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026-938-03-4301-LUP-1999-723 �F �q(�) J - Application for Land Use Permit � County of Sawyer y ° _ PO Box 668 - Hayward WI 54843 715/634-8288 The undersigned hereby makes application for a Land Use Permit and agrees that all work � shall be done in compliance with the requirements of the Sa�vyer County Zoning Ordinance and the laws and regulations of the State of Wisconsin.CON TRUCTION NIAY NOT .� BEGIN UNTIL THE PERI�IIT IS ISSUED. � �� L-. TQ �� A�R � PRINT- USE BLACK INK OR PENCIL � �.p / . � � �r�, a .! - [._Y�l��Q17/5�T/H N v'� l�+-.h' Owner Builder � � o F �;�i�� '��s;�E � /s��'�! cv.�.�..�� f��, � . Mailing Address Mailing Address � �. � .4 7� ,.� ' � /`1�r� -��- �.S'� y �� _.�'�ar,� � _ lotJ. .�'�YA'.�� City, State, Zip City, State, Zip ��.� `c�'c�'Y--.3"Z.�s ��,�= �./�"�P' Daytime Phone Daytime Phone Building Land Use f' -� ( ) New ( ) Filling � Zone District r�„ ; � ��,�,,,�. � : �J'Addition ( ) Dredging , ( ) Alteration ( ) Grading Lot Size � �^ ( ) Moving On ( ) ( ) ,� ( ) Acres �/d ' = ; Primary Structure Accessory Buildin� Addition g ( ) D�velling ( ) Gara�e-attached'detached ( ) Dec� ^ ( ) '�ear round ( ) # of car stalls ( ) Porch ;E I� ( ) Seasonal ( ) Storage Buildin� ( ) Enclosed i� O Frame built on site O Screenhouse O Living room � ( ) 1��lodular/manufactured ( ) Greenhouse ( ) Kitchen I , � ( ) Mobile/manufactured ( ) Other ( ) Bedroom �� O Other primary structure O Q�f Relocate/enlar�e U' > ' O O � O # ofnew � i� �► �l Type of Construction j` a (.�j Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete i � . � ( ) Other • -- . G , � � Construction Cost $ �p_ �pd �j 1 f��,6 - � � /�:1�/�r ��ld J%7 f d �o�s�i"d ° Vol 3 (� Pg y39 of Deed Certified Soil Test # �`/-/y� ��- J((�,% CSM Vol Pg Sanitary Permit # �'%• 'y�' `� n (,� z Plat Envelope Or: It ^' Condo Vol Pg Year Installed i I�" Aff of er septic V P O�vner When Installed: � I� ,ic� c �' C�� -1SS�1 • Application for Land Use Permit—Page 2 - Describe Construction:List dimensions of each structure,srory,addition,or alteration. � #1. #2. #3. #4. Size�ft.wide h.wide h.wide ft.wide �ft.long _ ft.long ft.long ft.long Floor area �yy sq.fr. sq.ft. sq.ft. sq.ft. Hgt.from gade/� to peak�ft.hgt. ft.hgt. fr.hgt. Stories� stories stories stories #of bedrooms rear lot fine or waterline of lake/river In the box sketch in: � Location and size of all existing and proposed structures. � �O AS�� $��u.�r e_ Location of septic system. y 0 Indicate distance to: � ��{��r� �Vaterline/Wetlands �� /.�c5�d A.�.1!�.;en Road +, iZ�tiz- a✓�h CiR.✓r Lot lines p'"'d�� -Tr`e Septic system/privy ' • �"Jr s �X��"�'j �'✓e�� t 70/,�CiEE.Nad.�/,J �_ �S�'f'r -9 Distance between structures. F^^� /ooca'r �3 �o • Indicate NoRh. �t Fire Number: W.s'y/o 6 � 0 � � ��r � Signature of Owner '"' W�s-y`b The above certifies that the listed infomiation and intentions are true and /� correct.The above person/s/hereby �f'/ uL-'/C �� give permission for access to the property for onsite inspection. -------CentO[Glle Of road------- a,�6k.P a��i u�-eP io-z2-9 r :�-o�.. [ssueDate nPrPmhe-� '1_2, 1999 ExpireDate December 2'L, G000 Office Comments: (�/ �,i",/,g,...,� // '�� Signature of Zoning Administrator PRIVATE SEWAGE SYSTEM DeparimentofCommerce Satery and Builtlings Division REVIEWAPPLICATION sureauot�nteyrateasernces Hayward Office LaCrosse Offce Madison Office Shawano Office Waukesha Cffce � 209 W. 1st St. 2226 Rose Streel 201 E.Washington Ave. �340 E. Green 8ay St. 401 Pilot Court,Ste. C Rt 8, Box 8072 La Crosse,WI 54603 P.O. Box 7969 Suite 300 Waukesha,WI 53188 Hayward,WI 54843 Phone(608)785-9334 Madison,WI 53707 Shawano,WI 54166 Phone(414)548-8606 Phone(715)634-4804 Fax (608)785-9330 Phone(608)2663151 Phone(715)524-3626 Fax (414) 548-8614 Fax (715)634-5150 Fax (608)267-9566 Fax (715)5243633 INSTRUCTIONS: To save time,schedule your review with one of the offices listed above pnor to submittal. Fill in all applicable data and submit this form together with fees and plans/information. Your submittal must be received at least lwo working days pnor to the appointment at the offce where your review was scheduled. Please call any of the listed offices if you need help filling out the form or have questions on what infortnation to submit. PLEASE PRINT VERY CLEARIY. A sample of a comple[ed form is on the reverse side for your reference. Personal information you provide may be used for sewndary purposes(Privacy Law,s. 15.04(1)(m)]. 1. APPOINTMENT INFORA�ATION-If you have scheduled an appointment,fill in the infortnation requested below to save time: Appointment Date Reviewer Name / `� Plan Identification Number � �%'�"/ ��7/ ��' 2. PROJECT INFORNJATION If this review is a revision or exte sion to your existing � plan identification number,provide that number here: Proje Name County I G � O f� ❑ City �Village [LJ�'own of: Project Location �� / , ,^ r ,�/ ��o GOVT. LOTSWI/45�7l4,S� T3� N,R � f(er)W S'�lv� �P1IGC S/7�Y�/'l. 3. APPLICATION FOR 4. FEE COMPUTATIONS FEE SUBMITTED System Type(check one): System Type '(include new and existing tanks) A � At-Grade UpTo 1,SOOgallonseptictank....................................$110.00...................... H �Fiolding Tank 1,501 - 2,500 gallon septic tank.....................................$120.00...................... M � Mound 2,501 - 5,000 gallon septic tank.....................................$160.00...................... N � Non-Pressurized In-Ground(Conventional) 5,001 - 9,000 gallon septic tank.....................................$200.00...................... P � Pressurized In-Ground 9,001 -15,000 gallon septic tank.....................................$300.00...................... O ❑ Other: Over i5,000gallonseptictank.....................................$500.00...................... Up To 1,000 gallon dose chamber...............................$ 70.00...................... ,_,_-„ �_.._ Building Type(check one): 7,001 - 2,000 gallon dose ch�eqb,��;�,,;,�.��..,:. .._......$ 80.00...................... P � Publio Bu Id�r9 Family q,001 - 8,000 gallon dose�anmrbeTr..............n...n...p...........5100.00...................... V�ID4.Z..�...�J�J.........$120.00...................... S ❑ State-Owned Building 8,001 -12,000 gallon dose chamber...............................$140.00...................... Over 12,000 allon dos r ;;y��-,J..W,. 9 ��e �_..$160.00...................... do Up To 5,000 gallon holding tank..................................8 60.00...................... �ri O '�' Code Derived Daily Flow �F�O gpd 5,001 -10,000 gallon holding tank...................................$100.00...................... Over 10,000 gallon holding tank..................................8150.00...................... � Check if Replacing Existing System F�cpenmental System(additional one time fee)................8300.00...................... Revisions to Approved Plan= .........................................5 60.00...................... Petitions for Variance: Setback...................................$100.00...................... � Petition for Variance Site Evaluation.........................$225.00...................... Plumbing..................................$225.00...................... � Revision...................................$ 75.00...................... � Groundwater Monitoring Groundwater Monitoring-Per Site..................................$ 60.00...................... (other than a propased subdivision) � SRe Evaluation in Lieu of Groundwater Monitonng Site Evaluation in Lieu of Gj�undwater Monitoring..........$ 60.00...................... �i o� SubtoteC................... l�-;A. o� Pdori Review: Enter same amount as SubtotaL•................... �� 'i� �'/ MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISIO Total Fee:................... �6� 5. SUBMITTING PARTY INFORMATION Telephone No. (include area coda&extension) Company Name !�c r a+/ Contact Person � ��s � ��s-s�3 � r`��ceT��T� ��7�r RoQ�� r �� No.&Street Address or P.O. Box Ciry,Town or Vllage,State Zip Code 5�O S/OK�fE Cr�(« Le>I ��SS7 � Aerobic or prepackaged treatment system fees are wlculated based on equivalent size septic tanks and dose chambers. = Revision fees are not applicable to temporary holding tanks or eutensions to existing approvals. NOTE: Fees are pursuant to Wis.Adm.Code,Chapter ILHR 2,and are subjed to change annually. OVER —� SBDA748(R.07/98) � _ N O O O O O N O� � O O� � O O DocuMENT No. STATE BARWARRANTYSDEEDRM 1-1982 TH19 SP�CE RESEftVED iOR PECOflOING C�T� 1336 � 5 . --- -_ _ _— -- t+eo�ae:�c�tnro . ---- -- — --- -- _ � ,c� i =--- se�E� :;m,r�� ' James R Staska and �'1 °� � This Deed� made between ...._ .... . Roce��'•`j �� r vrd the __ ... , I ! as tenants in common . yt:.G�� ,��8.�. n-�� „ John P. . Veron , .__ , . . . __ . . - - � q p . ._ .. .._ � _ ,i � ... _ . . .. .. _ - T` � � � ... _ . '� � .. _ ..._ . . . .. . ... .. . . ... � � i . _---- _, ._ _ _. . . I _ � �,. ��7 I.i vu�J . ., 3 ... ..... . . .. .. . .. . . � rnntor� . _ .. G a s,��, ` " i - -- -__'-... , .. . --. , , . �'� �� Richard--F��---Rohlfin9-------------�----�--��-------------�---'"_ �II C� F;�•a.v , .. and...-------__- - I ----.-._......---�-----'-----�'----------'-�---�--'---......--.........----�--�-�'--"-� Grantee, � �7 � �� I --�-........ . ....---�------ - -' -' _ �I W1t718550t71, That the said Grantor, for a vnluable consideration._... _ _ li One dollar and otLer valuable consideratio pFTuqNTo _._.... ....... .._- _ - ..__....... . - - --- --- -....._ Saw er i �I s .--................. � �S conveys to Grnntee the following described renl estate in .._.. ' I /� � County, State of Wisconsin: '��i ___ __ __ _ � � ' Taz Parcel No: _'--""'--""'-_....."--"- I �I The Southwest Quarter of the Southeast Quarter (SW 1/4 SE i/4) . �i � Section Three (3) , Township Thirty-Eight (38) North , Range I Nine (9) West . I�II� �i I � I�i $t?t.3� ?o i � FEE I �'I, II ;� ' I �i '� This __.is__not_________ homestead property. (is) (is not) I;I Togcther with all and aingular the hereditamente and appurtenances thereunto belonging: ii rantors _ . .. ._... ..___..._--.._. ._..._ _.. . ....._... .__..._.... And_---9--- ----'---... -- ---------...--- -- - - - _ � --------...... �I I warrants that the title is good, indefeasible in fee simple xnd free and clear of encumbrances excep Ia11 easements , reservations and exceptions of record. I I and will werrant and defen�d/'the same. I t3 _ .._..__...._...__.._--------._._., 19_89_. October � I Dated this . . _-.-.- '-_-./.----'--------..__. day of ---- II GRANTEE ' S ADDRESS : (SEAL) ��7''''"-�L..'�`-`�'-�" - - ----- (SEAL) � RR 3 Box 612 , %,7ahn.__E_,._.veron... _ __ .. St . Anne, I11 . 60964 �,� '� , • II�� ._(SF.AL) -...7rs.'�l.Y,:'�.� .lC1i�l�.� .. _._. .15F.:\IJ � �James R . Staska AUTFIENTICATION ACBNOWLEDGMENT Signature(s) STATE OF WISCONSIN I ---------'-------'---'--------'-------'---------'------ 59. - ----------------�-------�---------- Sawyer_---------County. �� -'-------------------'-----------'- '- ---------- -- f ��I authenticated this _.......day of......_._............._, 19...... Personally came before me this ._.�s.'f._.day of .,, ----.-------October-------------- 19..._._ the aboce nameci ' -'--'-- ��, .--�----��---�----------------�-�-------�------------��----�----------�---- John E . Veron and J s R . .....-�------�-- ----�- -�-----� � ��-- --� - ---..,..�m€�............. , � Staska _,.i'� �S.l�\i.y.,.._... -� �-�--�-- ---�---�-----...... ----�---�- -�----�-� ---�-�'---�--'- ----�--------�-----�-- --�-�--........ -- �l-:,......, ., �'- TITLE: MEMBER STATE BAR OF WISCONSIN ---- -- . � • � .__.....�...'�..... --"---------•..._-'-- --'--'------'-'--------` •'--� > . •. . i' (If not, -----.....-------'----"".---'--------------------'-- -'-----""'------' '---' "'---�-'-----' ---\---- 1_1 �./�.._..�,. .... , authorized by § 706.06. Wis. SCatsJ me known to be e person S ' -ho exet6Yed"�the ��.� £orea ' g instru ent a acknowhdge e sarRe. � _ . • �,/`•� {�,�� .� � THIS INSTRUMENT WAS DRAFTED BY • C � �d'e��'•� �� 1T ""_"__""_"'_��__""�._--'n--•�"--�—�`-' _:•�'' '_. �I W i s e B r o t h e r s L and Co . , Znc. .`, . ` --��-----'-------------------'------'-----------------'----'----'-' + � � � . �lta�?_ .L�.r..�_�.��.aO�;:_-.-��-._ James x . Staska Saw er �----'-----'-------"'----"-"-----"----_"-�---"---. ... NotarY Public -----'---y- -...._ _.__..--- ---County�, R"i�. II (Signatures may be anthenticated or acknowledged. Both h1)' Commi�ip\` is `pe1r,,manent. (lf not, state ecpiratic� are not necessarY•) date ..`'".\��V,.�'�, ---.. ...� 1�� ..1 _ _ 9 - --_ _ . - -- _ . __ - -- - �, - __:- __ __ __ �,� ,g �, 3 I •Nemee of Persons eiR��ng in eny capacity ehould be typed or v*�nted below thei ��tur�.� 4 o�p��rr n�n /lm R'iC('l1VCIN 11'I. . ..un G•�-nI PIv�.6 !'.. Ir,-.