HomeMy WebLinkAbout002-940-16-2105-LUP-1989-303 K
' /1pplicaCion for Land Use Pcrm.it W
• County of Sawyer y
o �The undersigned hereby makes application for a Land Use Yermit and aqrees �
tl�at all work shall be done in accordance with the requirements of the Sawyer � ,
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County Zoning Ordinance and the laws and regulations of the State of Wisconsin. �
PRINT - USE ONLY BLACK INK/PENCIL �,A
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ma ling address mailing address �
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city, state, zip city, state, zip
Building Land Use :;one District -L.
( ) New ( ) Filling )z�^ p� --�j
( a--Addition ( ) Dredging Lot size (J�5 ��p ��7 Z� 2' S �
( ) Alteration ( ) Grading ` ^� N �
( ) Moving on ( ) Acres �a
( ) ( ) �
New Constr ction �
Size �� fC wide ft wide �
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1 ft long ft long �
Floor area sq ft sq ft
m
Total hgt to peak to peak x�
Stories ks
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No. of bedrooms rear lot line o waterline ^(��
S� ��1
(year round) or (seasonal) � �
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Type of bldg or addition � i o
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( ) Dwelling � i rr
( ) �arage (1) (2) car i i � S
O Storage building i � i C (r
( ) Boathouse � � ��
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( ) Livingroom i i o
( ) Bedroom i i 7
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( ) Kitchen-dininy � 'SJ1� i Q
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( ) Porch - enclosed/roofed -� i i . O
( 1 De 1 - open i -� i�^� 7"
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Type o �construction � t ` � 1
( rame ( ) Block i � � i�
( ) Log ( ) Concrete � 1Y � �' _ �� � � �
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( ) Pole ( ) Steel i M� f��i,l�, `� 12���
( ) Metal ( ) � ��l} �
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Construction cost $ i � n
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Vol � Pg �/ � of deed i i �
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Cer. Soil 1'est i ' fD
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l`L j! -QU 6) ------ -CL road -- -------- �I
Sanitary Permit / �7 .
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Issued � Denied
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/ ' .t�''�'� �� �jlvN�b� �L��//� �— �l�4-k.E -�)L`-�
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o r --� 7oning ndministra or l
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� A�,n': ic.ition fni Land Ur;.� Y��rreit ��
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7'hc imdec�ignod hcrchv m,ikcw up�,lic:�tinn Pnr n LnnJ ils:r I'rrmil :mrl n��rco�: o
Lli.il �11 wur{c shaLl bc J�ru�� in uc.curJ.�ucc wiLl� Liic r<�yuircmcu�s uf thc Sawyer ,
County 7,oning Ordinance and the laws ancl re�ulati��ns uf Che State of Wisconsin. �
PRINT - USE A7,NCK INK OR P-F.NCIL
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Ru�i.ldinF l,and Use 7c�n� Uiztric: � �
( ) New ( ) I'i].Lin�; � _ -
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( j Addt[ion ( ) �lrcd�;in - L��l- tiizc _ . �J��' . _��� /,.��.� ..� . " o
( ) Altera�ion ( ) Grading ` " °
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L�f�� m n
( ) Moving On ( ) Acreti �.
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�ew Construetion �
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Sizc• � � t [ wi�lc t [ wiJc
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R ' fc tong ,gc � �„i,, � �
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Flour ar��a i��/ sq f[ ---- - - . . sq f e �o I�
--'---___. -_
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�, /b ro i,���.il. � � �� �„�:ik F
____. ..- - -- � --r. . .
SI.JClPS ---'
__—_____... � .__ . ... .
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No. ofi beclm<,ms � roar I„t I in� ��r- watrrl iu�� I
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(v�•nr r��ini.l) �ir 1,.�.�s<,n:, ij i _. � c�
'1'yp�� o( bl.df, ��r addi_liun i i �
( 1 Uwc1J inil ,� � v� 4
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( ) Garaf:� 1(1)� (3) ��ar { i -.�— � a r
Stora E builJin � � = �
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( ) I.ivi-nr:ru��m � i �
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( ) F:itclicn-�inin��, i i
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( ) Porch - enclosed/rooFed i
( ) Ue�ck - open - ( E � i � �z
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Tvpr c�l cons[.ructi�.�n �
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( �) Pr3me� l ) P�locic �i . . , �C`�
( ) Ln� ( ) Cunrt-��fc. � �. �..' � r. . "_,., � �
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( ) Pole � ) � .a
( ) Mct��! ( � _ �� _ _ i ��w�r5� �lt � !�— /3Z � i
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� � � V � � �� ..:� StateandCounty StetePeimii # 1 ?� �. ]
�. U �. I, � Permit Applicatiun Cuunty Pennit tt 81 - O ��
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' ��,. for Private Domestic Sewage Systems Couniy S2AWV6T'
CST -8 - 262 -
DENOTES STATE APPROVAL REQUIRED
ete Approval Received from State it Required S[atr Plan I_D- iF
�. OWNER OF PROPERTY Mailiny Address � _.
y�- E , ,/ l/ < >p�f3
'�'i�/ /��%/C',C L�C� T�"�' ��L�C � �. L « �l� �C.cL;' .
,. LOCATION: % Y<, Secti n T� N, R� E (o�l W Lot Crty
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Subdivision Name, neares road, lake or landmark Blk# Vdlage �
`�/ i /��•� I-fi �!�(�.�7� ��. � i � 'i /. / i lownshit�
� �l'� S�i � � ijGf ��G �
TYPE F OCCUP NCY: Com erciel � Lndustiie 'O�he� (speafy) 'Vaiiance
�" _ T
Single family [�, Duplex No. of Bedroomc _� J( �. No. of Persons /
�- SEPTIC , TANK CAPACITV��_Total y:Jlons No_ ul t.inks
HOLDING TANK CAPACITV Total yallons Na uf t�inks
Prefab �oncreie�_ Poured-in-Place Steel [ {��,�_ Fiberglass Othei Ispecifyl
New Ir stallat�on n 7�
- Replacement
Lift Pump Tank or �S'� hon Chamber Total 9allone Pref concrete_Poured-in-Place_Other (Specify)
. EFF WENT DIS SAL SVSTEM: Percolation Rate Total Absorh Area— sq. ft.
New � Replacement Alternate (Specify)
Seep Trench: No. of Lineal Ft_ Widdi Depth Tlle depih (topl— No. o( Trenches_
See ge �ed�Lenyth ,�� / Width-1 `'S- / Depth�,}_�_Tile depth (topl_�-L—No. of Lines�__
Seepaye Pit: Inside diameter Liquid Depih No. of Seepa9e Pits
Percent slope of land (�� � / Distnnce from critical slope
ATER SUPPLY: Piivate ��_ i Joint �_! Community U Municipal �, _,'
,-�ncis namc as listed on EH 115 if other than present owner:
ihe undersigned, do hereby certify Ih.�t the information I havr repnnr�l n in accord with Soi:tion H6220,
lisconsin Adm�nistrative Code, and that I have sized [he e�fluent dispotial system from the EH-115 piepared
y Ihc CeilyEicd Soil Tr/�!ei ' �
AME [���!�'���CI ��!( 2�.r�� .[� -1-'1/ C.S.T. u � ) - � y � /and oiher informe;ion
biained from " '- �-�,t � � (owner/buildeil. i� � •i
lumbci 's Signatwe �•.� � ..'�AtFP!M1�PRSWii �� `/�.=� Phone rt�'24 � 9 . UFf�
lumber's Address
PLAN V I EW�. Provide sketch below of system (inciude direction of slope and all distances in accord with H6220. Well loca-
tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neiqhbors
property. If well has not been drilled please indicate.
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Not Write in Space Below - FOR COUNTY AND STATE DEPARTMENT USE ONLY
: of Application Ob - 10 - 81 Fees Paid: State 14 . 0�_ County 3b _ UO Oate 10 JLll1C 1981
mi� Issued/F�e'fc$tZ� (date) 06 - 10 - 81 Issuing Agent Name I)01111:1 L Iorc ^ '� k
ection Ye{�No ' State Valid# Date Rec'd
:ounty (whrte copy) 3. owner (green copy) DIVISION OF HEALTH, PA. BOX 309, MADISON, WI 53701
tate (pink coPy) 4. plumber (canary copy) Revised Date 711/78
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