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014-842-07-1201-PVY-2016-004
��S� ��� � � SAWYER COUNTY ZpiVI1VG&CONSERVATTON ADMINISTRATION � 10610 Main Street,Suite 49 � Hayward,Wisconsin 54843-0676 � (71�,634-8288 � PLUMBING/NON-PLUMBING SANITARY PERNIIT APPLICATION � In accozd with Chapter Covun 91,Wis.Adm.Code and � Sawyer County Privafe Sewage System Ordinence � � See the attached infoimation packet for instructions for completing Uus application APPLICATIOIV INFORMATION—TYPE OR PRINT ProperryOvmerName - n Fmperty Legal Ducripoon � c ' L P "v� GL �JV/.l�,^� '/., S . T�� N,R � W PropertyOwner's silingAddmss LotNum6er BbekNumber �as n�E,�ftf� s f. City,Sra�e - ZipCode PhoneNumber SubdivubuNameorCSMNumber TnP�����[ �Z 5 3� — ��o�c� `�a-I-�Y`I � TYPE OF BUII,DING:(Check one) State Owned Ciry N�Ru � ❑Public �1 or 2 Family Dwelling—No.of bedmoms ��'��°8° • J�t��F �''` L^ — �Town of �7 rt NC��i— Fue Numbe y PUBLIC BUILDING/LAND USE:[Expla�m<useipuryo��formis Parcel Taz Number.(12 digit legacyaumber) pami4 G.�..Gmpqround,hseval,rcemeodenhrtinmenl event em.)] e � a�--:e �-l-1-�L�-�Z-1��1 TYPE OF PERMIT: TYPE OF NON-PLUMBING DEVICE/SYSTEM/TOII.ET/UNIT: ❑Non-Ptumbing(Priry,Toilet,Reshoom,Etc.) ❑Privy-Pit Toilet(CST# ) ❑POWTS Reconnection(SAN# -_� ❑priry-Vault Toilet(200 gal.min.capacity required) ❑POWTS Comec6oa(SAN# -_, (Vault size:_gallons oS cubic yards - ❑POWTS Revision(SAN# -_� Vault PrivyType:❑Concrete Steel�Polyethytene❑Othet ❑POWTS Repa'u(SAN#_-_� ❑Composting Toilet System ❑Incinerating Toile[Device ❑Other. � Q15 Portable Reshoom Unit ❑Other RESPONSIBILITY STA7'EMENT:(Check one or both as appmpriate) - - �I,the undersigned,atsume responsibility for the ins[al(ation of the non-plumbiag sanitary system for which this peimit is issued ❑I,the mdersigaed,assume responsibiGty for ' tallation of the POWTS activity for wlrich this pe`mit is issued. Plumber's�Owner's nName:(P`ine) Plumba' er'e Signanue � MP/AffRSW No: Businaa Phone Number. .>q'SC•\ l�i-�1, 6•1 ��—" � . rm�xr:aaa�:s�so-�K nry sm�e,zP ��SEE .4BOVL OFFI USE ONLY: � p�/( jb Disappmved ennitFer. CSTNa. Date]ssued Iasuing grntSi �Apro b ❑�«�,.����ba� '�156,' �a�� ,�verse Dete,,,,�ariao — �.�k'I� comMErrrs: (' **Expires 2 years from date ofissue*• Expira8o¢date• �`� ��6 SfiORELINE PROPERTY:�YES NO If"Yes,"Nazne of the body of water. CONDITIONS OF APPROVAI/REASONS FOR DISAPPROVAL: 's�� �� �� NO REFUNDS AFTER �,,�„�,, I$ �%� ISSUEOFPEAMIT �'"!`°5�J � p �' � ���-��� � Rev.03l21/11. i APR 13 .� >� SA`��Y��i',i;Ci'�,i f`��� ZONING AD��ii��iSTRATION �. : �- - � . . PR IUY . . . P L.O . . � � . T �L. /� N Please pr�t • . . OWNERS NAME �4So.� �2-�2r�„� ; .Section � � r �- R.�.W Towriship og �Ph��* t . /1. 61/. a /�,�.. Gov't Lot . . Lof �_ • Subdivision name � � � � � Lot Line . . . � . � I V. s � . . � . ���, • � � J" � CP�.�,e�� -. . � P„ePC>e%A 'f>I � .f+✓ rss+,me. . -V--'--'---'.-"— ��.._ ._... — '-- ' � 1 i � 1-Il'V' _'_""'_'__ .....__ � ._.._'__"'—y � " � r� p . . . � � . . . . . � . o __. . . \ __ . . . � � . . \•� . . }g.:t� �:�j;:�}.t.'i'v[$YSiK�'FnS�I�� ' � , . 'r5� YSC. . . . � � . .%un.�+$'�','-ie.r. :. r:l.�r d .:$ii't.i.'.j7't:y'. s-'n..i.�i :q ..�� . :.l1'i ' .� s. .�. . :"�t . .. _ � ¢�ti•Y�`'L`N"'4`u�l}••II�qFYIC . - , � � Lot Line . � Page 1 of 1 - 1�2a� EState Sawyer County Property Listing Property Status: Current Today's Date: 4/14/2016 Created On: 2/6/2007 7:55:28 AM ��.� Description Updated: 9/3/2014 � Ownership Updated: 9/3/2014 Tax ID: 16525 7ASON S PETERSON JANESVILLE WI PIN: 57-014-2-42-08-07-1 02-000-000010 Legacy PIN: 014842071201 Billina Address: Mailina Address: Map ID: .2.1 JASON S PETERSON JASON S PETERSON Municipality: (014) TOWN OF LENROOT 525 MONROE ST 525 MONROE ST STR: S07 T42N R08W JANESVILLE WI 53545 JANESVILLE WI 53545 Description: PRT NWNE LOT 1 CSM 21/250 #6052 Recorded Acres: 9.860 Site Address * indicates Private Road Calculated Acres: 0.000 14399W SEELEY FIRE LN HAYWARD 54843 Lottery Claims: 0 First Dollar: No �' Property Assessment Updated: 9/26/2014 Zoning: (F-1) Forestry One 2016 Assessment Detail (RRi) Residential/Recreational One ESN: 400 Code Acres Land Imp. G1-RESIDENTIAL 1.000 9,000 0 G6-PRODUCTIVE FOREST 8.860 11,500 0 � Tax Districts Updated: 2/6/2007 1 State of Wisconsin 2-year Comparison 2015 2016 Change 57 Sawyer County �and: 20,500 20,500 0.0% 014 Town of Lenroot Improved: 0 0 0.0% 572478 Hayward Community School District Total: 20,500 20,500 0.0% 001700 Technical College �� Recorded Documents Updated: 9/3/2014 � property History QUIT CLAIM DEED N/A Date Recorded: 8/4/2014 393578 CORRECTION INSTRUMENT Date Recorded: 8/4/2014 391577 QUIT CLAIM DEED Date Recorded: 6/30/2014 3�1047 QUIT CLAIM DEED Date Recorded: 7/30/2004 323642 http://tas.sawyercountygov.org/system/REAL_PROPERTY/REAL%20ESTATE/listing.asp?tid=611169... 4/l 4/2016 .- . _ :` F"-,. • o. , _ } . . .. - �' .r�Kt� � „ . . 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'�} �r�!^�.~ 1� � � � ' �` \\\�,� i l f , a� �� �� . 4'�� ':• � �� � �, j�` � qi ' e, �. . .. ._�,� � j 1�� . � ,��. ,� � >t� ���.��.:•� . �.; � q,�' , � �� ��� � �` ��� ,� , , � � ,� �� .,, , `�f .. _ _ r,'}� � �Z" ���`s 4' , ' a , i �S f �',,�, `�... . s� " � ;� '�'' `t . , � � .,,� y ' t 1 � .1. . _ , , .� . , . ,. { ':' � t� i � e , ♦ �� � ��p '#r, ' � �i� , i ��r ;i �, � . � j �e..-� _ j, j +"i - ' . � . ,st � � t. . i�,-�. - i �, �.k' 1'`� ;;,: +SS `� .�� ` ,��* ,� ::� � t� � 1 i � 4{�,�5 7+ `�`. � 1 � � � _ , ..,.r,....f` r� ti�,• �7� iif'� i� .��+j, �ii . o o � Application for Land Use Permit (*Non-shoreland*) � � � Sawyer County Zoning &Conservation H rn z . 10610 Main St. Suite 49 - Hayward WI 54843 � � � 715/634-8288 � � � a *Property that does not have waterbodies located within the boundaries. � � � CONSTRIlCTION SHALL NOT BEGIIV UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. USE BLACK INK OR PENCIL,MUST BE LEGIBLE OR APPLICATION WILL BE RETURNED. D / � � �c:�0✓1 1�'�-e✓�SU�I �i..�nL'/` ( �z'�'2r'Sc., C'pres����;'�«i/ Owner Builder � S�S �O:�l r vP S�. S v� S �DV�✓�G�' .��'� � � Mailing Address Mailing Address �m ,_j n in.e.5 v; ��e. �✓y ��Sy) .�1 c��Lf'S✓���� � S3 j y� � � City,State,Zip City,State,Zip CsDS-�7 aI -��I�I y �00�'-9 ��.!-�/�I9 ,� Daytime Phone Daytime Phone o'+ � Email: �,a tono.e-{-1t5oti 73�nw�c�; I,CO� � 4 o>r� � ° �. Site address of project: ��c3 �/� l,e/, 5�'e(2 y �r"C �v�e� �ic�r �`- i N s Y�'y3 � e Propo�construction(check one): � ,o �I (�Neyc%r replacement dwelling/primary building.Number of bedrooms: � � ( �w or replacement accessory structure (If adding) fD � ( )Addition or alteration to dwelling/primary building.Total number of bedrooms: '�' � ( )Addition or alteration to accessory structure ( )New business or use of existing building ( )Use of land Construction Cost: Primary Structure$ ,�j 1� d�� � a Accessory Building:$ Addition:$ ,2 v Additional Information: Z Describe what you are building.List each project separately. � Project#i.5ize of footprint:_2�ft.x 3�3- ft= 7�� sq ft. Total sq ft: � �_includes lofts/basements,Height from grade to peak: 'Z(a� " -� i Project#2.Size of footprint: ft.x ft= sq ft. � Total sq ft: Height from grade to peak: � Project#3.Siza of footprint: ft.x ft= sq ft. rl ' Total sq R: Height from grade to peak: - � PLOT PLAN 'J � �, Show lot dimensions and indicat� north. � U�` `v Show the location, size and dimensions �, „I\' � of each structure on the property. Show � p ��� ��� 3 ap new structure. Show driveway, location � .� I , p = ----• ._..-� of septic system aqnd distance from �p �1��J'�`��'`" � i structure. Show the distance & location � � �WQ���.�� road centerline,lot lines&wetlands. � rn. / f'�, vf � Y`��J :s � � '� �� "You are responsible for complying with State�Federal Laws z �t��q '�`�?^ "' `' '-����``"�' conceming construcGon near or on wetlands,lakes 8 streams. ,� y Wetlands that are not associated with open water can be .p Q ` O ���.�,+ difficult to iden6fy.Failure to comply may result in removal or �• i5 3 Q � ���� /� modification of construc6on that violates the Law or other � i��� � penalties or costs.For more infortnation visit the DNR wetlands (�� � tia idenfificaGon web page or contact a DNR Service Center. � li � ' �p r \\ � � �•.� '� The undersigned certifies thal the listed infortna6on and inteo- -� � �"F� tions are true and cortect,that all xrork shall be perfortned in � (1 � =- compliance wilh the requirements of the Savryer Canry � e� �SV Wn��aN� �' � Zoning Ordinance and the laws and regulations of the State of� � ^ �f � � Wiscronsin.The undersigned person(s)hereby give permissiai + ���,.r„ � _ . 3 for access to me property for ansite inspection. �� 0 O / —-------- ""C' T• "_�''� n �.J _ �`f_�= _. _� ._ . _ PertnRs expite 12 rtronths fmm date of nsue.NO REFUNDS. � ,,� �,1 _ _ � ������°� �' �� � � ,� ��� ° -�o �,`� ��` ' v\� r t s`� �?•- •� � Originat Signature of property owner(or agent with Power of Attorney). 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