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HomeMy WebLinkAbout002-940-36-1111-LUP-1988-189 Application for Land �se Permit County of Sawyer _ 0 E The undersigned hereby makes application for a Land Use Permit and agrees • � that all work shall be done in accordancc, with the requirements of the Sawyer M ' County Zoning Ordinance and the laws and regulations of the State of Wisconsin. / PRINT - USE ONLY BLACK INK/PENCIL '�' . ��;i,�� �:I! ��-� Q.�t � r r !_������r�� c. ;�Il��L l� ��.�JN�/� � �� Owner Builder y� � �1� /;.. ��. Z d3�x �//� mailing address mailing address _��1� �nl�ll?D �� ���5�3 city, state, zip city, state, zip Building Land Use Zone District �� %� � (�•,') New ( ) Filling r � ( ) Addition ( ) Dredging Lot size rt ( ) Alteration ( ) Grading N n ( ) Moving on ( ) Acres ZQ ( ) ( ) � m New Construction Q Size �b_ £t wide ft wide �2' ft long ft long C � Floor area � sq ft sq ft ��1 ro � Total hgt '� �• to peak to peak x Stories No. of bedrooms rear lot line or waterline 1i1:�. (year round) or (seasonal) i ,yLL _ ,<�• i i Type of bldg or addition i i o ( ) Dwelling � i �, r�+ ( ) Garage (1) (2) car � � � i ar (�!f Storage building i i C rt ( ) Boathouse � i m ( ) Livingroom �� � � ( ) Bedroom i i t ( ) Kitchen-dininq i i ( ) Porch - enclosed/roofed j� ' p!✓ i ( ) Deck - open i 5 i c � � �� 3�a7 � � � � i 5� i +'�°' i � \ ' .R^�- � Type of construction � • � �N i � ( ) Frame ( ) slock �f.j--; i � � ( ) Log ( ) Concrete � I.+,i f � R\ (� Pole O Steel i tio � � «� pQ Metal ( ) j i a� i � N Construction cost $ �z�• ��J i �D s�� �4 � 5� � ° � �— _ i � � l�J � Vol ��� Pg ,f 7't�- of deed � ty6 S}� ]y. ''�.. . i � i 'r � CSM Vol Pg - �--�"' i Iti� �.�+ \ i w i rt Cer. 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' ; i � -� � �'� �\ �` � i i �r � �� � 6 . � �� � �' � ' � � � � ' � '' o '; � � � � �-- O , �� � � ,,� �� _ . �, ��� . � «: � '� �� W i�� ;%'/ F� � � . �-- `\`� , ;:, '> � j (� ` ii � , \ `�� // ���� � '�36 ��_ =� 36 ;ti..�_G\ � � - g f ;` 1 ' � % � � ' � � \l G ' � o \-�� -:�;.. , � � '' • �' �� ' 3 6 ' � �' � � ,,� � a . � � � ' — .a ��� � � G �:: ' •" ,: ,... �:3 � : �. � __ c,, r- / 36 'a� �{` � ,,, i 14, �� � " o _E. ' <' � ', 1 ' � `� 6 0 �` G � � __ �_ ' � N �i�lc�ntr� ,_`� �;��4�n _ — -- -- —_ — - — - -- ---- -- ; -�, i . .. ��� ' ,� \ ` - p,, � �� �� O; j;� C' �� _ / � ' ' ._ a ,�36 � : • �l � ' � �I • U � � - ' - __ _ -- __ ___ — I N ,� � '�_s �,__6 % I 6 . c> � �a :� � , , . , , U ., �� � . 36�� _ _-- _ _ _ _ ,� .i,,� T , 3 '\ �i 6 � ' � � o�� �' c', '�?l � '� �— �i 6' _ - -- . 36� - o `� � � � � � � �'� , % , � a -- / �', ' :;"�3� � Q � ? ;�\ - -_ _�i / w .� - �� E> � 36� '�' � •� - `--a � ; .�. K:\ ' '— o � •�,� � N , � _ � % �-- _> 1 � l-�:, - - � 6 • i � � . _� ,_:. � _ _ _ _ _ : � � _ — � U� _- — — ---- __ -- -- ---� � 6 . ------ -----_ _-- --- -- -----� I -- / � � � ,�iu� � _ , //° ji;��f� ��;� i � ; � - � � . ,#,:,p,Y,:. .. . • � , �� • �� � J �EPARTMENT OF � aPPLICATION �' SAFETY& BIT�'yLDINGS iVDUSTRY, � y� �'�' FOR SANIT�RY �i��isiory � _ABOR AND PERMIT P.O. BOX'�969 � lUMAN RELATIONS (PLB 67) MADISON,WI 53707 a� � �ttach plans for the system on paper not less than 8Y: x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal n� vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter i-63, Wis. Adm. Code, must be shown. An index page or each page must be signed, sealed and dated by the designer. If designed by a Master 'luml�er, the date, signature and license number must be shown. A iegible reproduction of the soil test report or the owner's copy must be �cluded. Shirley Ann � Froperty Owner. � Mailing Address: � I1 � C• '` $ � � C' �. � _�c t1 �_ . ��. �, .7�-/�: �t 2_ i�W� ,,91�.i`� i_�' ��_� � Froperty Location: G�'or TownshipS �—� County: NE Ya NE'/a$ �I� �T E'i� NiR " �1or) W •(-' _� , I r�. Lot Number. Blk No.: Subdivisicn Naine: Nearest Road, Lake or Landmark: State Plan I.D.Number: sND�q�, � f�h,� ►�.i� (lf assigned) `/PE OF BUILDING -- Number of ❑ Public" ❑ Variance"` � Other (specify)* Bedrooms: � 1 or 2 Family *State Approval Required. "�- TOTAL NUMBER PREFAB POURED-IN STEFL FIBERGLASS NEW REPLACE- OTHER GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specify) SEPTIC TANK CAPACITY �,'_''��- � HOLDING TANK CAPACITY � L�FT PUMP TANK/SIPHON CHAMBER "...4NUFACTURER: �FLUENT DISPOSAL SYSTEM PERCOLATION RATE ABSORPTION AREA lMinutes p�r inch): PROPOSED (Square feet): ❑ NeW � Replacement �� � Experimental � Seepage Bed ❑ Seepage Pit � �� L7 Alternative (specify►_ __ �� Seep�ge Trench �C. 0 tiVater Supply: Owner's Name as Listed on Soil Test Report (lf other than present owner►: � Private ❑ Joint ❑ Public �'� ��a+� 5� I, the undersigned, hereby assume respcnsibility for installation of the private sewage systern shown on the attached plans. f��e of Plumber: � Signa J� t �. MP/AAR4�91M�iJo.: Phone Number: � � � � C�.�Jn��'�-�--'�-'��. � T�? ��: 3�� ��- 7c� ..� ' : , Fiumber's Address' I�laaa�of Desiyner: ��t 3�3 �i1 ��.. �i � �.t#� ����� ,.�t�� �; � � f_�,� ►����.. -_ — COUNTY/QEPARTMENT USE OrJLY CST 82- 183 Signat r f Issuiny Agr, Fee: Date: [� qppROVED Sanitary Permit NumLe� �6� . U� J- Z �=HZ L� DISAPPROVE� 29521 Reason Dis ovai• falternate course(s)of Action Available: ;hange of ownership, building use or plumber requires a Sanitary Permit Transfcr Form (67-T) to be submitted to the county pri�ar to in- tallation. Failure Yo�omply wiil void the sanitary permit. )ESTRIBUYION: White-County,Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumbe. ��"s1R-SBD$398 IR.07/81) . . �. '` . . . , �PARTMENT OF INDUSTFiY, INSPECTION REPORT FOR SAFEi Y A[30R & HUMAN RELATIONS pRIVATE SEWAGE SYSTEMS BUREAU OF PLV G.BOX 7969 ADISON,Wf 53707 s�.����ri,,"i u w,���n�•� �CONVENl�IONAL �J ALTERNATIVE ,,,a,s,9��„ � ❑Holding Tank �i In-Ground Pressure �i Mound __ INSNE(:I IOM[)AiF �Atd[ F PERMIT HOLDER� ADD�7ESS Of VERMi7 HOLDER� � - � �Z ��pN S�NSEN - � -- REF.7T.ELEV. CST HE� PT !L��V :NCH MARK IPerman.:��refrrenc�•po��tl DESCRIBE IF DIFFEHEVT FNO�.�PLnN ' G O NtN �o�N�2� o� Dw. BcrTo� c� S,��NG -- C�`n1 San�ta.y Perm�i N�m;,ei. �,�. ����Pluinber ldN;M7R5W Nn �p SA RRt� — — — Sl-�wY�2- �9 �� — EPTIC TANK/ � - cHovioeu V,ANUFn(:�IUHER �x1STIKGI SVU ���UIDCAPACITV TANKINLETEIEV TANKOUTLETELEV ROVI'CEDLABEL LOCKINGCOVER � �� 1[�YES L NO ❑YES I-�NO Rf�SM�SSEN S�IJC T{�M� HnAU PROPEF�T� WLLL BUIL�INCi ��'ENT TO FRESN Vf Ni UTA Vf N7 MATi. ��I��r/WATER NUNIEER OF ��NF � AIFl IN�ET aiuuiNc n�-araM �EET FF`.OM gO �I�J �`jQ 1�� _�nYES GNO _NEAREST- ---- -' L_�YES ❑NQ " �— �SCSSING CHAMBER: --�•utiar si��i+aN Mn�,i�v nc1uF�F�i � wnHN�Na�neE� � �ocKiNc covea h'nnl:��f AI;TUHEH HFlJU1Nli LI(7tlll>I�APnl:llv V1iMVMC�DEL pPOVIDED PROVIDFD� UYES �JNO ❑YES C.INO �YES ❑NO -- NUMBEROF v����rrwry wF�-�- �n,�ni���, �er�rTOF�esr� VUMV'nNiJ CUNTR()L50�'ERA(I()Nnl t INF �IP INLE7 GALLONS PEN Cti'CLE: FEET FROM (.i�IFFERENCE BETWEEN [_]YES L�NO __._NEAREST__ _ _ - - �PUMP ON AND OFF) -- --- --�n� nnr.�titi� ^.�artr;��n� nrvu�.onr,r,v�,. 50lL ABSORPTION SVSTEM.Check the soil moisture at the depth of plowing FORCE o� excavauon. (If soil can be rolled into a wire,construction shall cease until MAIN _ the soil is dry enounh te continue.) -'-- CONVENTIONAL SYSTEM: - ,���,�•; i iouio — --� dtii��F ��n UEPiH� wiorH i_eNc1H tio ov r�isra PicE tir,��.irv�, n,,�nrE�Hi��,_� PIT - BED/TRENCH �6 TN�vc.+es _ ` �- .- D�MENSIONS ' � �` T�IPR2 �� - NUMBER OF v"�����;�`� wti'. i i �,iti�, �r,rtoF�+es�� I INE AI�a�^.'LET DISTF.PIPE MATERIAL NO D�5<<� —� / — � �� � �,r�nv r����-�� � u o�arN ��isr�v rivf uisrr� ciPF P�PFs FEET FROM �� Y ����j ,� � ,�� ����,� �,�,�� ,��,,,t�a ���� �ti��� ��E,: FN�� �puc 3 �'� (,��� __,�ZI ��_�____- — NEARESY - - ---- P�tOUND SYSTEM_ Mo�md site plowed perpendicular to slope �heck the texture of the fill material for PROVIDE A DIAGRAM OFSYSTC-M and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE.SHjJW ELEVA- meets the criter ia for medium sancf. TIONS MEASURED. �YES ��NO _ --- - ---- rtiir:inwitiih�.-�iir-tr�r—---- ni;:.ii;v;;n�irw�ii�;�---- � SOIL COVER rExr�,��E I 1YES lJNO ❑YES -- ❑NO -- —_— 56Eoe�� � Mu�rriEf� '�FP111'.,,FF{1HF�.�'.11 HfU �EN� �. `.Efi IfiF�.(�11 HEL� :)EVfHIJF TC17S'�IL — cooDe;J it�� �t�� �'�YES �NO ❑YES ❑NO I ❑YES ��NO 1�--- , PRESSURIZED DISTRIRUTION SYSTEM: ------------ - -- - - -- F i��i�FN������i'�ve coe-E�+ -- �,���7f� �ENV�t� NO.OF L/+TER4L SPACiNG ��FZnVEL DEPT��k4FLOW�IVf BED;TRENCH — rArNc�+es OIMENSIOPiS - MANIFOLD MATEAIAL N�; ()�SIH f�iST41 GIVE UISI IiIHUII(�t'�PIVE MA1EV11AL&M1�+NKIN(� MC.NI1 Cll C7 NUMP 1i:Nlf CiLf) DISTR YIPE �,��,�S �)IA � t l k V E l k V 1?I n F l E V �ELEVlST'IOf�f AND DISTRIF�llT10N -- ---- - - covri�Mnii��ini - vrF�r�cai_�i� r�oaHr^,.r�No:,ir r,PP���,ve� Ilc��l,�l.'� IIf1lESVAI:InJt� I•I�Illll)(:(IliVik(:II.V f'l;�hiti � VNFORPJiATION - - _ C�YES ��NO L�YES I�NO , __.----� PHOPEHTV WEI I BUILDING�. OtiSERVATION WEl L$ NUMBER OF LINE ! __.__ _._ __ _ ' . --� PERMANENT MARKERS COMME F�E�C FROM - ��� ❑YES L�NO PJEAREST _ _ ---- - U YES ��NO - --- - --- ---- --- . -a Retain in r.ounty file for audit. Sketch SYstem on ------- rir�t---- ------ Reverse Side. s�," ""- �, � l /� D ILHR SBD 6710 (R.01/821 ����`�_ 7�7—__"�Yl��l/— J? Z� . -- ----