HomeMy WebLinkAbout010-941-33-1212-LUP-1990-341 - Applicat:ion for Land Use Fermit �
County of Sawyer y�
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1'lie undersigned hereby makes application for a I.and Use Permit and ayrees �
tliat all work sliall be done in accordance witli tlie requirements oE tiie Sawyer �,O
County Zoning Ordinance and the laws and regulations of the State of Wisconsin.
PRIN'P - USL•' ONLY Bl.7�CK 1NK/PIStlCIL
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Total I�gt � to peak to peak x ��
Stories �_
No. oE bedcooms ""��--�---- rear lot line or waterline :''
(year round) or (seasonal) � �
Type of bldg or addition � r . � oC
( ) Dwelling i. � ..'_ _ � i �' rt
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Sanitary Permit �� - �1jZ. � _.
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issuea 23 November 1990 �eniea N �
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SAWYER COUNTY ZONING ADMINISTRATION
INSPECTION REPORT o
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Owner Patricia and Keith Raven
Address Route 6 Box 6485 Havward , WI 54843
Name of Business
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Euilder C
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Address
Plumber
Address
Inspection ( ) Property ( ) Setback - lake
( ) Dwelling (X� Setback - road
( g) Privat � ( ) Public ( ) Mobile Hm ( ) Setback - lot line �, y
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( ) Addition ( ) � �
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Discussed with owner ( X) F, �
Discussed with builder ( ) �,,
Discuseed with �°
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L B 6 7 - State and County State Permit # 19 06 0 �` .
� �` ' Permit Application County Permit # gl- 2 32 �
for Private Domestic Sewage Systems County Sawyer
"DENOTES STATE APPROVAL REQUIRED CST 81- 253
Date Approval Received from State if Required State Plan I.D. #
A. q. NER OF PROPERTY patricia T1. and Ma�liny Address:
'I 2 7f' ��Q e /��v 2_ - � �a,�a� � �5'���'
B. LOCATION: ��ZY��G_Y4, Section ,j�, T� N, R�--�-(or) W Lot# City
Subdivision Nar�i�'W ' NC nearest road, lake or landmark Blk# Village
� Township ��..�
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C. TYPE OF OCCUPANCY: *Commercial "Industrial "Other (specify) "Variance
Single family �_ Duplex No. of Bedrooms � No. of Persons �'�' _
�• SEPTIC TANK CAPACITY /��� Total gallons No. of tanks �
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete Poured-in-Place Steel�_Fiberglass Other (specify)
New Installation 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 Linea� Ft. Width Depth Tile depth (t ) No. of Trenches
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 � l[� ?� Distance from critical slope !—
WATER SUPPLY: Private � Joint ❑ Community ❑ Municipal ❑
Owners name as listed on EH 115 if other than present owner:
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 effluent disposal system from the EH-115 prepared
by the C tified Soil Tester, /
NAME .� G L. of� C.S.T. # �,�..s-�!y and other informa;ion
obtained from Lt(�e (owner/builder}.
Plumber's Signature .�-�� (�/�p;MPRSW.# 1G' ��Phone # 7lS=G3�-S�L73
Plumber's Address — � — � s
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20.Weil loca-
tion shall be included on the sketch. Indicate or dimension location of all welis 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 10- 13- 81 Fees Paid: State 14 . 00 County 36 . 00 Date 13 OCtober 1981
Permit Issue (date) 10- 13- 81 Issuing Agent Name GaYle Jorczak
Inspection Yes No State Valid# Date Rec'd
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
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