HomeMy WebLinkAbout010-941-26-4311-LUP-1991-110 .
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��`'�� 1lpplication for Land Use Fermit �_
N�4'"�V�� ,� �'�ll�,�`:1-- County of Sawyer
�'�_ , ,.!.!C.. o �
The undersig�ied hereby makes application for a Land Use Permit anc] ayrees
-! �
tliat all work s}�all be done in accordance witli the requirements of tiie Sawyer °,
County Zoning Ordinance and the laws and regulations of the State oE Wisc�nsin.
��O�w � � • � PRIN�r — usL ONLY ULd1CK 1NK/F`liNCIL
C/�.� a ��
��N�► �� �v1��s z. ��� a%�� E�15��-� � ��►
Owner Builder
�)�--�- �--�,� L-� � '`, �� � /�c�X ��� 5`
mailing address mailing address
_ 1� A 4�u.� w i��i t� � S�1 s��l� l-�►s 4�w,��' � tiv� ����
city, state, zip city, state, zip
�uilding Land Use Zone District �,�-+
( ) P�w ( ) P'illing S $q
(I�nddition ( ) Dredging Lot size rr �
( ) niteration ( ) Grading N �+
( ) ttoving on ( ) Acres �� �p� ,
t � c � �
r: _ ,
tt- � � �_�;C:-� �r`�.�;=4>d �_:,�., d t�;�'�
New Construction '
( � ci�T �..�,c.;E ,, �,_��',
Size � f l wide �"'"�'''` �`�= f t wide �!,
V;
/ �-- f t long ( � f t lony �
Floor area I� sq ft �1�_� sq ft {'�
i � �? l
Total ligt � � to peak I �- to peak %�' r
-,.
Stories � I �
No. oE,bedrooms �� ' r rear lot line or waterline
�ear. round) or (seasonal) � � �
( i i o
'I'ype of bldy or addil-ion i ; C
( ) [lwel l ing � .,�, �� .':� � � rt
( ) Garage (1) (2) car � � - _ _ � � � � �'
( ) Storage building �, � � � ` �'� � � �
( ) E3oatliouse � � � � �G � i N
( ) Livingroom �y�/' � i o
rY � � I
( ) F3edroom � G ,. ,� �
� r �i 7 �
( ) Kitclien-dining j \� i
( ) Forch - enclosed/roofed � � ��� �24 +� i �
( ) Deck - open I�v � " " �
(�" _t�C-� �'X��f�.� �Sc'/�', i � 20� D � -
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TYPe f construction '� �� p8, � ,�_ i �
( [�rame ( ) 131ock � � � _1_�_� �` �0 1 CA
2� ; � � �
( ) ►,og ( ) ConcreL-e � � � � _��I2° 1 o i �
( ) Pole ( ) Steel y� ��c._�` ' 1�, c�'�r,k,r hi �...-
( ) t•f e t a 1 ( ) r '1�o Y �j )�a'' ,�,.�`��,,r t �
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I VO . `�=' -��\�- °' I (ND
Construction cost $ � pb j �,'`I � ,I ►Z2' � �
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TOWN OF
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LA K E 13� .'3.6
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� P L B 6 7 State and County State Permit # 10 36 0 - ,
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�q Permit Application County Permit #
� for Private Domestic Sewage Systems County
Sawyer
"DENOTES STATE APPROVAL REQUIRED CST 79 - 372
Date Approval Received from State if Required 12- 08 - 8 � State Plan I .D. # g0 - 50789
A. OWNER OF PROPERTY Hayward Animal C11ri1C Mailiny Address:
�o � N � , ki,Lt� lSz �QT � � /} i� a � T, i�c. , � c� �/ ;3 `�
B. LOCATION: �L' }�'�'a �S � Ya , Section � , T� N, R � (or►� W Lot# City
Subdivision Name, nearest road, lake or landmark Blk# Village
C� -r � `�� '� Township l�f� �/r.t,',q2�
C. TYPE OF OCCUPANCY: *Commercial "Industrial "Other (specify) 'Variance
Single family Duplex No. of Bedrooms No. of Persons
�• SEPTIC TANK CAPACITY � 0 � �1 Total gallons No. of tanks �
HOLDIIVG TANK CAPACITY Total gallons No. of tanks
Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) _
New Instailation Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate � � -- Total Absorb Area �"' `� sq. ft.
New � Replacement Alternate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenchf�s
Seepage Bed:._.�—Length •�_Width�—Depth�Tile depth (top)_.�..�—No. of Lines �
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land t '�� Distance from critical slope 1�1�
WATER SUPPLY: Private� Joint ❑ Community ❑ Municipal ❑
Owners name as listed on EH 115 if other than present owner: �"���_ � V �2 � �,� �;
I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
Wisconsin Administrative Code, and that I tiave sized the efftuent disposal system from the EH-115 prepared
by the Certified Soil Tester, O
; NAME + -+i.i C' Y. 2 � G G .3 C.S.T. # � . � — `I �f / and other information
E obtained from 'p [" ".! ' n ., (owner/builder�.
� Plumber 's Signature�Y- , '�'-z- �y L--=� I�1 p�Mp�g 6 .- ' - /� Phone # 7�,�j —��� 5 �ylj'�j
, Plumber's F.ddress � 2 Stone Lake 1'1T1 5 �
� PLAN VIEW: Provide ske,�{;h below of system (include direction of slope and all distances in accord with H62.20. Well loca-
ition shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors
� property. If well has not been drilled please indicate.
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Do Not Write in Space Below - FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application 11 - 10 - 80 Fees Paid: State 14 . 00 County 36 . 00 Date 11 November 1980
Permit Issuedl��aCt3� (date) 01 - 08 - 81 Issuing Agent Name Elaine I��ling
Inspection Yes x No State Valid# Date Rec'd
1 . county (white copy) 3, owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
4
Department of Zoning and Sanitation
Sawyer County
0
Inspection Report �
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Owner
Address
Name of business
Builder
Address
Plumber �
Address
Inspection
H
( � Private ( � Public Property Sanitary-instal � �
Dwelling Setback - lake
Violation Mobile HM Setback - �road o�
Garage Setback lot lin
( � Sanitary ( � Zoning Privy
tz�
N
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x
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Discussed with owner yes no �
Discussed with builder yes no
Discus5ed with plumber yes no
Discussed with ' yes no
Dat e �%- /�- �G�
Signature of Officer ��� j����--�'
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Plb. # 60
1/78
PROJECT DETAIL DATA SHEET `�
NAME OF BUSINESS �-�Fjy�uARo A NI Nr� L/N 1
LEGAL DESCRIPTION ,t) %2 � S L� %v ��G �6 TtuN �ll N R 9 GU
OWNER �ToFJF� � ku�is� _ P1AILING ADDRESS RT oZ
Mout�.ILt ZIP �0�1�9
ARCHITECT, ENGINEER, ,,C�il l F�(!r.5 ����'J��� ADDRESS �� � S f�'1 IY F ���
PLUMBER OR DESIGNER
� ZIP Jc��f��
TELEPHONE NUMBER %/3!- ,��S' C /�/`�
1. Check appropriate building usage(s) and fill in the information requested opposite
each usage listed. Please consult Section H 62.20.
Existing building New building ��S Addition _
( ) Apartments and condominiums . . . . Number of bedrooms _
( ) Assembly hall . . . . . . . . . . . Seatinq capacity _
( ) Bar . . . . . . . . . . . . . Seating capacity _ # of ineals served _
( ) Bowling alley . . . . . . . . . . Number of lanes ( ) With bar
( ) Campground and camping resorts . . . Number of sewered sites
Number of unsewered sites
Total number of sites
( ) Camps . . . . . . . . . . . . . . . ( ) Day use only Number of persons
( ) Day and night Number of persons _
( ) Catchbasin . . . . . . . . . . . . . Number
( ) Church . . . . . . . . . . . . . . . ( ) No kitchen Number of persons _
( ) With kitchen Number of persons _
( ) Dance hall . . . . . . . . . . . . . Number of persons
( ) Dining hall . . . . . . . . . . . . Number of ineals served daily
( ) Doq kennels . . . . . . . . . . . . Number of enclosures
( ) Drive-in restaurant . . . . . . . . Inside seating capacity _
Car-service -- Number of car spaces
( ) Dump station . . . . . . . . . Number of dump stations _
( ) Employees ( total of all shifts) . . Number of employees •
O Hotel O Motel O Cottaqes . . . . Number of units with 2 persons per unit
Number of units with 4 persons per unit
(� Medical and dental office bldas. • • Number of doctors, nurses, medical staff j
Number of office personnel �
Number of patients ,3
( ) Mobile home parks . . . . . . . . . Number of sites _
( ) Nursing homes . . . . . . . . . . . Number of beds
( ) Parks . . . . . . . . . . . . . . . Number of persons_ ( ) Toilets ( ) Showers
( ) Restaurant . . . . . . . . . . . . . Seating capacity _
( ) Dishwasher and/or disposal?
( ) 24-Hour service
( ) Retail store . . . . . . . . . . . . Total number of customers
( ) Schools . . . . . . . . . . . . . . Number of classrooms � Meals ( ) Showers
( ) Self service laundry . . . . . . . . Total number of machines
( ) Service station . . . . . . . . . . Number of cars served daily
( ) Swimming pool bathhouse . . . . . . Number of persons _
( ) OTHER . . . (Specify) . . . . . . . �_ _
COMPLETE OTHER SIDE
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��� �:� Indicate whether the following facilities are present.
Floor drain yes x no Number of drains �
Food waste gr;n,�+ar yes no
,,,,� Dishwasher yes _ no
� Automatic clothe_� washer yes _ no Number of clothes washers _
3. Septic tank cap=,city � DOC�
Holding tank ca�;�=_city
Septic or holdir�g tank man!ifacturer
4. SEEPAGE TRENCHES: total square feet width of trenches
length of trenches depth
number of trenches
SEEPAGE BEDS : total square feet �j(� � width �� �
l ength of bed �/� " depth � y "
SEEPAGE PITS : total square feet outside diameter
depth below inlet
total depth from top to bottom of pit
Sigr�a�ture ofi p�rso� completing form: FOR DEPARTMENTAL USE ONLY
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Address ���/1; ���� � �lt � „� �--���
Zip 5'0" � %'�
Telephone Number �� j�. S� C S � � �'°�5`�
Date
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Wiscori^i.ti ..��.�� l.�� c . ��r; ��i ',>i� i;li^ d_i _��,c�tion of' Ua �ius Ja;i,�
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th� 1:�_ri�l h<>> c;_n ,' �.,c'r f L���+ , rui�l that :��i�J la.nd lir�:� in pa�� L oi' thF�
rior�t��a�ae� b n� � :�n�,i, ���, . �, r ;iic �o;ztliea�i o:�c-fourtli (., . , � or ;; .E. � ) `
anrl t}ie ��o,� tir,���rL .,i;�_ 1�„�,� L„ o.i' Uhe -�ou�:'-ieae:L on��-tvur�tli (:; .��.d . ; �
oI :� ,. 4 ) ol ,, � ! ,;i L�: , �, � ,;-':i ;_ (2u) , letrrts�i:if; .Corty-oii��� (��.1 )
i�OY.'�f:; � }��i'll�� i].Lll'. (: i .-, ,. L � lOIVIl O� i1.1'V'vJ0.YC1 , :�'dl'!yC)� .:OUll�y" � (.1S—
con�in �l�sc� iLcd � .; f�ill oris :
� o�n�ucn� l�� �� �� l lii�. ��1 � ;�12ier. ��+'esb of tiie souti'ieast ,ction
corncr o � . _ � � , I �_uu . . �,i;ence l;olti� OS°27 '00" �.e;� t 10��). G:`;
i'eet to ari ii -�ii j�i f�� � �'�'-�,�; oi: tiie no��tii i�i�i,t-ol-v�ay oY _ . 'i' .i�. "li"
vrtlicYi i;; tlic l��r���1 -,; f -��:���;i��iiitih.
i'ii��ic� Uoi� ��;��. '. ' j,.� " .�rc, � G17. . uy f'eet aloii�; tlie not:��l�i rigiit-
of-��aay oJ� U . 'i� . i�. "�_ ' t-� �:�i i,oii pipe;
1��1r�i1C(` l.�)I ��� _ ���.�..ir �� ..�� . _ ,3-� �vj. j� .��C'.(: � t0 'dYl 1Z'OI1 �.11})l.'� .
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i'Yieiice ��o�_itu .. �1 " ;;;isi: v31. . b1 i'ent to an iroii pil�c;
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'ihoncc ����, I;li 1�; " ,
ls the �,oint-of�-I;��>;,;_�.ini.�i,�..
Sa.i�� r,r,r�c�J •�,�� t�"�; i�=� 1. 1 �� acr_es ;�ioxe-or-less.
S�_�d i>ai c:� l ���'o ; �� L to easemerrts and re;,ert��a.tions o�" record .
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