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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 � that all work shall be done i�i accordance witli the requirements of the Sawyer � �t, ' County Zoning Ordinance and the laws and regulations of the State of Wisconsin. PR:CNT - USE ONLY BLACK INK/PENCIL td W � June L. Pedersen `� ��� h �1,1 ,�n s 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 O O b t� New Construction d C�i � Size �f ft wide ft wide � C�7 � tt � 7 ft long ft long � Floor area �� sq ft sq ft � � � 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 � �' '-� � i Type of bl.dg or addition i i o ( ) Dwelling �/ � � � rt ( ) Garage (1) (Z) car I � � � � � � i a' o ( ) Storage building i � 5'�j i C r-r ( ) Boathouse t hG�l ' �t �� r� i. �-r � � i N• ( ) Livingroom � � •�/ ( ) Bedroom � � � � ~ i �s��/'\ '� ( ) Kitchen-dining � i i + i o (,� Porch - _ex��osecl/roofed �' � �> �'� \ P.tv �. i 0 0 O Deck - open i .32' � i 1'n N ( ) - � �' ..r�,�9� i— oo i i � i ( ) � � /�✓� i o i � i i � i , � r-�^h' Type of construction '� � ' i O0 � O Frame O Block � � �� in i i (�Log ( ) Concrete � �'`� i �, i ( ) Pole ( ) Steel ' $�� �� �'� i ( ) Metal ( ) � i i � i � � i m Cvnstruction cost $ JL�. " i � � 216 � ' � ' Vol 343 pg 244 of deed i � �. � i � � . CSM Vol -------�g---- � i ro � � _ . • , � � �vd� ---...__ y-i � Cer. Soil Test i � �D � ----•------ road ------------------- z o �' sanitary Permit [c)� -�21(0� �•.T , a y �� z , �� Issued 12., �'��(\�-� ��j� Denied iT � '1 � .5� � E� 4 —I � � � _ ;,L �.�c�c-�=��--.� ��P�U�.�. !��� — \e L. Pedersen owner � 7oning Admini trat r .2�p� SAWYER COUNTY 7.ONING ADMINISTRATION , INSPECTION REPORT � �o K 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 " o w_� �, ntz-? , r,nn n�,-v� v3�,3 r��� mr; "' - - - (��i iv��--rc��, L r`�.�_ - _ ._ `— �__�___—��= - - _�__ _:�_= q _,— � � -� ye'mtaJu.l�� �. 53 � 44 'fI ��� --� � � � r _ �_ T.' �l y� - ���p�� � �' l �r�c ai��`/IoPu � «/ai ,��c4(y � �� �� o i s /v!,Nc /�'��/�.���-S��'- � �. rt �ii.�c�i o�txU/��,Y�u�lc�n9 ��l� l ;n r � '/�e O. i�z 5/� G o �� /�ercl� T i�cc�/✓ ��l � n �'��,ti• � ��\ 1.` i — — — — G� _ I � l— �L°t",�'7—-- -- — — — i � cY' � I dY � r � ro � H H � IA � O � Discussed with owner ( ) � Discussed with builder ( ) Discuseed with � Date ��� /ln - cf�� E Signature of officer ���,�1_� ^ �- �� '� �� � i o� �^ � _�n" �.. �� � �� � r � — � w� _ � ` - ; �� _ �. ; � o � � �� -- _ -_ I � ° .I I " "Fo ±` OS1 ,w'�$ '" ' � ' r.'` � __ _gy . �- � i %c;,;1 ' m ���,1 � �1�1 • w ' 1 ��� ..+e� ' . �e��� �� `� � A w'15 \ j or 'A�' 1 �1"� N@� �— .c�V� I ' c U l , � ,B. 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Q� ' ` a� . a i�. �• •` . � ' lii { j . f;� � r , � APPLICATIDtJ r^OR SAWYE,4 COUNTY SANITARY PERh.%IT �/ AppZication il�2�p? Date _�!�3'� �\ Fee of $Z0. 00 rsceiveu '"' � '!1 1/' CL • ���/ Date � L%�S�County CZerk f Application is hereby made for a Sa�ayer County Sanitary Permit for �oric to be done on t?ie premises deseribed l:erei�i. I��FPs� PE��1'�S�r�t �Jj�,�;�a�'���� t•�� ;.� �� ���,° - <i-����,��,�-�....-��, — Owrzer �� , 4' ` dd ; .xzq�'" Telephone i_.r..,���; L.C]-[ + � �' ;r� , The o f the � Sec. r,_: _ Tmn. / � /' R. „ or / � ��SS l-(�1c.� u Lot 3ZocK _ Sub-division ;¢ 2� .' �j�- �f /�-� "T— , � /N' . �)1k�:=P�:...J4' �.: _ /.. .'CGj. ���CI.�.� e/%�[ i i,t.. �//'� ' �-(�� ./ Work c ' templated To be per. ormed b v Number of Bedroome _�_ Number of Rathrooma � � Uis?Lmasher ,,,�/r�� Carbage Grinder ,�-z� Automatic �Jasher_il•� , �� ''�'- -� �� �,t�-�� . Soil Description �,� - � n �- f _ Septic Tank Size 5�' `� gal. ` C Seepage Pit HeigTit Diameter � Seepage Trench ,�- Length �_ ��idth ,�_ Depth /G� ' � Septic 1'ank Permit # �d��` ,1 �— � Percolation Teat Form PLB 43 attaehed �/ � Yea No � � Contemplated co etion date ' �— : Il`' �'�-�J � AppZication App � ed �J-yy�-G�/Permit # �-:-�G • i Sanitarian y � wner Agent ,Jo t �.e atel— Remarka FinaZ I%2spec$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 a � '` 1 �--�- -- -----�_.� ------ --�---, �, � ' � . ,>��'� ,. ' � � i �\ < < � , \_ d `� I \ i � \��_ ! i � , ��. � f � j '�\ I 'i � � �;�� I " '� , ,� i � ;,, i i ; � ' I � cLY � i �, ��I � I .�� � , � � - a ! � � � r' � I � j ! ' � ► � . � '� - � _ ,_�_ , �� _ � � �� � � � A � , , � ---- ! �6�, � , — _ -, ; '� _ .--�s; I. �I � �' � � `f�=z `�, � i ,, � \ I 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¢, ' ,';; ; ,,, „ . � � . i ��� Agent�(S'� naturel � i . 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 � Privy _ ' _ �....._---��^- T ! r 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 � }� �1 r 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" i. �' 7/ ' �"�'-� � �:..�- � , .� ., .- ,, � ,� , <��. , � ,. .� , i ' '?�. � ✓.� ' '' ��• �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 - � � '" /� �'� PF:rI534U::OH N0. ' � o� � MdSTER PLL21B6R LICE65E N0, �" / � � ADDHE55 �- .t.t.C��P � l) �/ CA7'Y� �� � SICNATUi� � l,C. �