HomeMy WebLinkAbout010-145-00-1100-LUP-1991-151 Application for Land Use Perm.it k-
County of Sawyer a
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The undersigned hereby makes application for a Land Use PermiC and aqrees
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that all work shall be done in accordance with the requirements of Che Sawyer °�_
County Zoning Ordinance and the laws and re9ulations of the State oE Wisconzin. '
PRIN'P - USE ONLY llI.ACK 1NK/PEtICII.
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U�,vo,� .�,v1.�FF �
Owner Builder
�!P � u.� i�, _�/0 Bo�C ��
maili� ad ress mailing address ��
��i(�,x l53 �ygy 3 �.�,, �cJ.�4��, LLL� -5���3
city, state, zip city, taCe, zip
�uilding Land Use Zone District �-_�_
J� New ( ) Filling
O nddition O Dredgin9 Lot size � d � C) � S �
( ) Alteration ( ) Grading ��� p � H
( ) hloving on ( ) I+c=es � p
( ) _— ( ) — r (c
-�1- �
New Construction ' � �
/
Size _��_ fC wide ft wide �
V
_��_� fL- long ' ft long 3
Floor area _��-�_ sq ft sq ft
Total hyt �Z( to peak to peaY, x
Stories _1_
No. oE bedrooms rear loC line or Cerli�'e ��'
�
(year round) or (seasonal) 1 �
i ��� i �
lype of bldg or addiCion � �
i � �
( ) U+ell.ing � Jf� i �.
� Garage �y�car � �n/ � n'
O Storaye building i �l� d-� i < s
�� �� 0 i m
( ) [�oathouse � I i N I
( ) Livingroom ��
' �'XS l � �
( ) [3edroom �
( ) Kitchen-dining � i
( ) Forch - enclosed/roofed j I �
� t
O DecY. - open j 50 . i
( ) � � � ��� � �
� 9�
( ) � I iy� � i
i ..
i �' i
Typ of construction � j � O � I
(�Frame ( ) Dlock '� � � � � i
( ) �,og ( ) Concrete � � I �/$ i O
( ) Pole ( ) Steel � j '�() i O °'"
( ) tdetal ( ) (� j I� � 1
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, 9 �i �
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Construction cost $ 50� � �� L�
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Sanitary Pecmit g3`I-]7 �
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�ssued _ 23 Ju1y 1991 Denied ��
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axnct. 7,oni.ng Administrator
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I , Ronald L. Peterson , kTisconsin Registered Land Surveyor, hereby state that
in compliance with Chapter 236 . 34 of the Wi_sconsin Statutes , and under the
direction of Vern and Joyce Inhoff , owners , I have surveyed , divide and
mapped 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 located in Govt . Lot 1 , Section 23 , T 41 N, R 8 W, and is a division
of Lots 10 and 11 , of Linden Subdivision , described as follows :
Commencing at the Northeast corner of Lot 11 , Linden Subd . , Thence S 47 °30 ' 00" E ,
along Che East line of said Lc� t 11 , 249 . 89 feet , to a rneander corner on the
Northerly shore of Round Lake , Thence along the meander line of Round Lake as
follows ; S 49 °04 ' 14 " W, 192 . 42 feet , Thence S 77 °37 ' S3" 4�T, 196 . 26 feet , to the
end of said meander line , Thence N 18 °00 ' QO" W, along the West line of said
Lot 10, 255 . 17 feet , Tlience N 74 °00 ' 00" E , 235 . 06 feet , Thence N 11 °00 ' 00" E,
30 . 00 feet to the point of beginning and i.ncluding all the land between the
meander line and the waters edge of Round I.��ke , bet�,�een the p� rcel lines extenced .
Subject to all existing easements and reservations .
��C�NSI
,�
� ��
Jj� RO;�ALD L. '- -
� PETF,RSON ��-
` s-sos ' �+
This instrument drafted by ` NA'rVJi•.kD ,
Ronald L. Peterson � w75. '_ ,
Sept . 9 , 1983 ��,-C� . ��
�r� c�� � � LL� �� .SI1 i� � f
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Approved this �_ day of 5� , 1983 , by � �; ,`, ��\� � �. — �����
Saw��er C unty 7.oning Admin .
Pa€e 2 of 2 pages .
'� 3 ��
� D I L H R APPLICATIO�V F'OR SANiTARY PERMIT �
SA4JYER courvry �
(PLB 67) "
UNIFORMSANITARYPE�MIT','�' �
�' `�`RaOR6N �'R"R Q'� CST 83-223 45430
—Attach comp!ete plans in accord with s.H 63A5,Wis.Adm.Code for the system,on paper not less than 8'/=x 7 7 inches in size.
—See r verse side for instructions for completing this applicatien. PLEASE PRINT
PR ERTY OWNER M LING ADCRESS �
:zi' a i � �5.3 sva.- Gv � ea 3
PROPERTY LOCATION �*� ITV:
1/4 1/4,S ,Ty/,N,R 8E (or►VyJ o rvo nr�-
LOT NUMBER BLOCK NUMBER S BDIV�SION NAME /�� �f REST 140AD, AKE OR LANDMARK STATE PLAN I.D.N JPABER
?/of' c'sH N-3i:3 ' ` R a
TYPE OF ING OR USE SERVED • — �
1 or 2 Family Number of Bedrooms: 3 [J Publlc jSPecify�:
THIS PERMIT IS FOR A:
�w System ❑ Tank Replacement ❑ Repair
�.i Replacement Soil Absorption System ❑ Revision i� Privy
ir.; Alternate System ❑ Reconnection � Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
I eepaye Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holdiny Tank
J System-ImFill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing,For Which A Previous Permit Is On File,Permit# issued
❑ An Exfsting System Tha:Has Been Inspected And Is Compliant As Far As Soil Conditions.
Total #r`of Prefab. Site Steel Fiberglazs Pl3stic
Gallons Tanks Concrete Consvucted
Septic Tank Capaclty ,1
L'ift Pump Tank/S�iphon Chamber
Holdin9 Tank capac'ity
Manufacwrec �—
IF THIS IS AN ALTERNATIVE SYSTEfJI COY1PLETE THIS BLOCK: J Mound U In-Ground Pressure
Total #of Prefab. Site Steel F'iber9lass Plastic
Gallons Tanks Concre:e Consvucted
Septic Tank Capadity
L�ift Pump/Siphon Chamber
Manufacturec
PERCOLATION RATE ABSORPTION AREA AHSORPTION AREA �n/ATER SUPPL�Y:
(Minutes per inch��. .REQUIRED(Square Fee��: PROFOSED ISquare Feec�: /
/
(Q l5 (S' ��'Private ❑ Joint ❑ Public
I,the undersigned,hereby assume responsibility for in allatio of the privat e system shown on the attached plans.
N e of Plumber IPr�mt1: Sig MP/MPRSW No.: Phone Nu/mbyer:
G/i��<'9 C� �� �LGC�.e�.� .,ler��� � �lf �6 7 ZS _.
Plu 's A r s. � Na Designer: �
e e-� ��/l ,�r�L f' 'sn
CO TY/DEPARTMENT USE ONLY
Sign ure of lssu'ing Agen: Fee: Date: ��Disapproved
C` $70.00 9-22-83 �avP,o�a� ❑ow�e�c��e„i��<�ai
Adverse Determination
Reason for Disap val:
Alremate coursels)of Attim�Avallable�.
oILI�R-SBD-6398(R.5/H2� DISTRIBUTION: Orig'inal ro CountY, One Copy To; Bureau of Plum6ing,Owner,Plum6er
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILCINGS
LABOR & HUMAN RELATIONS pRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
�CONVENTIONAL ❑ ALTERNATIVE $ta�ePlanl.D. Num6er.
(H assignedl
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
N U e �- ry a NER �1 V � � —F- C ADDFQES�OF%ERMI�HOLOER /�� � ie � � � ' S INSPEC�N OA�� _ ��
+ r �� 5 « �
BENCH MARK IPermanem reference point) DESCRIBE IF DIFFERENT FROM PLAN�. REF. PT. ELEV.: CST REF. PL ELEV.:
Name oi Plumber�. MP/MPRSW No. Cou��ry�. San�tary Permit Number:
�(Q W 1- e N c e. L Ce..,11'1 (1 Ufr�. l- � (� � � S �1 l-c� ��— 0 3 — � �
SEPTIC TANK/HOLDING TANK:
MANUFACTURER�. LIQUID CAPACITV. TANK WLET ELEV.. TANK OUTLET ELEV_ W�+RNING LABEL LOCKING COVEF
� J �7 PROVIDED�. PROVIDED:
f" 1 F� Lf- �— / � Q Q � / .. O ��i - � �YES ❑NO ❑YES ❑NO
BEDDING�. VENT DIA.� VENT MATL_ HIGH WATER NUMBER OF ROAD: PROPERTV WEII�. BUILDING�. �VENT TO FRESH
" ALARM FEET FROM ��NE�. � ,_. `� P.IR INLET.
❑YES ❑NO C � � ❑YES ❑ NO NEAREST �y�
DOSING CHAMBER:
MANUFnCTUHER BEDDING�. LIpUID CAPnGTv PUMV M1^pUEL PUMP;SIPr�ON MANUFACTUREH WARNING LABEL LOCKING COVER
PROVIDED�. PROVIDED:
❑YES ❑NO ❑YES ❑NO ❑YES ❑ NO
GALLONS PER CYCLE: vunnPnrvocoNTao�sovEannorun� NUMBER OF PROPERTV WELL BUILDING VENTTOfRESH
(DIFFERENCE BETWEEN FEET FROM ��"E "iR i"�ET
PUMP ON AND OFF) ❑YES ❑NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing �en,crH oinnnerEr� nnnTea�a� An,o nnnaKirvc;
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
WIDTH LENGTH NO. OF OISTR. PIPE $PACWG COVEH INSIUE DIA s1PITS LIQUID
BED/TRENCH / ' / � rNErvct+Es roinrE in� P�T oEPrr+
DIMENSIJNS I S `� � � S �r � l�
GRAVEL DEV7H FIL� DEPTH UISTH PIPf DISTR PIPE DISTR. PIPE MATERIAL�. NO. DISTR. NUMBER OF PRO�ERTV WELL� BUII.DING�. VENT TO FRESH
BELOW PIPES ABOVE COVEFa El FV INLf i ELEV END PIPE LWE. AIR INLET�.
�� :, l� � // FEET FROM
�- �. Ej. (p � Q J `t NEAREST—s �SO
MOUND SYSTEM:
Mound site plowed perpendicular to slope �heck the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
❑YES ❑ NO
SOIL COVER TE%TURE PERMANENT M1IAHKERS 08SERVATION WELL$
❑YES ❑NO ❑YES ❑NO
DEPTH OVER THENCH:BED DE�TH OVFR THENCH,HED [)EP7H OF TO�'SOIL SODOED SEEDED MUICHED.
CENTER EDGES
❑YES ❑ NO ❑YES ❑NO ❑YES ❑ NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH W���TH LFNGTII TPENOCHES LA7EIaAL SPACING GRAVEL DEPTH BELOW PIPF FILL DEPTH A80VE COVEH
DIMENSIONS
MANIFOLD PUMP MANIFOLO DISTR. PIPE MANIFOLD MATERIAL NO DISTR DISTR. PIPE OISTHIBUTION PIPE MATEHIAL & MARKING
ELEV. ELEV. DIA.. ELEV. P17E5 DIA.:
ELEVATION AND
DISTRIBUT'ION
INFORMATION HOIE 511E HOLE SPACING DRILLED COHHECTLV COVER MATERIAL VERTICAI UFT CORRESPON�S TO APPROVEU
PLANS
❑YES ❑NO ❑YES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WEL�S: NUMBER OF PROPERTV WELL�. BUILDING.
FEET FROM LINE
❑YES ❑ NO ❑YES ❑ NO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNAT E. TIT�E.
DILHR SBD 6710 (R. 01/82) �-L� ��"'-a-�, �f�=�"- " �a �zi�
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