HomeMy WebLinkAbout010-941-26-3403-LUP-1990-188 ApplicaCion for t.and Use Fcrmit k.�
County oI Sawyer ,a O
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7'he undersigned hereby makes application ior a Land Use Permit and aqrees �
that all work shall be done in accordance witl� the requirements oE the Sawyer �°
County 7.oning Ordinance and the laws aud regulations of the State o[ Wisconsin. '
PF2IN'P - USti ONLY ULACK 1NK/PPt1CIL -
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�_Jnt'1 �� � _l�nc�y�iq � VM�Iv _—'/aU�' /4�(� r11��
Owner T-- Builder �
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mailing address mailing address
l-�avwar�) i1!� ti s4a���� ��qvwa��l 1n1�� sv�v 3
city, �state, zip city, state, zip `
Uuilding Land Use Zone District I
(x) New ���_��
( ) Filling s sq
O Addition O Dredging Lot size f-r �
( ) Alteration ( ) Grading / � v� H
( ) Ptoving on ( ) ncres � �.l� V�
( 1 ( )
New Construction ' —�
Size �_ fC wide ft wide �
�Q ft long ft lony
Floor area sq ft sq ft
�
Total hgt �_ to peak to peak x
Stories � _
No. of bedrooms rear lot line or waterline
(ye�r zound) or (seasonal) � _ �� �jyi�_iq *
i
7ype of bldg or addition i 3 '<> � ��
( ) Dwelling /'� � p � _ �--�' - _� ,
(� Garage (1) (2) car (y ) � i c�� ��' �
( ) Storage building `� � `° -p �Sv S+Sh� j �.� /j�•
O 6oathouse � p Q i N
O Livingroom � N n � � � �I
O Bedroom i IM1 o GO � ��2 �I i
O Kitchen-dining � �I" ei � � J
O Porch - enclosed/roofed i L — r'� � i
( ) DecY. - open i „f � � i j/>�� � ..
( ) � � I i � � � 1
( ) �
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7'ype of construction i � � �a���ny I i � •1 i
(�O Frame O Block � I le} -� i i �
( ) I,og ( ) Concrete � �'1' i J��.I
O Pole O Steel i I I ' �
� 4"-
(,�j t�etal ( ) i � � i '�' I
� ~ (noc>t� � ��
i 1 i �'��m
Construction cost $ � i �
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Vol G.(p`�1 P9 1 �0.:� of deed i I f�j , �i �}:
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Cer. Soil 1'est`�5 —Q¢' � �T/{�y�_ �� i m �
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, Sanitary Permit � �:_u ��-� �->;�9 L o _...
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Issued 31 July 1990 Denied I�.`
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/ owner 7,oniny ndministr tor
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SCALE: I INCH= 200 FEET FOR ASSESSMENT USE ONLY NOl
DRAWN BY : �p� �. �i. DATE : 2- i7- 7s INTENDED TO SHOW CONCLUSIVE
COLON (:) INDIGATES GOVT. LOT EVIDENCE OF OWNERSHIP OR
SHEET 4- �OUNDARY LOCATIONS
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1 y.2 0 J I'+.I 8 .13.8
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PLATS Nor USED : .14,4 � .�4. ► 9 SCALE: I INCH= 'LOO F[�T FOR ASSESSMENT USE ONLY Nf
_ _ _ ..._. _ ., _ . _. . . �. , �.P . - - - •-•--- •- -- - - - _
Plb 67 State and County State Permit # 2380�� _-
� : Permit Application County Perrpit # 5=23,�
for Private Domestic Sewage Systems County -��`'�� ` ' ��
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"DENOTES STATE APPROVAL REQUIRED
CST 5-041
Date Approval Received from State if Required _ State Plan I.D. # _—_ _
A. OWNER OF PROPERTY Mailiny Address:
/� // �
C/K l'"�r .L/ G� (/f //�l( �/i / Lr' �! ��� ✓ / /�C( '/L(,'�Li ✓c1 / (.(.' r�l, j �� C �� .�'
B. LOCATION: �F Y4 � ��i Y4, Section 1Z , T N, R ' �
� �( ���--{er� W Lot# City- ---___
Subdivision Name, nearest road, lake or landmark Blk# Viilage
r, ;� ; Township� <�� ��. _,�-;f
,
. :� ., :
—��/ t<.'<. �' ��i S f �' �� l i.� �<r L�<! �� �/ � -
C. TYPE OF OCCUPANCY: * Lmmercial *Industrial O r (specify) *Variance
Single family �� Duplex ' No. of Bedrooms � No. of Persons ,�-
D. TYPE OF APPLIANCES: Dishwasher YES �_ NO Food Waste Grinder YES�NO # of Bathrooms�
Automatic Washer �YES NO Other (specify)
E. SEPTIC TANK CAPACITY � � Total gallons No. of tanks
"'Holding tank capacity Total gallons No. of tanks __
New Installation __�_ Addition Repiacement______ Prefab Concrete _ _
"`Poured in Place __ Steel � Other (specify) - __
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) / 2) / 3) __�_Total Absorb Area �Z,C'> sq. ft.
New� Addition Replacement "Fili System
Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches __
Seepage Bed: Length _� ;� �Width /Z ' Depth �l- �� Tile Depth 4 Lf `� No. of Lines 1
-- ,i
Seepage Pit: Inside diameter Liquid Depth Tile Size `� _
Percent slope of land /l�l.?�v Distance from critical slope •� ` _
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 Certjfied Soil Tester,
NAME �<l � •-c ..� c c: l r� .-., �/r�r .- C.S.T. # ''� > •- �l f" and other information
obtained from L,� �i �-i . ' �v r> ' (ownerl�nifrkr).
Plumber's Signature '/�`%��-'%---��� � .�;��.•-- �/MPRSW# /�' 7 y Phone #f,���(- �/ z �.-'j __
PLAN VIEW: Provide sketch below of system (include direction of slope and ali distances in accord with �
H62.20, including well). �/� `�,�, �r //t" �c- I
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Do Not Write in Space Below - FOR DEPARTMENT USE ONLY
Date of Application 12-11-75 Fees Paid: State 1 a 00 County 10.00 �ateDecember 11�I.�Z�__
Permit Issued/�eXtl�dK idate) 12-11-75 Issuing Agent Name Robyn Kephart - ��`i='�'�i'�,'
�- � �� 7� Valid# ��i�� ,� Z i�' Date Rec'd
lnspection Yes t� No ��
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (��y', co�•�) 4. pl!amber (canary copy) .. • . .- . �,- - �
: � • .
, Department of Zonin� and Sai.itation •
- � Sawyer County
- C
Inspection Report
Name of pragerty p/V i G� L u� G�dl
_____Description S� ` 5� S e� 71-I/N�✓{�/ �✓
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Owner Sli�,,� � Address �.� . S , �{Gz��.vC�✓Gt�
�
Builder Address
Mastex--Plumber �.. �u�n� Address (���T i3 p x J(, 3 /�!�vcvG�'�
Inspection
(V�Private ( ) Public Property Sanitary Installation
Dwelling Privy
Violation Mobile home Setback - Lake
Garage Setback - Road
( ) Sanitary ( ) Zoning Setback - Lot line
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Discussed with Builder �� Yes � No
Discussed with Plumber Yes No
Date of Inspection 1��r y 7�
Signature of o#'ficer��.�q;u��� ��ti�v _�-