HomeMy WebLinkAbout014-942-33-1206-SAN-2024-056 C�
�
SAWYER COUNTY ZONING & CONSERVATION ADMIMSTRATION Z
10610 Main Street, Suite 49 �
Havward, Wisconsin 54843 s
_
�715) 634-8288 �
sanitarian(n�s:�����°crcounh�go��.or�; �
COUNTY SANITARY PERMIT APPLICATION
In accord with Chapter DSPS 383, Vl'is. Adm. Code anc:
Sawyer County Private Sewage System Ordinance
APPLICATION INFORMATION—TYPE OR PRINT
Property Owner's Name Property Legal Description
c e e' ,. • L�,., �N►�.) '/4 NE '/4, Sec. 33 ,Twp. �/a N,Range �_W
Property Owne s Mailing Address Lot Number Bla;k Number
` 1
� a 3 8(o N Co ur, + Nw T
City,State Zip Code Phone Number Subdivision Name or CSM Number
1-�qy wa�d, W s S�l S 2/3 � � ^
TYPE OF BUILDING: (Check one) ❑ State Owned ❑��ty tvcaresc rtoad
�Public ❑ I or 2 Family Dwelling—No. of bedrooms ❑vilta�e 1 F� umber � �w T
�Town of 1,.�Y�c`c.lc) � _`
COMnf�'Ct41 'v
PUBLIC BUILDING/LAND USE: [Explain the use/purpose for this Pareel Tax Number: (12 digit legacy number)
pennit,(i.e.,campground,festival,rec;reationlentertainment event etc.)�
33em., 0..r���;�5 ,�►�s �'o�� ag�n., e..b��s o ! `4 - `� y a - 33 - 1 a o �
TYPE OF PERMIT: �-� _ ��c, � Additional [nformation:
�POWTS Reconnection(SAN# $� - �3S)(��O��v
❑ POWTS Connection (SAN#_-_) *Attach a Ptot Plan with alt required information per SPS 383.21
❑ POWTS Revision(SAN#_-_)
❑POWTS Repair(SAN#_-� *Soil Test[nformation(CST# f'7 - 1 y
❑Other:
*Gallons per day 1(.SU
RESPONSIBILITY STATEMENT:
i,the undersigned,assume responsibility for the installation of the POWTS activity for which this permit is issued.
Plumbcr's Namc:(Print) Plumbcr' i rc MP/h9PRSVd No: Qusincss Phonc Number:
1�a Vcsoe,K a30a3(� (7�s) G3y- l�'79
Plumber's Address(Street,City State,Zip Code):
� c, aaa s w.+.� L 3 I^��.Y war c, w L sti�ti3
OFFICE USE ONLY:
❑Disapproved Review Date: Permit Fee: Date[ssued: Issuing Agent Signature
�Approved ❑Owrer Given Reason for � q�� I�i>n ,,� I S j�i i ��/��1��,��
Denial � � � I
COMMENTS:
**Expires 2 years from date of issue** Expiration date: � I 3I �=�C.F
��k s/t-N �s �c- �c-w��`s., b� I�g t �.�o�1.S�"'1� -Ib �ikc.rc.s-� c4,�`�'�'�`-1
CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
. �►, �� , �f �-�, �i �''� ' .i` _` r t
�M e� �,�k� �1� y �
� � � � � , :..i-e S �y � .. -_.�._..._......,_... t:�' �
rl r{��' -
�i�,�-�� � � � �2ti �-
i �'� APR 0 1 2 ,
, � _ �
Rev. 04/21/15 SA�fJ'�'C ^."`�,
NO R�FUNDS AFTER ZON�NG aah9lN15 i E'.;;'i in'�
ISSUE OF PERMIT
iSS�S
PLo'T PLAn}
Z-� -
. o � �
r���1 j S
1 ~~��„ Z , ,�
1-�`�I '�Y �'^' �� ��-��..
� „�� �� �v�1
• h� � �_
a - � T .
7 ; ��
t �
`�� �� � � � a �
�1 i- - '� °" • _.�� �0�
x. ''� � I
~r �
� �w � •
e•
d� ��
°� �• ,C
. C�I � = �
.o-�.-�o:o._ � .� z
o. •, •6 � ,c,, .t� : �
•Op- �0 I ! 07� �hr4 6 �i
�P � �'s „j v +
o� � � � M O
_ r, � � �r X R h.�
� ` � . 1' s . t' C ` t h.
rF / O a V 0. y t�
' / t � v �� � � y� �
�, /
��a / ttN '��' '� _ � �
6 ,� . 3' } H 3 � �n` �
� Q �. � 3 2 X m�� R 7 d
• . {7 7 O, t e+ M x .�.
P Y � � .'. �x � cY �? °L
/ti. p �• J 4' o V q � � U'
� �' Z � N $ u ��p �
p� � r Y } 3 �7 '� Z a �^ .°�
3 � 39 cx3 �' � � '"4
� � .O = �� � s � X�J & 4 � o a
� '� Y f' e 4 �w °
� } M A J J E a.d = 6 ,E �
� •. Z u � A1 6 Ly ��► t J[ �,' O O
, N �. � .�, � � -- a � �'." J� � � � j � � df
- p 2 � a u, 0 ,� ro � u v � 3^. '' e - e b < i
A a O � O � ao D -o .Y'ir W tu � � O U a�£�4 '�'.2 �
'� ^ � , y � Z� 2 � o d U w as= �'e Tryi 3
J� �� � Q' r L'A p � s b `' .� O r q � h � O.p Q J
Y m y O d' � � �Ft � o d L.. e0 � K O u " r � �� � `
�t/)� �'+ g .: n s
fl �11 � � {� IG � > �S� vI n 'l (O+Q N N 0. 4 4 6 'k