HomeMy WebLinkAbout002-840-18-5113-LUP-1989-253 �
1lpplication for Land Use Permit
' County of Sawyer y
o �
The undersigned hereby makes application foi a Land Ose Permit and agrees
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that all work shall be done i�i accordance witli the requirements of the Sawyer �
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County Zoning Ordinance and the laws and regulations of the State of Wisconsin.
PR:CNT - USE ONLY BLACK INK/PENCIL
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June L. Pedersen `�
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Owner Builder � �
200 South Dee Road �_��c� �j �ok ��-S(o �
mailing address mailing address
Park Ridge Illinois 60068 ��ac��� W� ���.3
city, state, zip city, state, zip
Suiluiny Laiiu i.ise Zone Listr:ict ���� � �"T"'i
( ) New ( ) Filling
( ) Addition ( ) Dredging Lot size .� �� r- (([�6��3vU � �
(� Alteration ( ) Grading N �
( ) Moving on ( ) 1�cres 5 . 60
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New Construction d
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Size �f ft wide ft wide �
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7 ft long ft long
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Floor area �� sq ft sq ft �
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Tota1 hgt � t�x��c above grade to peak x t-�
Stories (
�Rtti � sr�N �-
No. of bedrooms ------- rear lot line or waterlicie
(year rouiid) or (seasonal) '� i � �' '-� �
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Type of bl.dg or addition i i o
( ) Dwelling �/ � � � rt
( ) Garage (1) (Z) car I � � �
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( ) Storage building i � 5'�j i C r-r
( ) Boathouse t hG�l ' �t �� r�
i. �-r � � i N•
( ) Livingroom � � •�/
( ) Bedroom � � � � ~
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( ) Kitchen-dining � i
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(,� Porch - _ex��osecl/roofed �' � �> �'� \ P.tv �. i 0 0
O Deck - open i .32' � i 1'n N
( ) - � �' ..r�,�9� i— oo i
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( ) � � /�✓� i o i
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Type of construction '� � ' i O0 �
O Frame O Block � � �� in i
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(�Log ( ) Concrete � �'`� i �, i
( ) Pole ( ) Steel ' $�� �� �'�
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( ) Metal ( ) � i
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Cvnstruction cost $ JL�. " i � �
216 � '
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Vol 343 pg 244 of deed i � �.
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Cer. Soil Test i � �D
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sanitary Permit [c)� -�21(0� �•.T , a
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Issued 12., �'��(\�-� ��j� Denied
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\e L. Pedersen owner � 7oning Admini trat r
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SAWYER COUNTY 7.ONING ADMINISTRATION
, INSPECTION REPORT �
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Owner June L. Pederseii
Address 200 S, Dee Road Park_ Pid�e, Illinois 60068
hame of Business unknown
Builder N;A
Address — �
PLumber N/A
Address
Inspection ( ) Property (XA Setback - lake
(X�[ Dwelling ( ) Setback - road �
(XX Private O Public O Mobile Hm O Setback - lot line r, y
Violation O Garage �X� Av_ sPr_-ha�k rt �
( ) Sanitary ( ) Zoning �n
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� APPLICATIDtJ r^OR SAWYE,4 COUNTY
SANITARY PERh.%IT
�/ AppZication il�2�p? Date _�!�3'�
�\ Fee of $Z0. 00 rsceiveu '"' � '!1 1/' CL • ���/
Date � L%�S�County CZerk
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Application is hereby made for a Sa�ayer County Sanitary
Permit for �oric to be done on t?ie premises deseribed l:erei�i.
I��FPs� PE��1'�S�r�t
�Jj�,�;�a�'���� t•�� ;.� �� ���,° - <i-����,��,�-�....-��, —
Owrzer �� , 4' ` dd ; .xzq�'" Telephone
i_.r..,���; L.C]-[ + � �' ;r� ,
The o f the � Sec. r,_: _ Tmn. / � /' R. „
or / � ��SS l-(�1c.� u
Lot 3ZocK _ Sub-division ;¢ 2� .' �j�- �f /�-�
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.'CGj. ���CI.�.� e/%�[ i i,t.. �//'� ' �-(�� ./
Work c ' templated To be per. ormed b
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Number of Bedroome _�_ Number of Rathrooma �
� Uis?Lmasher ,,,�/r�� Carbage Grinder ,�-z�
Automatic �Jasher_il•� ,
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Soil Description �,� - � n �- f _
Septic Tank Size 5�' `� gal.
` C Seepage Pit HeigTit Diameter
� Seepage Trench ,�- Length �_ ��idth ,�_ Depth /G� '
� Septic 1'ank Permit # �d��`
,1 �—
� Percolation Teat Form PLB 43 attaehed �/
� Yea No
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� Contemplated co etion date
' �— : Il`' �'�-�J �
AppZication App � ed �J-yy�-G�/Permit # �-:-�G •
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Sanitarian y �
wner Agent ,Jo t �.e atel—
Remarka
FinaZ I%2spec$i %' � t ^-�
Sanit¢rian �,����'i" ��,� ��-f� / ' � y - �� -- -
Om>ier/Age.nt Notified (Da��>)
Rem¢rka
"�� Sexd c�•� ;inat and three copies IJ2t31 , * '�'� _ _
fee c; $"L0 . 00 to County C�ark
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Indicate Lot size and shape, location o}' dmellin\)��,tzlc tGnk
(ST), septic field (SP) or seepage pit lSP) and dietance o
portion of septic syatem from dweZlingy �+ell and property Z �ne. •
If property Zies c�ithin 50 feet of a l¢ke, river or a strea�i 8a l �\
indioate and chor� distance therefrom. i
If any portion of the contemplated oonatruction �aiZl Zie wi;'thinl
25 feet of dwelling, meZZ, septie tank, septic field or aee�¢gei
pit of ¢bbuttirig omner so indicate, i
2he underaigned agreea Lhat all work nerformeu und eq ipment
irataZled a?xall be in accordance c�ith t?,e S¢nitary Coda of�9awy�er
Ccvnt� and all appZicable Zawa and reyuZ¢tions of the Stnt� of �
i✓tisconain and recommendationa of the S¢wv�r County S¢, ' ,';; ; ,,,
„ . � � .
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��� Agent�(S'� naturel
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li,".1'; C. �.,�ECTION � ' i � / Y MADE �Y i/�: >.� .'/,! -�. ;i1� .
INSPECTION CALLED FOR BY �-� � � � % DATE %- � y" ! `'
,/ � _ - �
041NE`R ' r � � % � �,--�•.�, ADDR�SS �
_'.�-- � -
� of 4 Sec. T N R - W i
- � - ��`� l<�.
'� LOT � IlLOCK SUBDIVISION TO[,TN f-=--��-r'
PLiTNIDER� � �� �i i',�� �IC.# ADDRESS '' � --'- -'- - ��� .�� ,
T �
WORK PREFORMED ��: ••� �- i .� � �- / � � ._ ,���
� ._ -- - ____- Mf3— - _—, _..
SBPTIC TANK - Size Material by � % '!' � - -�
----- --�---�-
PIPE T�"fE: From House tc Tank ' Outlet
Surface epth
Manholn Ext. : Yes No to Cover
Other E:ctensions :
Vent Taater Filled Tank: Yes / No
SEEPAGE PIT - No, of Pits Dia, Depth belo*�r Inlet
Y Total secon�c `"
,,f� Seepage Area Dia. Depth below Inlet
� Gravel around Pit ; Yes No
I
� Manhole extension belotia surface inches .
Lining material used Vent ; Yes No
� _
� S�PAGE FIELD-Length of tile lines � % � ft . Number of lines :Z �
` � IQ Distance between lines r ft . Length each line /, i; ft.
f''�i� �D ' ' i
J � f Width of trench � � �rrci�es, Fi ter materials used". ., -
/ a-.r.e�t,LL<� �
,�� �!- �- T11e below �t
��` � Q � Depth of filter materials % inches . grade - % in� ,
�� Area of trench bottom � ' �--- Vents ,(
,� �,
°�/ t o rt-�,�.��s.L4J — i�o .�r
e�e -
tip � �, � o � � Conunents J
Distance fror.:. � � a � ° s. a a�i
� a +� �� + +� a
`� a x � � 3 �
Septic �� � , I
Tan�: '�` ' �
Seepage _ •�
Pit . ` '` (,
Seepa;- �� {
I�'ield
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Privy _ ' _
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Plb. �43 SEPTtC TANK PEW4T N0. ���/�
R C P 0 R T 0 N S 0 I L P C R C 0 L A T I 0 N T C S 7�
A N D S 0 I L 8 0 R I N G S .
TO
DIVISION Oe HEALTH - Pll7M8ING SECTION
. p,O,Boz 309� Ysdlaon, wis. 53701
purauanL to H 62,20� Wls, Adminietrotive Cod�
NMTi ����G�n �,P�S-1+-t� PAOPERTY AllDRESS ���CC//`l ����i �-l�� J
IACATION (Ch�ok One) Clty � Yiling� _� Toxn L- /J/f .% S �/�,� �' _ Cwnty � �,��/�i �c�
City-0r Tomship
NAT6R SUPPLY FROMi Publlo Utlllty Coopetativ� Priveta Well ���
� /' �, / ' �y/
S::dAGC DISP06aL INSTALLID BY� / , ��/�._�� !% . Addresa ���-`�� ;.i ,�/%/ .�= Date
TiT
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SE7TIC TANK SIZC �U � Material � /-1�� J Paroolatlon & Soil Borings Tea4 Dete / ���� �
i. �-�-.r." � ,1,,i� / .9 'y //%' iF � �r
EFFLUENT DISP,� TS1� S]z� �� No. Lln, Ft. �% Trenoh Nidth -���� Dapth of Til• :�---�-
Seepage Bed� La�gth .-�- Wldth ��� Depth of TSle y// �
Seepads Pit� Outside Diameter Liquld Depth
� �' '� �-«�----�,�'
TYPY OF OCCWANCYt
RESIDFNCEt Numbec of Bedroctm � OTi¢R� (epeolfy) -c�i��-rc�n-2 ��ii*��-P Mimher ot Persone ��
FOOD HA57Y GRZND6Rt Yse _� No ��Distwasher� Yse �No ��Au4ormtlo Clothee Naaheri Yes _� No /�
P E R C 0 L A T I 0 N T E 5 T
TesL Depth CMreote� of Soil Hwrs Bater Test Time Orop in Wetor Lavel Inohea I1lnutea
Numb�r Inolu� Thloknasa Sn 7noh�e Sinoe Hol• in Hol• Intervsl Seoond to Next Lo I,�st To P�11
lst Wetted Overnivht in NSnuLes i6st Perlod laeL Perlod Perlod One I�ah
Exnmple
P- 0 36'� ^o Soil 10" Cle 26' 25 ee or no 30 1 2 . 1 2 1 2 60
/ G " .� ° �� S�,' 2 ; � ,��- =,z-�- � �- l'
�2 ., " ,2 '' �s � ''s. ,., / � ..-.--� �_>- , ° G '
� '" `� s '�5�.- i -�- .� s � " l '
RECCRG ➢ATA FRON: MINII4IM OF 3 TFST HOLE�
Comp+to eiz� of absorptlon erea Sn a000rd xith H 62.20 Nle. Rdminlstrnilve Code.
S 0 Z L 8 Q A I N G S - Hinim,m 36�^ Belon Pro oaed Abeor Llon 5 stem
Teot Sotal Depth De th to Ground Hater
i�u:nUar Inohes Observed EstSmnted Charaotar of Soil with Thlclmeee in Inohoe
¢xna,pl� .
[3- 0 72" 12" aok o Soll 12" C1 18^ Sand 18�� Gravel 24"
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�CO�� DATA FRGM N:YIPtUM OF 3 TEST HOLES
I, the underelgnod� hereby aertity LhsL the petoalatlon Seats reported on thia fo� rero made by me or under cy super-
vSelon 7n aoeord witn the prooeduree nnd methud tpeoified Sn Chs�ter H 62,20 (13)� Nisoonsin Admir.SstreLive Coda� artd
thaL tha data reoordad md lonation oC yL�e_sL holea ar� oorreot to tha best of rry Imow adp,e °�d 6elief.
N.V'� �-P �L.G.,�� �C �- /��� TITLE C.-��'f�y�,. .
2ype or rint - �
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PF:rI534U::OH N0. ' � o� � MdSTER PLL21B6R LICE65E N0,
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