HomeMy WebLinkAbout002-840-17-5206-LUP-1988-283 , Application for Land Use Permit ' ,
County of Sawyer . y
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The undersigned hereby makes application for a Land Use Permit and aqrees �
that all work shall be done in accordance with the requirements of the Sawyer �, �
County Zoning Ordinance and the laws and regulations of the State of Wisconsin.
PRINT - USE ONLY BLACK INK/PENCIL
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�. �(�T k Ic.�_ �'(a-12�N� �i�t�L��?, t—
Owner Suilder
P.O, E�Ok -j 2, 1736 Johnquil Lane � �
mailing address mailing address
1 W}'��(� W t _5�-� Plymouth Minnesota 55441
city, state, zip city, state, zip
Building Land Use Zone District 2[Z -2,
( ) New ( ) Filling
(�Addition ( ) Dredging Lot size � �
( ) Alteration ( ) Grading �n n
( ) Moving on ( ) Acres t�,� I
( ) ( )
�oRG1-4 To
tvew Construction�lc�NldqT�� C-�RY��E
Size �I� ft wide �Z ft wide � �
�
� ft long � Zp ft lonq �
Floor area 333 5q ft 38U Sq ft .,��p °
ro
Total hgt �'L to peak �Z to peak `Z� x �
Stories �_ _� /
l
No. of bedrooms �' rear lot line or waterline
(year round) or (seasonal) i
i �
Type of bldg or addition i i o
i m c
O Dwelling i i tr, rt
(.}�Garage �zar i� i a o
O Storage building i i C rt
( ) Boathouse i c/� �!�` '(� i u�i
( ) Livingroom i `X� �`\1�1�J i p�
( ) Bedroom i i �
(.�Kitchen-dining'f3RP-F � � Q
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(�Porch - enclosed/roofed i i N
O Deck - open i i �
( ) i i �
( ) � � .p„
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Type of construction i i I
(�Frame ( ) Block i i
( ) Log ( ) Concrete � � �
( ) Pole ( ) Steel i i (J1+�
( ) Metal ( ) i i ��
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Construction cost $�5�.� � � �
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Cer. Soil Test �—�.55 � � fD
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__________CL road ___________________ z
Sanitary Permit gQ —��� �
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�Rl1v :$3q �(;O ��S os� lr�r C" C' N
27 oczo�B� l9&� �
Issued Denied N�
-2. 8 ,
N �
� - ��o��. �T�r� -��r� S'
owner Zoning Administr tor
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fi�� � � atatc and Coun:y State Permit k
�� I'��in�it Applicu�iun County Permil # '���1'�
, „�„ for Priv.itc Domestir,Sewaye Sys:ems County
'DENOTES STATE APPHOVAL EEC]UIRED CST 80-155
)ate Approval Received from State �.f Reyu�,red State Plan I.D. tF __._„
A. OWNER OF PHOPERTY PAailiny l�ddres�.�. 61z4 Virginia Ave. :
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i.i LpCAT ON: ---',fr---- '/<, Seotlnn 17 , T 40 N, R-� E I,il W I_ntx City
Sub i�sion Name, Paz't Of CiORF��est ruad, lake or landmark Blk# Village
�.,' � �` I,Ut ,���� �.�/�!-._ � �` /� ownship R� S�"—��
C ' �� . -- i � .-.-�--�-
. PE F OC UPk CV. Commercial � Industri;il 'pthur Isnecify) °Varianr.e
$ingle tamily � Duplex No. of [3cdrooms 'j� _No. ol Pcisons�
�� SEPTIC TANK CAPACITY�Total gallons No. nl tanks %
HOLDING TANK CAPACITY Total gallons No. ol �enks
Prefab concrete Powed-in-Place Steel /� F���er9lass Other
(spet i fy�
New Instatla�ion Replacement ?
Lift Pump Tank or Siphon Chamber_ To gnllons Prefab concrete__Poured-in-Place_Other (Specify)
. - -. _ . ._ _ . .__ - -- - - - �----- ---- -------
-_ EFFLUENT DISPOSAL SYSTEM� Percolation Rate � Total Absorb Area�lZ—sq. ft.
New Replacement r� Altemate (Specify)
Seepage Trench: No. Lin�al Ft. Width___._ Depth Tile depth hop�._No.of Trenches__
See a e Bed:.�c _ Len thtv�..t'�—Width ' De th � ��Tile dc th to � r
P y � 9 �-�--- F' --��---.1-- p ( pl-.1�—No. of Line� � .
Seepage Pit: Inside diam tcr__Liquid Depth No. ot Secpa9e Pits_
Percent sloP� of land y�� Distance from cri[ical slope —_
'ATER SUPPLY: Piivate}{�Jo�!.J Community �J Municipal ��
nris name as listcd on EH 115 if othei than present owner: '
, the unders�gned, do herehy certify that the information I have mport�•d is in accord with Section H6220, `
"Jrconsin Admir.istrative Code, and that I liave sieed the effluem Ais�,u,al sYstem from the EH-115 preDared
n the Certilicd Soil Tester, �
�:"�ME ���// � %�7 !�j � � � C.S.T. #,� '� �� and other information
i�-I-�`-�ff--'�— ���.L�
,h�alned ro� m ��� 1� (� (owne�/buJder� �� �
.��mber's Signawre, ' r �17� � _���"Z;' �t -7 -� aL� �P/MPRSW-# � �� � Phof�e # 'f_��c � � � :
'I:imber's C.Adress�Lf' ��,Y ,�'�� t � —
� PLAN VIEW� orovide sketch hclow of sYstem (inchide direction of slope and all distances in accord with H62.20.Well loca-
,� tion shall be included on the sketch. Indicate or dimension lor.ation of a�l wells on the property or neighbors
�I property. If well has not been drilled plcase fnJicate. _._nt-� - ' /�-
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Not Write in Space Uelow � FOR COUNTY AND STATE DEPARTMENT USE ONLY
co-: ot AVP��tation 7-14-80 Fees Paid State 14 . 00 County 36 . 00 Date l4 �Tnly 19Q'�
��rit Issuad�r�pd� (date� _L1L��_Issuing Ayent Name F;1d171E Nehrlin�
pection Yes No State Valid# Date Rec'd
_ �o�mty (white copy� 3 ov .�en copv! DIVIcinN OF HEALTH, P.O. BOX 30J, MADISON, WI 537p1
ate IPink coVYl S. pi .-r. �c.a-i3rY :oF�v1
� Revi�^�1 Date 7H/7p .
REPORT ON IPJSPECTION OF SANITARY PERMIT #_�•�y_
� ' Name ar,d Address of Permit Holder Person/Persons at Site 2 Date of Ins�
�0 1lN �ol-FMnr� L,IUi RN O�NNlg ��� ` r� L �
� � ��/� � nA-u. �SYu�F Time of Inc ecti
�i73r�2, ress, tcense o. o ns a� ing p umber P
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�(.i�INSTALLATION CONSISTS OF: � Septic Tank � Seepage Trench �Dosing Chamber
[]Seepage Pit � Seepa eg Bed ❑ Holding Tank [] Fill System
'�T�EN : ermanen re �erence �niJ� scri e :
Nw Gc2k�r2 Cr (�l.pG. E�cT7'onn eF �; pl,v�'1
Elevation of vertical reference point:�G�` _____ Slope at site: � �o S,
( ' '4ATERIAL AND DEPTN OF SEWER: �'J � � " �
'6',<[PTIC TA��K: Manufacturer:_��pC__ _ Liquid Capar_ity:
Tank Inlet Elevation :_ q� _ _____ _ Tank Outlet Elev: $ � /d
� Ft to lot or property linec �,�c,___-- _ _ - - � ft to well � 7 ,3ao
i :')D1; ;ING TANK: Manufacturer:_ N of gallons :
H of gallon pump set for a cycle _ 9allons ; total capactiY of distribution
lin �s _ gallon ; size of pump ______ head; gallon per minute
horsepower _ ; brand name of pump and nadel number
Is the warning device installed? ❑YFS ❑NO Wired? ❑YFS �NO
(fi HOLDING TANK: Manufacturer ___ _ ; o ga ons �
.
cons�ruction ; depth to the cover ft; If septfic t- anTc—is
being used are baffles removed? YES ❑ N0; ft from residence;
ft from well ; ft from property line. Type of warning device
Is the warning device installed? ❑ YES ❑N0; Wired? ❑YES ❑ N0;
Locking device on cover? ❑YES ❑ N0; Diameter of vent and material
Distance from building to vent —
i �; SEEPAGE PIT SIZE: A of pits; _____ ft diameter; ft liquid depth;
ft to residence; ft to well ; __ ft to property line;
ft. to ordinary high water mark of lake or stream; ft to edge of slopes
greater than ; seepage pit inlet pi�e-elevation ft; bottom of
seepage pit elevation _ft.
, :.0) SEEPAGE BED SIZE: _ �_ ft width; _��_ ft length ; � � tile depth; � -
y0 li.neal feet tile; _� ft to residence; ��� ft to well ; �� ft to lot cr
proper:y line; _�� ft t.o ordinary high water mark of lake or stream; _�� ft to edge
of slup�s greater than 20% falling away toward lakes, water courses or drainage ditches
Elevation of tank discharge line enterin4 bed `�.� ' ft.
;�_ 1 SEEP,�U�Tk�h7�. : Total length of seepage trencFi ft; width ft;
tile depth ___ ft ; ft to well ; ft to ordinary high water mark of
lake or stream; ft to edge of slopes greater than 20% falling away toward lakes ,
water courses or drainage ditches; eler,ation of tank discharge line entering seepage
trench _ ft.
�,12) Has system be�n installed in area indicated on EH 115? �,YES � NO
i13) Has system been installed in floodway? �YES �NO F]oodplain? �YES � NO
�G1LHR-SBD-609 N. C —'
Signature of Inspector: ���� � � �,�y� )
,,:.
Department of Zoning and Sanitation '
Satayer Count.y o
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Inspection Report ro
H
OWneT Pauline M F ,7chn L . Coleman
Addrees _6124 Virginia Ave . �' Euin.s , hIP1 554�4 0
Name of business �
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Builder
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Address ,�
-- - --- �
Plumber LaVern Denni.s 7
Addre:�s
[dinter° , [�i �.` s��pg6
Inspection
y
(X� Private ( ) Public Property ;;anitary-in3tal S �
X Dwelling Setbe,ck - lake `+ �
Violation Mobile HM Setback - road �
M
Garage Setback lot line
( � Sanitary ( ) Zonin� Pr1vy
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Discussed with owner ) yes no �
Discussed with builder � yes no
Discuased with plumber yes no
Discussed witli yes no CO
Da.te �I S �fu �. �i _ I
Signature of Cfficer v�� 1�`,� ����j'ml
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/��Y�G �2S/�,F'C//Oe.. (�(/� �h /luJ _e� / .qJirLJ.z / "
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CwnLt' ��t :oawya� . ..3
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The undetoigned hrreby mal<as applia3tio�, for �, . .• �� U�« Permit and agrees �
that a].1 work sk�all be done in acc��r��'�n��_^ !Nith �1�:� -.�� e�.�;��aircmer,ts of the Satayer �
County Zoeio� Gr3inan�.c �uid the �t <w_ .� � .r o i ' � �- � � - '.n� State of Wisco�sin. �
i �� ;�i. � i , ,)*�:.,Y At:yCK INY.IP�:dC2L
;
(�'c�n�
Michelle A . :�n1 I
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Owner �--�--- �-� �-- 3u� � '.. _ --�- ---�-- �
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mail�..ug adu�ess � ir:i_iii. � . . � ... � �
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1.`S(m Q�1�.'�� ,-J P/ s.,� � 7�_ ___ ��� � _._ � r . ._l' / ��_�.�.S.'. _-_ �_'�__:J
C1C}� , state , ziE) � ' � ' � � ' � -
Bcilding Land Use c� n� ; ,_: ; _ ._1i�2--------
( ) New ( J Fillir.c � �
(� Addition ( ) Dredginc ,. , . . _ _ ...-_. ~
( ) Alteration ( ) Gradiny �' n
( ) Moeing on ( ) ------__ , _ 4 . 71 acres v
_ . _ . _ ._. _ -- I I*1
i ) � � --- -- �
C �? ,nr�[�C �-oUntoA'[�� � -pi
New Construction ( appit�or�� ��"��'- ���`�' �
_ ���j1 n
Size ZO ft wida . � ` ��'"�`� 1�
3 7 f'�t .on9 ___.'. _'1 . _ '- �.: 1c>n�.� Y
— -- N
`1 `I� sq fc €�� y �;:� r �_ ' �
Floor azea _ ___. _ �, "
.__ p;
� + r
Total hgt � 9 to neak _ / y __ �-� '� ���y4, ,x
Stories � ---- __ ._. _-.
_
i
No. of. bedrooms ---------- + ' '-�--�--=�»t--�*�--t� water] ine �
___ _ _-- �
___ .. ._ _ .-- <-
(��_o+c l�eac�i�al ) � ,u��`� L � � �
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Typc oT bldo � eddii.i^n � C�iZr� .: -' �i ' ' �� mrG �
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O L-welliny � v� �g` S,
(� G,ir�ye C'-� ('�) c�r IV�"� � '� ' < i1
; ) Storag^_ b;ii lding . i � � , �• �
Nj�ATIOn� � � /` �� !
!hy Aoathousc - N[w F� ��r � . �,� o
(�7 Livingm� :n �' �OU�T�on� � i /� /�\s - � �
(�Q Iiedroom . � � f � ` o
. go�i6i Go v / C� ,o*,�
O xitchen-�:i�iiny i� a"� � . ( f o
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N
( } Pozch - enclosed/r� , � ' �
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O neck - ope.: i \ w , �- o
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rzame ( ) L'lcck i k
( ) 1.og ( ) Conci �•L��
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Pole ! ) St.ce i � �
( ) Meta] � � ___.__ ____._ � , 4
1��� i ti� �-��� �� � �
�1� pOD. GD\TlO�f � �— O
Constrtction c:.,�:t $�:09ui_ 9R_.R�`�j2� i � 'a4it � I
OUD. h=11T�S � — I\
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E. Patrick Dargis
�wnEr zoning Admini trato
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