HomeMy WebLinkAbout010-941-22-1211-LUP-1990-187 1lpplication for Land Use Ferm.it �
' • County of Sawyer ; ,a
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The undersigned hereby makes application for a Land Use Permit and aqrees �
that all work shall be done in accordance with the requirements of the Sawyer ,�,, ,
County Zoning Ordinance and the laws and regulations ot the State oE Wiscrnisin.
PRIN�r - vsL ONLY f3L11CK INK/FLNCIL
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mailiiig address mailing address
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city, s ate, zip city, state, zip
Building Latid Use Zone District R-1
( ) New ( ) Filling • t-�
� 1lddition O Dredging Lot size �LQS ' X 319 � � �
( ) Alteration ( ) Grading m n
( ) Moving on ( ) Acres � , �f (�
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New Construction ' v�
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Size ��-- ft wide ft wide �
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�/J ft long ft lorig x
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Floor area �2.� sq ft sq ft C
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'Total hgt 2� ��, t��ak. �-}T� to peak '.~�' �
Stories �
No. of bedrooms �-- rear lot line o�xliue
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(year round) or (seasonal) i �s �
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'I�pe of bldg or addition � —= � � o
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( ) Dwelling � i G �
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( ) Garage (1) (2) car i i r o
O Storage building � � i C rt
( ) Boatl�ouse
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( ) Livingroom i � �' � i �
( ) Bedroom i ,�f � i, � �
( ) Kitchen-dining (�, � �--a--`----� . �'�L '', i
( ) Porch - enclosed/roofed U" i ��' �-- i
(kf Deck - opeci 11 i p �10' 1$`'0' � 0
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Type of construction � ---' --�'i� (J
(�` Frame ( ) Block . �
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( ) Loy ( ) Coiicrete �-- —� z� i 1 �
( ) Pole ( ) Steel i �R� (V
( ) Metal ( ) i � l�l � "i � �
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Construction cost $ y��?,J �' i i �
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Vol t_���� pg� of deed i �d�� i �
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CSM Vol � F'g �,r'�- i i a
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Cer. soil Test (p --(�p sm�rt+ J � ZDS � � � �
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/_ --1 L road ------------------- z
Sanitary Permit �w —�d o
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Issued 31 July 1990 Denied N �
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owner 7oning ndminis rator
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Plb 67 State and County State Permit # �21n- _
� , Permit Application County Permit # —_�� _
for Private Domestic Sewage Systems County Sawtirer
*DENOTES STATE APPROVAL REQUIRED CST 6-00'7
Date Approval Received �from State if Required _ State Plan I.D. #
A. OWNER OF PROPE ,TY Mailing Address:
`
�raen �mith ��'. 5 Hayward, wis . 5�84�3
;
B. LOCATION: "yj �Y4 `��L '/4 , Section z2._, T�_1.�, R_� � (or) W Lot# �.LCity
Subdivision Nam�e,� nearest road, lake or landmark Blk# Village
off Hospital Road ( twn rd) Township A�yWardo
C. TYPE OF OCCUPANCY: *Commercial ` Industrial �'Other (specify) *Variance
Single family X Duplex No. of Bedrooms � No. of Persons �
D. TYPE OF APPLIANCES: Dishwasher YES y NO Food Waste Grinder YES Y NO # of Bathrooms_L
Automatic Washer YES _�IVO Other (specify) _
E. SEPTIC TANK CAPACITY�qn Totat gallons No. of tanks 1
"Holding tank capacity Total gallons No. of tanks
New Installation __ X Addition _ __ Replacement ___ Prefab Concrete __ _____
*Poured in Place Steel X Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1 ) _� 2) _�_ 3) �._Total Absorb Area ���_�q. ft.
�
New_� Addition Replacement * Fill System
Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches _
Seepage Bed: Length �Width 1 n � Depth �t �! Tile Depth �6!, No. of Lines �_
Seepage Pit: Inside dia eter Liquid Depth Tile Size �'��
Percent slope of land �d.t Distance from critical sloperiOYle
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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 have sized the effluent disposal system from the EH-115 prepared
by the Certified Soil Tester,
NAME Cldrence 1`ietC�f C.S.T. # 55-li71 and other information
obtained from self (owner/builderi.
Plumber 's Signature �larencs T�=etcalf MP/MPRSW# 14�98 Phone # 71�i 5��-= z34`�
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
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Do Not Write in Space Below - FOR DEPARTMENT USE ONLY
Date of Application 01-I�-1a-76 Fees Paid: State 1 . 00 County 10 . 00 Date Apr'il l� , 1�`T6
Permit Issued74��� (date) OLF-19-76 _Issuing Agent Name Robyn Kephart - Deputy
Inspection Yes J No Valid# _ _ ___ Date Rec'd
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1 . county (white copy) 3. owner (green copy) � " � OF HEALTH, P.O. BOX 309, MADISON, WI 53701
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;anK cop; . 4 nlumber (canary ce��yl
' Department of Zonin� and Saz,itation
Sawyer County
Inspection Report
Name of pmpez-ty �,,,,�4-��
___ .Description , 1.t) 'y- ��I- �e(, _� �`lI l�9 l�"
Owner ��t,i �--�„-..`r� Address `���-`�'�;- �lzti:�.��vrC� -�L�15
Builder ��,�,,,,,�� Address �, ; r`r��,.s �-
T�a&t ex--�lutnb e r L . �Yl�P�Ct4�� Addre s s ���w��.+J��f�- l,v i S��
Inspection
(5U Private ( ) Public Property 1� Sanitary Installation
Dwelling } Privy
Violation Mobile home 5 Setback - Lake
Garage Setback - Road
( ) Sanitary ( ) Zoning Setback - Lot line
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Discussed �r�ith Builder �� Yes (. � No
Discussed with Plumber Yes j No
Date of Inspection �Iq� q �
��Signature of O#�ficer �J,
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N•T— ��'��+�i�c.Yz ,7.1IN.—,esw. HOSPITAL ROAp _
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B[ARIN09 �ASED ON SOLAR OBSN .
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JUNE 7, 1974 g o
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AONALD L�Y �$ o�•'� R 0 A D E A S E M E NT ��;�
� PETERSON � 58e°61'i5"E,385.63�
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I, Ronald L. Peterson, Wisconsin Registered Land Surveyor, hereby certify
that in compliance with Chapter 236 :34 of Q�e Wisconsin Statutes and under
the direction of Owen Smith, owner , I have surveyed , divided and mapped the
land herein described and that said land is located in the Nl�-NE�,
Section 22, T.41 N, R.9 w. described as follows ;
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Commencing at the Northwest corner of said N1�1�►-NEK►, Thence S. 88° 51 ' 15" E,
along the North line of said NWl4-NEy�►, 705.03 feet to the actual point of
beginning, Thence S. 0° 39 '15" E, 886.03 feet , Thence S. 88° 51 ' 15" E,
385•53 feet , Thence N. 0° 39 '15" W, 886.03 feet to the North line of
said NMn4-NE}4, Thence N. 88° 51 �15" w, 385• 53 feet to the point of beginning.
Subject to all existing easenents and reservations.
Thie instrument drafted by-
Ronald L. Peterson
,Tune 7, 1974
Approved this J�day of June , 1974 by �, -
Sawye Count Zoning Administrator
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I TOWN OF HAYWARD
SEC. 2 2 TWP 41 N. R. 9 W
HOSPITAL ROAD
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