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HomeMy WebLinkAbout002-121-16-3100-SAN-1971-22031 �d }' g � �1PPLICATION r^OR SAWYER COUIJTY SANITARY PERMIT Application # 2� { Date '_/ "7� Fee of $Z0.00 received �•''1' )/ � � � ° f, i� I Date � � Cowatz�CZe���-1 �� l"� �JOT /l/ Ilv3/0� � kpplication is "nereby made for a Sawyer County Sanitary IPermit for worri to be done on tlie premtises deseribed hereix. � �A��,� ����,yre�h � �r�r G'a l,,vsKi _ � O�ner Address TeZephone The o f the See. � E� T R. �_ or �� N� � Lot33�yBZock � Sub-division �ri��j ��„�/3eEzcL� 8� � £ /l�P�<rSewL-I- L4wrcnr_e �4N, .0 �41� .Jork contemplated To Le performe'd b�y — Humber of Bedrooms ,2,_ Number oj Bathrooms _� Dis'imasner �C, Garbage i,rinder ,�� Automatic Washer/yo _ Soil Desci•ipttion �{,� _ Septic Tank Size �/,$D qal. � � Seepage nit � I�eight � Piameter 6 Seepage Trenen __ �engtn [,7idth __ Dapth Septic Tank Permit � ��)�� Percolation Test Form PL'd 43 attached // Yes n�o Contemplated completion date d— /�7J AppZieation�Approved_ Pernit #.�0� l Sani.tarian �_%:' _t f'�.J ._ '.� , �...`i�' 7 —�— Oa�ner Agent �dntz fi�u Date Remarks _ Final Inspection � � /�� Sanitarian ,5�-/7—.7� ����� � %G�%'<'�`��'-°-," Owner/Aaent IJotified (Date) Remarks *** Send orig�nal and three copies w:th."** fee of $ZD.00 to County L'Zerk � _- — ----- _ _�_ i \ ;i \\ '. , `� I � i ' � J� ' � � � ' ...�.�.-.�r�o ; 1 � � � �� � ' � � i i � , � „ � , � ,'� � '� � � _______l ��� � �eD __ 4 � � � i � i � � ��� , ; , ; � � � , � �� + i { � ,, ; , � , �� _ - 1 ; � -:�..��.�..__. � . ; ; . � � ,. � , � i ; ; �` ` " , + � .�.-...1.�.,___:� t 5: i? � � � �.�._r..,,,,� � •%~T I � Indicate Lot size and shape, location of dmeZling (P) , septic tank (�T), septic �ieZd (SFi or seep¢ge pit iSFJ �znc disianee of an�� portion of septic system f�om dwelling, u+eZZ and propert,y Line. If property Zies mtithin SO feet of a Z¢ke, river• or ¢ stream so indicate and �how distanee therefror,;. If any portiorc of the eontempZated constructior� wiZl Zie n�ithz:r, 25 feet of d�ellis2g, weZl, septic tank, septic fieZd or seepage pit of ¢bbutting v�ner so ind�eat,e. The underaigned agrees th¢t all wvrk nerformed and equipment instaZZed shall be in accordance with t?!e Sanitar;� Codz of Sawyer County and aZl applicable Z¢w� and regul¢tions of the 3tate of wisconsin and recomm.endations of t,1,e Sau��er 4nunty Sanit¢rian. / -" �`% ,�. .�: ._ _ ` i Ourtte� Agent Signatu e • . P� �� �hl Nisoonsin DeparLnent of Health and SooSal Sarvio�s Division of Health � SEPTIC TANR PERMIT APPLICATION TYPE OR USE BLACK INK - PLEASE PRINT A, OHNEA OF PAOPERTY Neme Addraae (StMat, City� Zip Cods) ' �f � l, s N�' ' a �L B, LOCATION OF PROPERTY H}IERE SYST NILL BE CONSTId1C?ED ALTERID OR EATENDED COUNTY S lU ,I� Cheok One� �G —3 0 ��i.'e-v� Ne a /�r� ✓r_ CITY VILLAGE LEGAL DESCRIPTION � ros�sxtr �/ (eio�x, wt, seo.)LQ o�r��o^a ' �h C, IS lACAL PEHMIT REuUIRED FOR THIS NORK4 �YES No PEAMIT NII�&A �. SEPTIC TANK CAPACITY �GALLONS NEH INSTALLATION� REPWCIIgNT� ADDITION_� MATERIALSt P'7EFAB CONCRETE POUAED IN PWCB_� 54CEL�Ol'F�R�_ NIMBER OP TANKS ?0 B& INSTALLEDt b n P E� TYPE OF OCCUPANCY Cheok Ones One ap.SYw'tami�v Reaidenoe ✓Camoeraial_Industrial_ OEhar_(Speaity) Number of persoas to be Acco�odated�� Number ot Bedrooms�- F, APPLIChNCES, ETCi Food 17aste Grinder YES `NO Automatic Clother Nasher YES ��.10 JisFsrasher YES ��0 Automatio Pota.to Peeler YBS ��70� OTFiER (specity) YES =M0 G. MASTER PLUMBER MAKING INSTALL9ATION ., Nemet �GG(�J-C'�7C '^�l/h�//E�G/^ Addrust l7`� " C � SL7NATURE OR APP ANTt L �f-C/ �j � Lioense Number� t� /O 7S� ADDRESSs ��y'T L/�-G S� °vi_] � � H. �(TO�� 80t9��6'�ED SY ISSUING AGSNT) / / 1 �i Daie of Appliaation ��„� `-� ` 7 � Fes Pa1d r„E � -��1 � � Z � PermiL Iseusd (daN) l �, - ,�j�irul4 Nueb�r 7 t. � � � LI .�.4 o � ,��� c���,,,. � ,�,�-n �' C r _; .r� ,�.�) "• Lam� villsg�� aity� oou�y�- to, epealS'y) NOTEf The Applloation oannoL bs oonald�r�d for Piling u++til nll of the abwe que�tlons u'� ansn»d and the fse peid, Agenis wlll fotward appllcation� th� t�� oP =1.00 for eaoh septlo teNc and the th3rd oopy ot tha pec�it (aatwry) Lo tlu Division of Health. Cheoln snd woaey ordu�a should b� made psynbl� to the Divleion ot Hsslth. COl1PLLTS OTHER SIDY NATff s COIMRt SEVTIC TANK PEId1TT NUHB6Rt � REPORT ON SOIL PERCOLA7ION TEST AND SOIL BORINGS TO DIYISION OF HEALTN — PIIJMBING SECTIOl7 P,o.BOX 309� Medieon� Wis, 53101 Pursuan4 to H 62,20� NS�, AdministravSva Cod� P E R C 0 L A S I 0 N T 6 5 T TEST DSPTH CHARACTER OF SOIL HOURS HATIIi TEST TIP� DROP IN NATEA LEVEL INCHES HIIJUT6S MIMBER INCHES TNICW7ESS IN INCNES SINCB HOLE IN HOLE INTERYAL SECOND ?0 EXT TO LAS? TO FALL �st WETTED OVEANIGHT IN MINUTES LAST PERIOD LAST PERIOD PERIOD ONS INCH E)IAt�LE P — 0 36^ 70P SOIL 10" C WY 26�� 25 YES OR NO 30 60 1 2 3 "' RECORD DATA pAOP( 2SINII7UM OF 3 7€S7 HO3E5 COI�@UTE SIlE OF ABSOAPRION AA6A IN ACCOfiD WI7H H 62,20 NIS. ADMItiISTRATION CODE. S 0 I L �B 0 R I N G S — MIN7MUM 36" BELOW P�70?OSEO ABSOAPTION SYSTIII BORING T01'AL DEPTH DEPTH RO GROUNO WATER DEPTH TO BEDROCK NOMBER INCFiES OBSERVEO ESTIMATED OBSERVED ESTIMATED CHARACTER OF SOIL HITH :HICI(NESS IN INCHBS EXAI� g � p n u K 0 OI n � m n u 1 2 3 FiECORC DATA FAOM MffiLiIIM OF.3 HO TYPE OF OCCUPANCYt RESIDENCE: NUMi3ER OF BEDROOMS ��� OTf�Rt (SPECIFY) NOMBBR OR p6RSW1$ P000 HASTE GRINDEA: YES�N0�_DISFifASF�Fis YES_ NO AUROMATIC CLOTf�S NASf�Ai YES�` NO - SFFLiIENT DISPOSAL SYSTEMe N6td_ EXTII7SION� AUDITIOH_AEpLACFIgNT� TILE SIZE�_ N0, LIN. FEE7' i'RENCH WIDRH DEPTN NUAIBCR OP LINES SEE4ACE BfiDt LENGTH NIDTH UEPTH TILF. SI2E N0, LINES SEEPAGE PITi ZNSIDE DIAMETFR LIW7ID DEPTH —�� I, the undersi�ed, here6y oertiry LhaS the yercolation teats reported on thie farm xere made by me or under apl super— vision Sn a000rd with the prooedures nnd method specified in Chapter H 62,20 (3 ), Nisoonein Adminlstrative Code� and that the data reeorded end location af test holee are correoL to the best ot �y Imowledge and Dalief. N� 7IRIE TYPE or PRIN7 REGISTRATION N0, OR MASTER PLUMBEA LICENSE N0. ADD�1E55 DA'fE SIGNATUAG �'i:� DO NOT MRITT IN SPACE BEIAW - FOR DEPARIM6NT US6 ONLY ➢ATE RECSIVED ACCEP7E0 BY PEE R6CEIyED VALID N0, ���� 1ZEYIENED BY APPROVBD PLRPIII N0. INMIAIS YCS OR NO DA7T ' �.tr � _ -'.. . . . -, ;.�. � .�;.,��'4a��_,.�i�F�S,,.. .��km ...`�..-�,� r . .Lyg �.��{; pl � 4 '' y ? >� � � � � � t .. '3'N"u�:^y_'Yf� :='k`��`��12..�..n�M,l[^ V�/ `� 'S:,"� 4 �f � c ��T(^�+�r �� q� y'. . � .,�J Y + �� ���" V {+ l � ... . .� }aa \ y / , wK.. J 4 J/ t �[ /r .i � ��� /�` I . / l :' .�.. . 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