HomeMy WebLinkAbout006-439-06-1401-LUP-1989-080 . npplication for Land Use Permit �
County of Sawyer N
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Ttie undersigned hereby makes application for a Land Use Permit arid aqrees �
tt�at all work shall be done in accordance witli the requirements of the Sawyer �
M 'County Zoning Ordinance and the laws and regulations of the State of Wisconsin.
PRINT - U5E ONLY BLACK INK/PENCIL
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Owner Builder �:
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city, state, zip city, state, zip
Building Land Use Zone District
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(/�New ( ) Filling
( ) Addition ( ) Dredging Lot size �'� � � � x ` ZU � � �
( ) Alteration ( ) Grading N �
( ) Moving on ( ) Acres `' �
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New Construction ��
Size l= � fL- wide ft wide �
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� ft long ft long
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Floor area - sq ft ' sq ft ;y
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Total hgt `>' t� peak to peak x
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Stories ~�-- ;�
No. of bedrooms -----�'� rear lot line �r-�+t�r�_,it3
/ �7v� ��_
(year round) or (seasonal) i— - �- I
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Type of bldg or addition � i o
( ) Dwelling � i � rt
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( ) Garage (1) (2) car � �
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( ) Storage building � i C rr
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( ) IIoathouse � � ~'
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( ) Livingroom � � o'
( ) Bedroom � � �
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( ) Kitchen-dining � i
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( ) Porch - enclosed/roofed � � �
( ) ,Deck - open , � � �
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Type of construction � - ,�� � �:
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( ) Frame ( ) Block J � ��x �
� ) Lo9 (I�Y�Concrete _ il- r, I5a`0-�`' tz � —
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( ) Pole ( ) Steel i � �o :� i\,_ �A.-
( ) Metal (VY1`:� ( .-! �, ; , ,' � _ .T ^ � -
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Construction cost $ � � � ��°"�"�� i c�i
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Sanitary Permit �7 — � 1�j o ,
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F'���[;�]...?.t10❑ �OS i,cL'7C 173p I'4.."°IiL ,
County of Sdwyer �7 �
The undersigned hereby makes application for a LUed Use Permit and agrees o �
that ali work sha11 be done in accerdance with the requiremenYs of the Sawyer .., �
County Z�ning Ordinance and the. laws and regu7atior.s of the State of Wisconsin. I
PR1ST - L'SE ONi�Y ALF:CK INY.!FENCIL
Sharon and �d �
LaMoine D. Erdman �
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bwner nu i:��',,,- n
Route 1 Box 59A _ ___ __ _ __ �
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mailing ad3reSs i:'� � 1 iu-� , c Ircas �
tdinter Wisconsin 54896 _ _________�__ I
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czty, �tate, ziP city, ^tarc, zi� (
Buildiny Land Usu Zone L'�ic=.i-r_.ct _A-1 ____
( ) New ( ) Filling 1320 � X 1320 � `�n �
� Additiun ( ) 6;-edgina t,o� =.;.ze� _.------_.'___
( ) Alteration ( ; Gr.adiny w n
O Moving cn O Pcres 40 � �
l ) � ) ---- _ ------�-�------�-----�---"- C�1
11 j ' '� i ; � 'r. I �
New Construction
` ft wide �
Size _ � --- ft. �✓idc . � I-
T � '�' i't lor,g y
, €t lony --'..---- .
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Floor area sq ft _____ Sq ft �
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Total hgt to peak to peak r x'I �
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Stori.es .� _ ��I
470, af be�lxoom=; 2 iear lot line os waterl.ine I
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(vear ro;u�d) c�yc�sC�x7 > � i 6�
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Type of bl.dg or .:�lition � � � �
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( ) Lh,elling .; i ��
( } Garage (1) (2; csr � - �� �
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( ) Storage building ,,� � � i � ''��
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( ) Boathouse. i ; 'o� i
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( ) Livingrecm ��� i �
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Bedroom i �
� Kitchen-dinir�g � �
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( ) Porch - enclosed/ro�fed � � �
( ) �De,c�kl L- open � ; I �
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Type of construction i iO
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Q('j r^rame ( ) Plock —+! �
• ( ) Log ( ) Cor.cr:ete 4--- ' ..___ � i
( ) F'ele ( ) Steel i t j �
( ) ";etal ( l � I i �n
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Construction cost $.7,�7C>�____ � " �
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vol 235 rg_., 612 0� leed i (� � - rn
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CSM Vol ---""Y4-"' _ '
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Cer. Soil Test _ 87-126 _ i� ------ �'
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Sanit�ry Permit 87-118 _ ��
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ENGAGED IN AGRICULTURAL ACTIVITIES_ ______ �, F�
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SANITARY PERMIT APPLICATION �o�NT�
� D'��� In accord wi[h ILhIR BaAS,Wis. Adm Code SAWYER �
- , �STATE SANITARV PERMIT#
CST 87-126 98333 i
-Attach complete plans (;o the county copy only)for the system, on paper not less thc:n SrnTe a�;.:�i.o.NUMsea �
8Y: x 11 inches in size.
-See reverse side for instructions for completing this application.
PE fITION
I. APPLICANT tNFORMATION-PLEASE PHINT ALL INFORMATION. _ _ Foa vnaiqNee ❑ves ❑ NO
--- --- - — ---.. _ _
P OPERTYOWNER PROPERTVLOCATION
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"AOPERTV OWNF.R'S M�AILING ADD�R}ESS LOT NUMBER �81.00K NUMBER SUBDIVISION NAME
--�L_�.�/�-v_1-L. _. . ,--..._----
�_.!TY,STA i E � LP CODE I PHONF NUMBER ' CIT.Y �NEPRE.`:?ROAD,LAKE OP LFNDMARK
�/_/.e/�-er �f// � S `l��l(o � ( ' ) `o viu_n�e �_ r� C3i wi
II. TYPE OF BUILDING OR USE SERVEU:
Number of Bedroorns if 1 ur 2 Famiiy_ . �_ r � p y):
OR �__� Public IS ecit
III. PURPOSE OF APPLICATION: ICheck only one in#1. Check#2.3 or 4, it applicable;
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1. a. �zy Ne�v b. ', Replacement c. %.., Replacement of d. '�i Reconnection of e. Repair ot ar
System System Septic Tank Only an Fxisting System Fxisting 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/building. Attach Common Ownership Agreement to County Copy.
IV. TVPE OF SYSTEM: (Check only one in#1 and only one in}�2)
1. a. �Corner,tional b. �� Alternative c. ❑ Experimental
2. a. iJ System- b ❑ Holding c.❑ Pit Privy d �� Vault Privy e ❑ Mound f. U IGP
In-Fill Tank
V. ABSORPTION SYSTEM INFORMATION: lCheck one)
1. a. ❑ SeeQage Bed b. �SeePa9e Trench c. � See�age Pi!
_. PERCOLATION RATE 3 ABSORPTION AREA 4 SBA ORPTION AfiEA 5.SYSTEM ELEVATION-6. WATER SUPPLY�.
(Minutes per inchj: � REOUIRED(Square Feet): PROPOSED(Square Feet)�. Q/ � �q
� � a %/G /v'�Feet N Private ❑Joint �J Publ:r
JL TANK � GAPACITY Site
New xisting Gallons Tanks --^ _ Concrete fiber- Exper.
in allons Total #ol Manufacturer's Name PrefaG. Con- S�eel ylass Plastic ApP
INfORMATION �
Tanks Tanks sUucted
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____ , _n___ �_ j jj-��
'.c�cTankorHolAngTank . ��... . . �S� �. _ .� /.-l_C.. _ _.. . _. .'. - '__. _. __�I__ _��J_ __� � LJ_
� dt Pum Tank/Si �on ChamDer ' � __ � �J �� T�
i7l. RESPONSIBILITY STATEMENT
I. the undmsiyned,essuma iesponsibiiity fr,r installation of lhe pr�vate cewepe system showr,on ihe atlached plans.
_._ ._-_. . .._._ ___ ___ _ _ ___...__-__. --- _ ..—..__ -
Ylunibor's Nzme(Prinq: �Plr:nber's Signature:(No S mps) MP[MPacw No.�. Business Phone Number�.
'�a�a�—���lda�� �.�•�—�!��� �--s___ _ S�� �11��.�7��'rv1J'�.
'lumbcr's ddress(Street, i!y a�ate.Lp C�dep. � Name ol De igner
��.� �3x ia a cu,`.�,�r,- Cc�� ` .�-vs��, � �,...- --�
VIII. SOiI TEST INFORMAT{OM
- - --- -
�ert,J�/�/q Suil T=sle(( ST)Name/� - --- CgT# ���
_!�:`_'Li „Kc--_...Yf �/��'.r���G.t"L_- _- _. --'___. ...___.._. ..--_-_'_
�'ST�s AGDHESS f5 ieet C-�ty.State,Z Cod/el � " � phone Number.
��� �iY /�� �J����L Ll//r C /J ��G�";7Z(y� . I
k. COUNTY/D�PARTMENT USE ONLY
` Dis� rweC � Sanitar �'ermitFec Groundwater I
[J pp � Y� � ate Iss gentSigneWre(NoStamps)
Surchn�ge Fee
,}.� Approvetl ❑ OwnerGrven Inrtial i I �
I AdvereDe�erminalioni �7� • OQ � �25 . �� 7-22-$7
K. COMMENTSlHEASONS FOR DISAPPROVAL:
-- - - ------- - - - - --- - -- - ---_--------�
,�C�is'S8�tormeily PIb�71�R 09/86) DISIH18UilON 'Jnginal to Counry,One GopyTo� eurea:i ol Plumtring,Owner,Plwnber
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DEPARTMENT OF INOUSTRY, INSPECTION REPORT FOR SAFETY & BUILi
_ABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS oivi,
P,O. BOX 7969 BUREAU OF PLUMBI
MADISON, WI 53707
�XiCONVENTIONAL � _� ALTERNATIVE s�a�ePia� io N�mnP� �
II� nx�y��edl
�_ � Holding Tank !_� In-Ground Pressure C� Mound I
NAME OF VERMIT HOLDEF ADDHESS OF PFRMIT HOLDEP IN57FCTION DATE
�� �na��vP ,�',-d�,w �� 2 7� /�o,c s � Lo � t /7:� , u:�� �o - 6 - � 7'
� dF.NCH MARK (Vermanrn� refere•�te omtl DESCHIBE IF y 6-�,�y6 HEf. VT. EIEV.. C51 Hf P PT E�E V
i � DIFiENENTPHOMP�AN
�iJxinr of Glumb�•r MP-MPHSW N�� L� n�iv "— —" --"—"" $ani�erV Pvrmil Numbrr
l�v�v�a/D �'I10 �� �o i✓ � a P'� 9 _�u/ - / �8
_��----
;.PTIC TANK/HOLDING TANK:
dANUFACTUNEh LIOUIUCAPACITY IANKINlFIftkV IANKOUTLF1Ft.fV WAANINGLABEI LQCKINGCOVER
PHOVIDED Vq!iV10ED
T�'YJ • C� ��_D pL1_ _9 �• .� 9�• U �YES �_� NO ❑YES ❑NO
'dEDUWG VENIUTA VENih�nll 111t�11WAiIH NUMBEROF ����A�� �"�JNE �IIv WELL BI�ILf�I^IG VEN� 7OFRESM
�� �Hti� LINE AIR INLET
FEET FROM
❑YES I �NO _ ____l I�YES L� NO NEAREST---� 7S � ZS� 7S �
- — ---__--- -- � --�
)OSING CHAMBER:
_ - --- -- - ----
�^nNUfnC1UHfH BEUUW(i I11)Uliii ,ll',l��ll � I'I1MPM��UI1 ��— �9iq'IV ',IP�iiVvn.i.�p�i;� n�.'�h�fH ��—� WAHNWGLABEI LOCKINGCOVEq
�ROVIDEO PROVI�ED�
I� YE� C�NO ___ i[� YES CiNO ❑ YES �� NO
;ALLONS PER CYCLE: Punnvnn,ucoNTc+o�sovEanncm;ni �NUMBER OF ''"'�F'f '�" wF: � e�n�owa vervrtuF��s�+
(0lFFERENCE BETWEEN IFEET FROM ' '"` '�R '"�F'
'UMPONANDOFF) I _ ; VES L_JNO NEAREST—�
�OILABSORPTIONSYSTEM. Checkthesoilmoistureatthedepthofplowing t '+����� i�ina�trti� inr� �uninrvt� r„n��,.:i,ti�,
�r excavation. (If soil can be roiled �ntu a wire, construction shall cease unul FORCE I
he soil is dry �nough to continuc.) MA�N I __ -- _�
:ONVENTIONAL SYSTEM: �-
�� BED/TRENCH wi�n+ �En;r,n� Nu ni uisiw r�ivi tir�i��i�ti� � cuvE�+ i�v5ii,� nin — ��aiiti �iouio
i ri,F tir��F s � �.,n,t �nn� PIT r.Fv1N
DIMENSIONS /[�/ �(o � --- � s�,�W
„HAVELDiPTH F�LLOFPiH 111.`.7!1 I'IPf UIti1N PIPE DISTF PIPF MATFHIA� n�r) p1$III NUMpER OF PNOVFfiTv �yE� L E1UI�.pIN�i VFNTTOFFESM
; F i riw �iv� �>'/ nHcrv[ cuv� i+ � t � � �rvi i i t � i � i ��i� ��u�� �, FEET FROM t w� n�N w�f r
�O .�i �r ll'�• �, t�--��!/C ' 703� --� �- NEAREST--sT7.S� �S o �LS- � to-
�10UND SVSTEM: ^
--T--- ---
Mound site plowed perpendicular to slope Check the texture of the fill matenal for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand. TtONS MEASURED.
❑ YES ❑NO
C_�ILCOVER '� xr�n�r — -- � ,rn�n»i �v� n+,u�.i ��.s u��sti��.cii��nwi �_is
- --- --T—I - IYES �� NO--_ ❑YES ❑NO
_;Ff".1 (?VFN THENCII HEI) .JEPT1� I1V( H iHE '.(�.�1 Hi i: I�f NIH 1:V iI1V`�till 1111)!,� I1 Ff lll f� A1VLCMEU
'.F�v I F �t F i�(�F ti � �
.1__ __ __ L_�YES. UNO C�YES C�NO ❑YES ❑ NO
`F�ESSURt7_ED DISTRIBUTION SYSTEM:
W�DTM LFNl�i�1 ry0 O� '_A if saAL 5!'nCIN(� =,�'.AVI l UFNT11 Nk lUW �'IPI FILL I)EPTH APOVE COVFH
SEDlTRENCH n�erva�t s
DIMENSIONS
���� MANIf0; I1 PIiMP hlnNlft)IU I)ISiR PIPE MANI(f)IUMA(ERIAI N[i I�i;iVi UIfifH PIPt I�I°,111111Ui1�1N �IVC MATFHIAI SMAHKW(1
t.LFV EIFV UI�1 LLEV �'i�'fl, Uin
T
�LEVATION AND - �— ,
i?lS71'IBU710N ____1_—_—
ditiFORMATION �'o�t si;E ���i�t Srn�:irv�, i;i:i�i � u c�u��n �.i� v r_uvr �� ninit �iin�- ver�i u ni �ir r a�N�+csvuNus io nvNHovru
PLANS
�JYES ��NO ❑YES ❑NO
,OMMENTS: PERMANENT MAHKEHS� OBS[RVATION WELLS � NUMBER OF �qpPERTV WELI BUILOING
� - i r-� � �
FEET FROM LINE
I lJ YES U NO �. YES !_ i NO ___ NEAREST _ ___
�ketch Svstem on Retdin in county file for audit.
<.everse Side.
sl(;N�.ut;e _.__ _— r�r�e "
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'll_HR SBD 6710 (R. 01/82) L{%o/ � �