HomeMy WebLinkAbout002-940-16-4101-LUP-1989-214 . ' � ' n�plicaL-io[i for Land Use Permit �
' County of Sawyer y
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The undersigned hereby makes application for a Land Use Permit and agrees
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t}iat all work shall be done in accordance witli the requirements of the Sawyer �, '
County Zoning Ordinance and the laws and regulations of tl�e State of Wisconsin.
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mailing address mailing address ��j
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city, state, zip city, state, zip
Building Land Use Zone District RR-1
(� New ( ) Filling
( ) 1lddition ( ) Dredging Lot size - > � � "3 � �
( ) Alteration ( ) Grading N n
( ) Moving on ( ) Acres Li >
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New Construction �
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Size Z�, ft wide ft wide 7d
J_` Y ft long ft long 'b
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Floor area 672 sq ft s ft r
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Total hgt �'� to peak to peak x
Stories I
No. of bedrooms ------ rear lot line or waterline
(year round) or (seasonal) ���
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Type of bldg or addition i i o
( ) Dwelling -� � i U' ,�+
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(� Garage (1) (�.Y car � i cL ti
( ) Storage building i i c rt
( ) Boatl�ouse i i c~n�
( ) Livingroom � ` Gi� i o
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( ) Bedroom � �,. �`�r' i
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( ) Kitchen-dinitig � , i
( ) Porch - enclosed/roofed i � � .,� �
( ) Deck - open � � � ��y i
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Type of construction i � �' ,� -- i �
(X) Frame ( ) Block � ~ �'
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( ) Log ( ) Concrete � " ; �v' �-� O� f i � `'�
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( ) Pole ( ) Steel � `- '' 3o I , � � "~
( ) Metal ' - � �
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Construction cost $ ,� �'�� � � i '' `"'' —1±�-' ''� �
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Vol � 1 � P of deed �
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Cer. Soil Test � 7- ��`` ' i � �
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Sanitary Permit % ?- � � " L ����J
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zssued 22 August 1989 Denied
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(`� ��~� . SANITARY PERMIT APPLICA710N COUNTY • � ' �
U D'�N� In accord with ILHR 83.05, Wis. Adm. Code SAtaYEF. �
��'•�.�...�.�...o� , STATE SANITARY PERMIT # 1 O
CST 87 - 019 86097 ' `°
-Attach complete plans (to the county copy oniy) for the system, on paper not less than STATE PLAN I.D. NUMBER
8'r� x 11 inches in size.
-See reverse side for instructions for completing this application. PETiTioN
2. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES ❑ rvo
PROPERTYOWNER �aul G . Zegler PROPERTYLOCATION
.QG� .0 �..,Q ��..fR '/e ,S� Ya, S /�— TL/G , N, R (or) W
PROPERTY OWNE S MA NG ADDRESS LOT NUMBFR BL OCK NUMBER SUBDIVISION NAME
�G � E l� Lu�1�� _ --- —
;ITY, STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANDMARK
� �s � O VILLAGE :
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1{. TYPE OF BUILDING OR USE SERVED:
Vumber of Bedrooms if 1 or 2 Family � OR L� Public (Specify}:
°It. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2, 3 or 4, if applicable)
1 . a. � New b. ❑ Replacement c. � Replacement of d. L� Reconnection oi e. ❑ Repair of an
System System Septic Tank Oniy an Existing System Existing System
2. ❑ A Sanitary Permit was previously issued. Permit # _ _ Date Issued
3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements.
4. ❑ The System is shared by more than one owner/buil�ing. Attach Common Ownership Agreement to County Copy.
�V. TYPE OF SYSTEM: (Check only one in #1 and only one in �2)
1 . a. � Conventiona! b. ❑ Alternative c. ❑ Experimental
2. a. ❑ System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP
In-Fil I Tank
i�. ABSOHPTION SYSTEM INFORMATION: (Check one)
1 . a. See a e Bed b. ❑ See a e Trench c. ❑ See a e Pit
�. PERCOLATION RA7E 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet):
�y /�� G/.r ,� Feet � Private ❑ Joint L� Pubtic
/I. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel 91ass P�astic APp
Tanks Tanks structed
�eptic Tank or Hotding Tank v��� �
ift Pum Tank/Si hon Chamber � �
/11. RESPONSIBILITY STATEMENT
I, the undersigned, ass�me responsibility for installation of the private sewage system shown on the attached plans.
'lumber's Name (Print): Plumber's Signature: (No Stamps) MP/M*F{5�7'NS.: Business Phone Number:
°/GIJ l�c.,a L � � � `� q8 I/�G3 l���, —
'lumber's Addr ss (Street, City, State, Zip Code): Name ot gne
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�111. OIL TEST INFORMATION _
;ertified S Tester (CST) Name CST#
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�ST s ADDRESS Street, �. State, Zip Code) Phone Number:
�'�'G 6 .d /`�i'f �� :2�J L.�• �s. .�� _ 5' u�--
X. COUNTY/DEPARTMENT USE ONLY
� Disapproved Sanitary Permit Fee Groundwater ate Issu Agent Signature (No Stamps)
� Surcharge Fee
'� Approved ❑ Owner Given Initial Q
Adverse Determination � �� . �� Y 2 5 . �� 4- $- 8 �
X. COMMENTS/REASONS FOR DISAPPROVAL:
3D-6398 (formerly Plb-67) (R 03/86) DISTRIBUTION: Oriyinal to County, One Copy To Bureau ot Plumbing, Owner, Plumber
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County of 5awyer y
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The undarsiynrd hereby makes �pplic;�tion for ;i i �.n�i tt;e i�ermit. +�nd ogree: � 1
that all work shall be done in accordance with the requirements of the Sawyer M
County Zoning Ordinance and the laws and _egulations of the State of Wisconsin. �
PR1NT - T15E ONLY BI�ACK INK/PENCIL CT�j
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owner suilder Jerry Ingbretson
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mailing address � maili.nq� address -�
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city, tate, z�p c:ty , si�ate, zi.�, n
Bcilding Land Use Zcne Di:�tri.ct /� /� �
(� New ( ) Filling
O Addition ( j Dredgina I,ot =.is.e _ _ 1320 '_ x 1320 ' s �
( ) Alteration ( ) �ra3ing �n n
O Moving on O Acsec; � v
( ) ( )
- --_------- - --
— — --- — �OP C!{ �
New Construction Dwelling C
Size 3B ft wid� 8 ft �aide �'
� ft lon9 ��_ ft long
Floor area � sq f� Zt�.O_ sq ft
W
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Total hgt � to peak _LZ,�__ to peak x
stories
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No. of bedxooms __�_ re�r ?�t line �e ,�
(Year round) 4aXa#7F4eX94�4X�ck --�--,'�O1
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Type of bldg or addi_Lion � � N �
�Dwellir.g � �'� i �. "
O Garaoe ll) (2) car � � a S'
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( ) Storage building � � � rt
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( ) Boathouse '
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( ) Livingroom ` � � i
( ) Bedroom � �5� %I '
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( ) Kitchen-:iining � �� $ i
( �'T'orch - o�e�ed/ro�,t,.�� i _. _ . . i
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( ) Deck - open � �
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t J — - -- w � y� �, Q J�9ia,�r z
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Type of constructior, '
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O Frame O rlock � � 3 O� i �v
DQ Lo ( � C ,ncrete � __-� _ -- i �
( ) Pole ( ) Steel � �--QoRu+ i ..-
( ) Metal ( ) � / � .
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Construction cust $�__ i �
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Vol QO Pa �6 / o� deed . � i � �
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CSM Vol ------�9-_---- � I i n �
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Cer. soil 'rest 87-01�_ __., � ---.---_ —���- � _ riD-�
--�------C�,-r�ad -----=-----�_-- �IZ
Sanitary t�ermit 87-019*______. • 4
*septic sized for 3 bdrms `i _i__--- 1 " • �
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Issued 27 May 1987 Denicd ------- ----------- ;''I�
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