HomeMy WebLinkAbout002-940-05-1235-LUP-1988-187 Application for Land Use Permit
County of Sawyer -y
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The undersigned hereby makes application for a Land Use Permit and agrees 7 '
that 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.
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mailing address mailing address
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city, state, zip city, s�ate, zip
Building Land Use Zone District R.—�
(�Cj New ( ) Filling t• O
O Addition O Dredging Lot size -�I G K�/�D ,�r �
( ) Alteration ( ) Grading �, n
( ) Moving on ( ) Acres �j,gz
( ) ( )
New Construction m
Size ,��,� ft wide ft wide
£t long ft long
Floor area � sq ft sq ft
cn.
Total hgt /� � to peak to peak x
Stories �
No. of bedrooms -� rear lot line or waterline
(year round) or (seasonal) �`�g
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Type of bldg or addition � � i o
( ) Dwelling i i G rt
(� Garage (1) �(2�car � � i w t+
O Storage building i � i c rt
( ) Boathouse i �, i m
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( ) Livingroom i , i �
-( ) Bedroom i , i
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( ) Kitchen-dining i ' i
( ) Porch - enclosed/roofed i � �
( ) Deck - open � � h�; i
( ) �J ' i i '
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Type of construction z,i . '\\'�_ . _��-a �
(k} Frame ( ) Block a� 'i ,V�', � I �
� ) Lo4 � ) Concrete ~�i. � vJ a,.\o ICX�.r�,(�p � . '�
( ) Pole ( ) Steel � � �a- _ /a� � I'��
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( ) Metal ( ) I /f a—i �o ' � � y� `'°_i I
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Construction cost $ <�r^,j�.�� i I � - �
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Vol �S Pg_},j of deed i � � � �,r�
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CSM Vol /�, Pg n,"_,'^%� i �`7 `�; i ro
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. Cer. Soil Test -79-�-] � I n
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Sanitary Permit �j-Q7C� ��� S1�_T /�D2T!-� -
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Issued 2_q {�.Y1l�ST �`�� -�e�L�P �ca� �w' ��-101
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�C�af.e / v ' 1--��N K-� I�u9-�-�-<�l'l�-1
" �� owner Zoning Admin stra or
c.an�\d:`13�(q"l
�are✓1�-: �83�
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TOWN OF 6AS � �. AKE
SEC . S TWP 40 N . R . 9 iN .
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� � � � � ��� 19980 �.
�� State and County Siate Permit # _���_
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� �.g.� - Permit Application County Permn �
for Private Domestic Sewage Systems County _ SaA�'el
'DENOTES STATE APPHOVAL REQUIRED CST 9 - 237
Ddte Appioval Received from State if Required _ State Plan I.D. #
A. OWNER OF PROPERTV Maiiiny Address�. P 0 . $OX 6�
�l /�� /� �e'�� /ll'J E? `C/ �� Q CC^ . !�/l�1 tc�a c��L% GG�. �. �%��/ �
R. LOCATION: /�fL�Y, "�'.G , Secuon � , T� , R� �--br�-W Lot# Clty
Subdivision Nartre, nearest ioad, lake or landrnark Blktt Village
^ j Township ��>_� GpL��
�h d!s^So �� /�d
C. TYPE OF OCCUPANCY�. �Commereiel ' Indus[rial 'Other �specify) 'Variance
Single family � Duplex No. of Bed�ooms �- No. of Persons
�� SEPTIC TANK CAPACITY ���' Total gallons No. of tanks �
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefabconciete Poured-in-Place Steel /�� Fiberglass Other (specify)
New Installation � Replacement
Lift Pump Tank or Siphon Chamber Total gallon< Prefab concrete_Poured-in-Place Other (Specify)
_ ______- _ . -- - -- � ---- � -
E EFFLUENT DISPOSAL SYSTEM: Percolation Rate • � Total Absorb Area � sq. ft.
New �� Replacement —Altemate (Specify)
Seepa�e Trench: No. of Lineal Ft. idth__Depth Tile depth (top) No. u( Trenche�:
Seepage Bed: Length -3 `� � Width ��-'- � Depth x �' �� Tile depth (topl���—� No. of Lines �
Seepa9e Pit Insid dlameter Liquid Depth No. of Seepage Plts
Percent slope of land � _ Distance from critical slope _
L'��TER SUPPLY: P� ivate ( _. Joint L� Comiounity ❑ Municipal L_]
)wners name as listed on EH 115 if other than present owner:
I, [he underslgned, do hereby certify ihat the intormetion I have reported is in eccoid w'nh Sectiun H6220,
Wisconsin Adminatrative Code, and that I have sited the efflucm disposal system From the EH-115 p�e�ared
by the Cer ified Suil Tester,
NAME .�� tt GSS. 7t ��S- 1/6 � and other mformaiion
ot>talned from � (ownei�i�uilderl.
Plumbei 's Signature l�.B.u� �� �qy(,'MPRSW$ l� ��� Phone 3i'J/j—li �/-�/2-� � �—
Plumber's Rddress /!7 c Y"A y /-/-rt ci c« E 4 �� `�Y d'Y �
IPLAN V I EW�. Provide sketr.h below of sYstem (inchide direction o( slope and all distances in accord with H6220. Well loca-
I tion shall be included on the sketch. Indicate or ��iniension location �f all welis on ihr propeity or neighbors
� 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
��e of Ppp�ication 5= 23- 80 Fees Paid: State 15 . 00 County 35 . 00 Date 23 May 1980
�rmit Issued/f�gj�tg� (d�+te) �- Z3- HO ._Issuing Agent Name E131Re Nehrling
spection Yes� No State Valid# Date Rec'd _
county (white copy) 3. owner (green copy) DIVISION UF HEALTH, P.O. BOX 309, MADISON, �"JI 53701
state (pink copy) 4. plumber (canery copyl Revised Date 7i1/78
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Department of Zoning and Sanitation •
Sau•ryer County �
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Inspection Report �
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Owner Timbexiine Land � Development Ltd . a'
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Address P . O . Box 60 Iiaylaard , WI 54843 '�
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Name of business `D
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Builder a
Address �"
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Plumber Lawrenc_e Lamphear �
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Address Route 8 Box 163 Hayward , YdI 54843 �
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Inspection "
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( }(� �rivate ( � Public Property X Sanitary-instal � �
j( Dwelling Setback - lake
Violation Mobile HM Setback - road �
Garage Setback lot line
( � Sanitary ( ) Zoning Privy `�' a,
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Discussed with owner yes no �
Di.scussed with builder yes no
Discussed with plumber �( yes no
Discusspd with yes no tO
Date � � �Lq N � "
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Signature of Officer �%� /�,�� �� �-y, ;;,�,�