning, Thence continue N 89°38 '46" E, 955 . 75 feet,
Thence N 0°38'OS" W, 300.00 feet, Thence S 89°38 '46" W, 955 . 73 feet, Thence
S 0°38 'OS" E, 300.00 feet to the point of beginning.
Subject to a11 existing easements and reservations .
, `SCONS�
,
; � � - I�
�orr��.� �. �
���� PETERSON
! I saos
� '�� ; HAYWAFiD / ,
This instrument drafted by \ f ` . W's / Q'
Ronald L. Peterson \ 9 � _— / 0
�/O ^ vr�'�
Sept. 6, 1983 �,\ J�JR
�;�C� ���
Approved this � day of �ya7� , 1983, by �������r;�
Sawyer County Zoning Admin.
1�����
188335
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sQ..Y�co�v j'
R 'ved tcx rec�d tii9 Y� HQE�
A D 19�c3 '�o'cla:k �
�� � �, Page 2 of 2 pages .
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Repl�l�c
Depury
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DEPARTMENT OF INDUSTRY, INSPECTION RE�ORT FOR SAFETY & EUIL DINGS
LABOR & HUMAN RELATIONS pRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF f'LUMBING
MADISON, WI 53707
�CONVENTIONAL ❑ ALTERNATIVE s�a�e �°�,,�, �.o. N�m�t�� ---�
(iI dTSiQnYf��
❑ Holding Tank ❑ In-Ground Pressure � Mound ___�
NAME OF PEHMIT HOLDEH ADORESS OF VERMIT HOLD'eR�. INSPECiION DATE.
�'c�m S T. �D 1e. 8r� a- �a �..uo:r io -(5-85
BENCH MARK IPermaneni reiere�ce Uo�ml DESCRIBE IF DIFFENENT FHOM PLAN REF. PL ELEV.: CST HEP. PL CLEV
� SIc�1.t►1 � E • Corh�r Q.i'0. e. ( �O � -
Name ol Plumher i:MPR$W Nu �ou��'.y Saniiary Permrt Numbu�.
�-acurene. �m �e�r � b-� � c�w r 85 - ( I q 651Q
SEPTIC TANK/HOLDING TANK:
MANUFACTUREH. UOUID CAPACITY LANK INLEi EL[V. TANK OUTLET ELEV WFHNING �ABEL �OCKING CCVER
IPROVID[D. PROVIDED�.
l IOO� � . ��, ���ES iJNO 'YES ❑ NO
BEDDING: VENTDIA.. VFN7 'Anll HIGHNJnTEti �UMBER�OF � � f3UA��� N��OPERTV NJcLL� 2UILDIN(;�. 1VEVTTOFRESH
ALnHM � LItdE � � AIP INLET
�� ('( � FEET FROM � as ' � � � �
;_iYES UNO � \ •� uYES �_iN0 NEAREST--� _ � I � �
UOSING CiHAMBER:
htANUF,�CiUf�ER BEDDING UQUIf1 CnPACi i v P�,^.9v M11f�l)f l �^,,^.YF SIV��f;rJ :^.nNU� nCIUHtit WAFNING LA6EL LOCKING COVER
PROVIDE(� PROVIDED
❑YES ❑NO C_JYES L_)NO L� YES ❑NO
GA�LONS PER CYCLE: P��^^P A��� c�vT"O�5 �'PEHnT���v�� NUMBER OF �'�'���'���r� wE�� aui�oin,�; � vevr ro FaesN
(DIFFERENCE BETWEEN FEET FROM ��NF aiF iN�Er
PUMP ON AND OFF) C_� YES �� NO NEAREST—�
SOIL ABSORPTION SYSTEM. Check the soil moistureat the depth of plowing — � � �����r, innar rE�s �.+nrt r,in� nrvn ��+A�+KiN<;
or excavation. (lf soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WID�H LENGTH � Ni� Of OIS`.;� �IV[ SPnCiN(1 C�jvFH U;51'�.Ji. iii%�. =PIi$ LIOUID
BED/TRENCH I rr.Fr�cr+es � n�nriwi�.� � � p�T ' . [ePrH
DIMENSIONS �, 3� ---� � �
GHAVEL DEPTH �ILL Df.PTH UiSTH PIVf UIS1H PIP! DISTR. PIPF MATEHI4L NO I)li�i�1 . NUMBER OF NVapVEH1Y WELL BUILDING� VEtlTTO FRESH
ee�nw aiPes i� nHovE cc v�H � i Ev iNi � � Ei_ry Evu P�vEs FEET FROM � urvE � 1 aiF iN�eT �
3 �. S ��•�� P�C ___�_a_� NEAREST--�► �SD � 3O � 30
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 rexnnvt � �uan�vrNrr.�,v:�t �+s �,��sei+��.>n��Nwe�i_s
_ � C�YES ❑NO ❑ YES ❑NO
DEP7�I fNER iHFNU� BED DEPiH t)Vt H TNE.NCH Hi U '.�! Pi�� Uf ftl✓ti�ilL tit�ilUf U JEEUFI) ,YIULCHED
CENT[fi EDGES
UYES ❑ NO ❑ YES �NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
wiorfa �eN�,rri No or inrEi+�i s��nc�Nc <tNnvr� ot��ir+ eE ��>wi�ii�; Fiu �earr+ a4ovEcovEH
BED/TRENCH raervcNes
DIMENSIONS
MANIFGLD NUMP MANI�:)Li) UISTR VIP[ MANIFn�DMAiFHIl�L NO UiSTN UISTN PIPE UISTHIBUIIONPIPEMATEHIAL & MAHKWG
ELEV. ELEV DIA ELEV PIPES DIA .
ELEVATION AND
DISTRIBUTION
INFORMATION "o�esire rio�es�nciN�� rsi��t_ocnri��tci � v coveNnnnl�r+ia� veHricn� �iFrco�aesPONosronaaaoveo
��nr,is
C� YES ❑NO ❑ YES ❑NO
COMMENTS: PERMANENT MARKEFS OBSERVA710N wELLS NUMBER OF "� PROPERTV WELL� BVIIDING
FEET FROM ��"E
❑YES uN0 ❑YES L� NO NEAREST
,
Sketch System on Retain in county file for audit.
Reverse Side.
si<;Nn iH 7i7�E
. �
DILHR SBD 6710 (R. 01/82)
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w'�°�^_�� APPL9CATION FOR SAMITARY PERRAITi
�
� DILHR SAu�ER �
couvry �
(PLB 67) �'
oePran.menraF UfVIFORM SANITARV PERMIT �" F-'
���V�Tpv LReOR 6�u�'p�'RE`RT���� C S T S S- 13 3 6 519 6 �
-Attach complete plans in accord with s. H 63.05, Wls. Adm. Code for the system, on paper not less than 8'hx 11 inches in size. .
-See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER ,1 MAIL�NG DGRCSS n ' i
�C,�im-e5 � �� C,v � �c ,��c�— �!" �i�2 y, ��1� .--�(. Lvr . Sy ?Y�
PROPERTV LOCATION -Ei-Wr � � � �
� ` Y1LLqGE, ' �
ti'Lf, 1/4S�'1/4, S / , T�'/, N, R " �E-for) W -rowry oF: /-�r�, wu..���-
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST HOA ,; LAKE OR LANDMliRK STATE PLAN I.D. NUMBER
� /' i
�� � c� � lf_i� l^U ��Ci�Q�-
TYPE��OF BUILDING OR USE SERVED
�S 1 or 2 Family Number of Bedrooms�. "7i ❑ Public (Specify�:
THIS PERMI�T IS FOR A:
<' ew System C� Tank Replacement ❑ Repair
i� Replacement Soil Absorption System '�.i Revision ❑ Privy
i-J Altemate Sysrem J Reconnsciion C� Petition for Modification
IF TH� A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
Seepaye Bed L�' Seepage Trench —� Seepage Pit ❑ Holdiny Tanl<
❑ System-In-Fill �J In-Ground Pressure ��i Vault Privy � Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit r issued
�,J An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total #of Pre(ab. Site Sreel Flberglass Pl�s[Ic
Gallons Tanks Cnncrere Constructed
SepticTankCapacity �-.a�., x
Llft Pump Tank/Siphon Chamber
Holding Tank capaclty
Manufacwrer "��j/�
IF THIS IS AN ALTERNATIVE SYSTEfJI C0�4PLETE THIS BLOCK: ❑ Mound :_i IrnGround Pressure
Total �'o( Prefab. Slte Steel Fiberglass Plastic
Gallons Tanks Concrete ConsVucted
Septic Tank Capacity
Lift Pump/Siphon Chamber
Manufacturec
PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA VVATER SUPPLY:
(Minutes per inch�: REQUIRED (Sryuare Feet): PFOPOSED (Sc�uare Feetl:
❑ Private '� Joint ❑ Public
I, the undersigned, hereby assume responsibility for installation of the priv t�sewa9e rystem shown on the attached plans.
Narlte of Plumber (Print): � wset� _�_��� 7�/MPRS�N_No.: Phone Number:
/
'_UcG�/-C'�s� c-C' ��-��i?r �"�ti'�'✓ ��/ce:2,-c,ce _ � �i�-Y���.�c�i� /� ,'� 17��)�5'4-Y�=
Plum r's A dress: ' ° Nar�E,of Deslgnee �
� � �, �/ �1 » � �� � A
�_6 d 1 1_— cf� �.� �✓- ��� �� ��'L� -o�-� ,G � c. ��'� �I.�-----_
COUNTY/DEPARTMENT USE ONLY
ISign e of Issuing Ag= t Fee'. Date: �
� Disapproved
L- Owner Given Initial
$9 5 . 0 0 c�-�7- g S Xl qPP�a�ad q�verse Determinatior
eason for Disa oval'.
Altemate course�s)of Action Available:
�ILHR-SBD-6398 (R. 6/82) DISTFIBUTION: Orlglnal to County, Ona CopY To; Bureau of Plumbing,Owner, Plumber
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