010-941-33-2302-LUP-2000-415 Application for Land Use Permit r � �
Cour�ty of Sa�vyer s <� ,�"
PO BoY 668 - Hayward �VI 54843 I� �y -
715/634-8288
The undersi�ned hereby makes application for a Land Use Permit and agrees that all work (
shal( be done in compliance with the requirements of the Sawyer County Zoning Orainance
and the la���s and regulations of the State of ��'isconsin.CONSTRUCTION MAY NOT �
BEGt�i UNTIL THE PER:�IIT IS ISSUED. �
PRINT— USE BLACK IrK OR PEh'CIL �' �
` � � �
�ca�i� � ���c�� �e� ��uc�` � -� V �.
��
Owner Builder �o� �
1(��.�� 1� -�:�-� ��� ������ t� � l �� �� � �
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Mailing Address Mailing Address i
�. �t, ti � � �0,�- S � �
;
City, S ate, Zip City, t te, Zip
�1 � � Gz�.T��3 i 7ib���t� �i��-- ��
Daytime Phone Daytime Phone �;
Building Land Use � i� �
i�e�v Fillin� _ '
( ) ( ) Zone District �,�,� � '
�Addition ( ) Dredging ��
i
( ) Alteration ( ) Gradin� Lot Size ��
l ) ��Toving On ( ) � _
( ) ( ) Acres � �� J �'
� k' �
_ �
Primary Structure Accessor�,� Build� � Addition ��
( ) D���elling � Garage- �tache ;detached � Deck � �
( ) Year rotind �) � of car stalls ( ) Poi-ch � ��
( ) Seasonal ( ) Storage Building ( ) ElZclosed � �I
O Frame builr on site O Scre�nhouse O Livin� roonl
� I �
( ) 1��lodular,'manufactured ( ) Greenhouse ( ) Kitchen �
( ) Mobile/manufactured ( ) Other ( ) Bedroom � �
O i�ther primary structure O O Relocate/enlarge a�
( ) ( ) ( ) # of new �
� �
1'ti�pe of Constrtiction �W >
{ � ��rai�-,e � j Log ( j Pole,�metal ( ) Block ( ) Concrete �� �'
( ) Other `-' ��(�J
—. ci
� IW
Constr ction Cost S o2v,Gb � i�' ��
dt9� I�78 --�3� y�s' ! + �
�'ol Pg �jy �of Deed Certified Soil Test r �(��" � 3� � i�.
� �—
CSM Vol ��a Pg_���(��-c t � Sanitary Permit # ___�� '- �� 3 � 'z
Plat Envelope —' Or: ,�9.� �"
Condo Vol -- P�_ — Year Installed �� ��
�
Aff�f e� septic �' P O���iler When Installed: � �
�Ul�� �� l l C.�����..,,l.lC C'G�. �,�o
/�`��
� 3�a� ;,�I�-
Application for Land Use Permit — Page 2 -
Describe Construction: List dimensions of each structure, story, addition, or a(teration. .
#1. #2. #3. �J� #4.
Size ft. wide � ft. �vide ft. �vide ft. wide
ft. long ' ft. long ft. long ft. long
Floor area� sq. ft. � sq. ft. sq. ft. sq. ft.
H�. from�-ade to peak ft. hgt. ft. hgt. ft. hgt.
► �
Stories � la, l ��, stories stories stories
# of bedrooms
rear lot line or waterline of � � lake/river
In the box sketch in: �
Location and size of all ' ��
existing and proposed structures. t,s--�_-�= - ,
,�--�', _. �
Location of septic system. , �
--- �- • .'.
. i,� _ .
Indicate distance to: i, ; ,� � - �
�Vaterline/Wetlands '� �
r
Road
LUC III1tS =�
Septic systemipri��y
«'ell
DistZnce bet�veen structures.
Indicate North.
Fire �umber: J
�� ��� � �
�;�����- `� �,c� � �
Si��iature of O�ti�ner
1�11e abo�e certities that the listed
infurmation and intentions are true and
corre�t. The abo��e person's'herebv
��ive perrnission for access to the
prop�rc� for onsice inspec�ion. ------- centerline of ' �._, road-------
Issue Date August 7 , 2000 Expire Date August 7 , 2001
�ftll'C COIIIIIl�[1[S: �
SI,I;�iIIIC� Ot Il1Il�� f�C�I111111S1C�1�OC
TOWN OF �I�
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DOCUMENT NO. STATE BAR OF WISCONSIN FORI1f ll - 1882 *"" '"A°t "'�EAveo rox ncconoina oer•
Z � � � � Q LAND CONTRACT
IndivWuul . J Curporolu
�'f0 OE USED FUIt ALL '1'RANSACTIONS \YBEIIE OVEIi
y'LS,OOU IS FINANf.tiD dND IN 079iER NON-CONSl1MER ,
ACT TRANSAUTION91 �
� . . . ..._ .,... _. _ _._._._ ..., .., .. _.. _'_... _ . _ .. _ . , .. . .. . . . . NKIAu'� 011lo�
.. . '_ bwy�1 Glouuly � ��/��_ yyy'''''' '
dOSEPH E. COYI.E� 8n 8dult P e��ud o� recetd Ih� �de� N �
�'iOIItP&Ct, by and between ""'--'-__"'--""-'-'-'--...""_"'--"-_'---'
�.in le man. �� v� _ n n �s �9 et � �cbc►
- �-- ----------------------------------�'�----�--------------_..------- -- --------- ------- - —
("Vendor", —� hf w�d re:orded In vol. yY/
whether one or more) and._...DAVID_J __ .LUCCA. and MICHAEi.E I.UCCA, ol H.,-..i:.d�_-o�� � �r e �� - YJ�
..husband__and_.wife._as..joint_ [enan[s__._____ . __ � '�?�'�
. . ....... ..... .. -- -- -
......___.._._ ("PurcLaser", whetLer one or more). �����
-."' "_"-.' ------ �
Vendor sells flnd a6n�ees to convey to Purchaser, upon the prompt und f�ll per- � �� I
fo=mance of thia wntrnet Ly Yure6aser, the following property, together wiUi the
reats, proflte, Hxturee and other appurtenant interests (sll called the "Property"),
' ............. Count State of Wisconsin: � -�- --� � � � � --�---- �� -��-
_-`
m.. '- �ld-Ykr ' R RETUPN TO
��=�- `
Tnx Parcel No. .33._41 ._9 ..7,_2_.__._,__
�
rart of the Southwest Quarter of the Northwest Quarter (SW}-NW} ) , Section
'_hirty-three (33) , Township Forty-one (41) Nurth, Rungr Nine (9) West , described
as Lot One (1) , recorded in Volume Twelve ( 12) of Certified SLrvey Flaps, Page
326, Survey No. 3017 .
Subject to all easements, exceptions and reservations of record.
This ....._. 16 not______... homestead property.
(is) (is not)
Desi nated in writing
Purchaser egrees to purchase the Property und to pay to Vendar at ..............�....___..._._..........__....__..___._.,
the sum of j--14.,OQ�-*QQ--"-"-----'----........------.-- in CLe fullowing manner: (u) $-.3-,$OQ�QO........---------------
at the ezecution of this Contrnct; and (L) the Lulunce of $._-10_,20Q.QQ......._._.._, toged�ur with interest from dnte
hareo[ on the bulunce outstendiug from time to time ut thc rate uC._..._.._..N,ine �9_).} p�i. ����t per annum
ur•til paid in full, sa followe:
�aid principal and interest shall be payable in F.ighty-four (84) montlily
installmen[s of not less [han $ 185 . 00 per montl�, commencing one montli from
the date of closing and on the same day of each and every month thereafter .
Provided, however, the entirg outstanding bnlance shnll Le paid in full on or Lefore the____��J.�ry._...._.. day ot
- :iep[ember--------------- 19.9Y__. ( lhc maturiLy date).
Following any defatdt in pnyment, intcrest shull aecive nt lLc rute of .9�L...__.% per ammm on lhc entire amount
iu default (wUich sLall inelude, without IimiWtiuu, delinquent interest anJ, upon uceclu•a[ion or malurity, the eutire
pr.'ncipal balance).
�I Purchaser, unless excused 6y Vendor, ogrees to pay montl�ly to Vendor wuounta sufficient to puy reasonuLly entici-
�� . 4xted ummul tnxes, apeciul asaessments, fire iind rap�ired inaunmcu prcmiums wLen Jue. 'Co lhe esLent reccived Ly Vendur,
Vendor agreea to apply payments to these oLligulionx when due. Such uwuunb received Ly the Vcndor for payment of
t'.xex, assesa�ne[�te und insurunce will Le Jepositcd iuto un escruw iuuJ ur lruslce uccumd, Lut sLuil uot Leur interest
unlexa ottierwien required by law.
Payments shall be applied flrat to interest on the unpaid hnlance at the rate specificJ und then to princip�l. Any
amount may be prepaid without premium or fee upon principul ut nny lime ufter.__date of Closin�y ��
I t1Sgiffixifili��4'r6XNd��i�A(��1G1SAtX1f@��6iG]iid�f'6ks#SLkb7HX
�wrx�tcaa�wuuuaooux
'�
In the event of any prepayment, diis cmilract yhall not Le treatcd as in default with renpect to payment sa long I
as the unpaid balunce of principal, and interest (und in such case accruing in[erest fruw mm�LL to mouth ehall Le [reeted I
as unpaid principal) ia leas than CLe amount thu6 said indebteJness would have Lecn had the muu[hly paymenta heen �
mude ns first specified nbove; provided diut mouthly paymenta ehull be coutiuned in the event uf credit of uuy proceeda
o[ insurance or condemnation, the conJemned premises beiug thercafter escluded hereYrom.
Purchaser states thut Purchaser is autiafied with the tiUa uy shown Ly LLe tiUe evidence submitted to Purchaeer
for esemination aYcept:
Subject to the Land Contract between, WILLIAM IIENRY PHILI.IPS and JEAN BLAIR VARDEN
PHILLIPS , his wife , and .IOSEPH E. COYLE, Purchaser , dated September 2 , L986 , and
recorded September 7 , 1986 , in Volume 393 of Records on Page 343-344 , bearing Doc .
N�. 201623 in the Office of the Register of Deeds for Sawyer County, Wisconsin.
Purchaeer egrees to pay tha coet oY future tiNe evidence. If title eviJence ia in the form of en ebstrsct, it ehell
b•i -etained by Vendor until the fu0 purchase price ia paid.
. Purchaser ahall 6eentitleclto take posseseion of tha Property on...._ date. of_ closing_ ____ _ . 18 ,
•,:�o.. o�� o�r.
: -_- -.. _ V��r�; � 1 l� � 4 �
WND CONTRACT—Indlvidual and 9TATF. IIAIf OF W19f.ON81N Wiacon.,ln Lerd OI�n4 Co. le<.
Cn:por�te FOItAI No. 11 -- IUtl: �IIIw��uL.�.�. WI�.
Purchaeer pron�iaes W pay �hen due all ta�cee and asaeasmen[x levied on the Pruperty or upon Vendur's interest
in ii and to deliver [o Vendor on demund receipts showing such payment.
Pnrc�iasec nhull keep the improvementa on Lhe Propurty insured ugains-t luss oc dumn6e occasioned by fire, es-
I;�nded covuru{�o purila und euch other hnzu�da ue Vcudor muy rcipiirc, witlwut co-ins��runcc, fhrough ivaiu•�re upProveJ
I�y Wm�dv� 'n U�r �ui1, pl �AN}}.���1�ugpb�y�.�nlur,...� I,'Fy rnd�lr •hull uql ��u�lulru Nur�vu�x �n�`,n e�u�un1 nar
lOMll L�Ift Y MOYY UWYd uudur L�u on 1'NY�. UfY IYYYI' Y�IYII ia U�u lu+imwluu P�'����II�II�Y WIIYII 1 uY. l �u ��ullY�uY Y IYI
eontu'�i. LLa danJurJ dnuue In fuvur of th� Vendorb hitercet und� Wlleae Vuudor olLorwieu u6'reen h� wrlLlu6, ���e orlg ne
ot all policies covering N�e Yroperty shnJl Le depusited with Vcudor. Pw�chaser slwll P�'�mplly give nutice uf loss to
insunioce companiea and Vendor. Unlen9 Yurchaser uoJ Vendur olherx•ise agrec in wrilin6, ���y��a���� Vroceeda sLall
be ayplied to resturation or tepair of t6e Property damaged, pruvlded the Vcudor deems LLe restoration or repnir [o be
econn��ically fenaiLle. . .
Purchaser covenanta not [o conmit waste nor allow waeto to be comn�ilted on the 1'roperty, to keep lhe Pruperty
in guud [ennntuble condition end repaiq to keep tlie Yroperly fi�ee from liens superior to tLe lien uf this Cuntract, and
lo con:^ly with all luwa, ordinanceu nnd regulutions nit'uting the Properly.
Vendor agrees thal in cuse the purchuse price wilh interest und otLer mm�cys xhall be f�lty puid und ull conditions
nhall he fully Performed ut l6e limes and in the mnwier nbovu specificJ, Veudor will on demund, execule und Jeliver to
LLe Pi�rchusep a Warrunty Deed, in fee simple, of tLu Property, frce and denr of ull lieua und encumLruncen, escept
xny liena or encumbrancee created by the act or default of Yurchaser, und except: ...._.-_-..-.--.---�---�-----�--------
.'-'-""'_-""'_"_"'-'-""-'---""'-__•'-'---'-'--•"-'-"'--'-'---'.........---'----'------"-------`�—'---'-----'- '
.'--...._--'—"'-'---""---"_-'_--"""-"-'--'--"""--'-"-'---"_.-_".--'--'--.__...__"---'-�-----"--'-----'----
..-"--._ ......-"'---'--._.......--'--.'-'-_"'-"'---""""---------'-....._.------'----------'---'-----'----"--'--------
"" - - -------------�------�----..-...----------------------.._'
. -._-.....----"-'_..._---------"'—'-' --"--��---'---'--'---'- -- — �
Purchaser agrces that time is of the[essence and (a) in the eveut of u Jefuult iu ihe pi�ymenl of uny prmcipel or
interert which continues for a period OI ..uo-.—UJ}'y followiug lhe specificd dun dulc or (b) in thc evcut uf a defuult in
perfo,mance of any olher oLligution of Purchnser which contiuues fur u period of....�1Q._ days following writlen notice
tliemu:Ly VenJor (delivereJ personully or muiled Ly cerlifieJ mail), theu thu en�ire uutst:u�diug bod.u�ce uuder Lhis co��tract
shull beconm immedialely due uuJ puyuble in full, aL Vendor's uplinu uud �viUinul nulicc (wLicL 1'urcL:iscn c�reLy
wuivet), und Vcudor ahull alxo huve thc followiug rigLls uuJ rcmedics (a��Ljc�L lo uuy liwit:dions provided Ly luwl in
adJitiu� to LLose provided Ly luw m• in equity: (�) Vmidur maR xt his optiwi, Lermi��alc lhia ContrucL eu�J P��rchaser's
cig6t,, title und iulercet in the 1'roperly und ruwvm� tLe ProperLy LucL 6hivubh atricL lureclusure with uuY cyuily of
redenr,diuu tn Lo eoudiLioned upon Purchnsor's full pa�o�icnl uf llic cntirc uulsCindiu�; Laluure, �cith Iulcrest Uierenn fi�om
the duto of default ut lhe rule iu ePfect on sucL JaleuudotheruwounteduehureiwJarliuwLichuveulall mu�iuut� previa�sly
paid bY �'�rchnser ahall Le forefeited as liquidaled damagos for Y:�iluro to Culfill Lhis Coulruct aud ua rculul Fur lhe
Propm�ty iP purchaser Yuils to redeem); m� (ii) Veudor m:�y �ue fm� specil'ic perforwauce oi lhis Cuulri�ct tu compul
immediute nnd 1'ull puymeut of the entire outstanding L:il��uce, with intcrest Lhercai :i� the rnlo iu cl f�cl ou dic Jalu of
defud: and oth�c amounts dun hereuuder, in wLich uveut lLe PropertY shull L� :wcLioued :�6 juJiciul s:de aud 1'urcLuser
shall L^. liablc for auy deficicucy; or (iii) Vendor maY e��� +�t lu�v fnr Uw cutirc uupuiJ purch��sc priuc or nn)' P�>��tion
thereof; or (iv) Vendor may declare this Contruet ut :in ond aud remove tLis Coulriictasucluud uu tillc iu a �piiut-[itlo
action if Q�e equitaLle interest of Pm•chaser is insig'nificuul; aud (v) Vcudor uuiy huve Purchuscr cj�uteJ f'ruw posaession
of the Properly und 6uve x receiver uppuinted to collec6 �iuy rcub, I�suuy m� prolils dw�iug thc pouduucy nf uuY .cLiou
under (i). (ii) or (iv) ubove.NotwilLsl:mdiug uuy onJ or wrilten et�ilanwds ur netions ol VunJur, uu ulecli�m uf uny
of tLe foregoing remediea shtill only Le Liuding upun VenJur i[ mid �vLcu pw�micd iu litiguliun unJ :JI cuatn :o�J expenses
including reusonuLlu uLtorneya Pees oP Vendm• iucurred lo enforccauY rcmedy hercunJcr (whuther :�Lalcd m� uot) to tho
extent not prohibited by lew aud expenecs of tille uviJeuce shull Lo added to priucip:�l anJ P:�iJ by Purchus�r, us in-
curreJ, and shull Ue included in any judgroent.
Upon the commencement or during the penJency of uny action�of foreclosure uf thia Conlract, Purchaser mnsents
to tha appointment of a receiver of the Property, including homesteud interest, to collect the rents, ��suea, and profits of
ihn Ytoperty during the pendency of auch uclion, nnd such reuts, issues, �ud P�'ofits wLen so collec[ed shall Ue held and
appli�u us the co�n�t shall direct. ��� � ' � �
Putchaser ahull not transfer, sell or convey uny legal or eyuituLle interes[ in the Prnperty (Ly assi6nmeut of any
of Pwcheser's rights under this Conh�act or Ly op[iou, long-term leuse or in imy olher wsiy) withon[ the prmr written
consmd of Vendor unless either the outstanJing Lulance paynLle under Chis Oonh�act is first paid iu Cull or lhe inlerest
conveyed ia u pledge or uasi6nnient of I'w�chusar's iuCurusC tmder l�is Cpntril�t sulolp as s��curitY Iur uu inJuLleJness of
Purd�aser. In the evmit of nny such transfer, sulu ur cmrvey+�nce w�thout V�ndur's writ[en cmiacnt, tho cutire outslanding
Lalauca pnyable under this Conteact shull 6ecome immediutely dne aud P+�Y:�61e in full, at Vendor's opli��u �vithout uotiee.
Vendor shnll make ull payments wLen due mider uny mortgugc outetauding Ugnin�t ihe Properly on the date of
this C.utract (except for m�y mortguge gruuted Ly Pur'chaser) or under uny uote sec�u�cd tliereLy, pruvided Pnrchuser
mnkes timely payment uf the amounte lhen duc unJcr lhis Contriick Pitrchuscr may m:il:e :ury such paymmits directly to
tLe 1,lortgugce if Vendor fuila to do so and all papwents so mndc by 1'urchuser ah:Jl Lu cousidered p��yments wude m�
this Coutruct.
Vendor muy wuive uuy default without wuiving uny utLer suL�ayucnt m� priur def�ult of 7'urcLascr.
All terme of this Cnntract ehull Le binding uPon and inure to the Lenefits uf Che heira, legnl representatives,
succeseoru nnd assigns of Vendor and Purchuecc (If not an owner of the Property the spouse of Veudor for a valuable
coneideration joine herein to telease homestcad rights in the suhject Property and eb�'�y to join in the ezecution a[ the
deed to he made in fulflliment hereof.)
�6 -_...., �s-__ _.
neted tLis - _Se tember _ 89
.../�1 . .__. Jay of --- ----- - � --- ---. . ... . .
t
.....� 1 _7�<.. `� .'trr`� __ ......_.(SEAL) --���M'� .. . .���/.... ........._(SEAL)
r �� � d
• _ ....J.9 .�PH..F.,...CQYi.£.------.-.------...... • ._. DAVIB. .L. ..LllCGA_. .__
...--.___........_..__..._--�--�----..._...._.._._(SEAI.) �--....__.__. .�,`-'`�.�WL�JI/��a'--FSEAL.)
� � MICHAELE LUCCA
_.._..... - ...._._... — --_- --- -.._....... __ - ......__.....__ ._ . ... ._ . -
Acknowled ment
���p�ggyg=y�Q1 ACKNOWLED6MENT
Signatore(s) of Joseph E. Coyle, to me STATE OF WISCONSIN �
�-----'------- -----------
kuown to be the person signing the Ss.
...._. �
---- focegoing--doeumen8�.-------------�--- - ---Mi11e-Lacs--------...County.
n�tari ed
�¢n�this .__���1ay of.._.8ep.t.emb.ex.._., 1'J.B�- Personally came before me this ___/�.--day ot
✓�,CC� /J��� SePtember , �g89___ the ubove nameJ
---�----� • -- � � ....... . ........ ... ._. . �- David J. l ucca and
.... - ' -- -- .. .. .-
Notary Pub11c, State of -
.__.�atricla,.Patko_Wiscons �6acty�r�Go. Michaele I ucca
.... .. . . . .. .. � - -
TI'IY.#Sc�tIDl5HH8cidY7lAY�k$ _.- -
([f not. -roY-.commiss��4 �c.�lY�ss,.,�-Fy�90-- - .
authm�ized Ly § 706.06,. �s.-0�y,,'��s� h [y '�L �o ��Qy,if'CbLe the ereon � �..:� �vL� execufed the
� { " ) r�1r� for�pli�L''�iystr�ih�{'1fi(�ii� ��kA.(v.@1�J�I�e ��m�.
� � :�� {�ip NOf/- YFU�VC 1 '!!1[SOfA �
fHI51NSTRl1MENT WAS��•fEO BY`� : �: ��K a�j.� ��ILL� �_A�'iS.CQUNTY . _ �/'/
Nornan L. Yackel : �Pu�i !(E, _ 1 < ti!, �My Cumm� �on Eap� s hne IS 199U k /��CiK � �KGC
...... .... . Y ...... . . � . . .
_" n
Attorne at Law j y- ��� n��+ � �....`O..fLQI.1/_r__._�_J.JNNYlJil{3)..: H-y�j-' ....
, / f.+ bYn� •Mr . .\ �r
.-------'---------------'--"-'-_'-t��drF.... ,•a--r.r������i''----- Notury PuLlic .-----._MiLle. Iacs..----...County, MN
(Signatures mey be authenticute�'�y� p�k�l�fed�ed. Both My Conuuinsion in PermuucnL (If not, stale expirution
are not necesyurY•) ��i�.i,m °� date: ..____- 5
YO�. ^ . _ . . .. -..�._, 19..�Q.)
•Nen.r uf ncrem�s uieuiub iu m�r �unucitr eLuul�l Lc trVi�l ur y�c��ulol{ IL,A �/n�ut��,t� �
!
2�5542 A�e�oA�,T �
EXISTINC SEPTIC SYSTEM Raqister�: Ofiice t SS
ONE AND TWO FAMILY Sawyer County
Document Nmnber R erved for record this � day oP .
( � S A D 20Q�_a�o clock
M and recorded as vol /%
]F THE EXISTWG SOIL ABSORPTION AREA DOLS MELT THfl ) �rQs onpage '�r/'�
MINIMUM REQUIREMENTS FOR GROUND WATER AND DEDROCK <�`��'__. _.i� .yi�_
DEPTHS AND [F IT IS FUNCTIONING, AN ADDITION TO OR Re�ister
REPLACEMENT OF A HABITAE3LE STRUCTURG CAN BE MADF, IN � � napury
MOST INSTANCES WITHOUT UPDATING THE SOIL ABSORPTION
AREA. IF THE GXISTWG SO1L AL3SORPTION AREA IS CiTILIZED FOR
THE ADDITION, EVERY ATTEMPT SHOULD QG MADE TO LOCATE
AND RESERVE AN ARGA WHICH IS SUITABLF FOR A CODE
COMPLYING REPLACEMENT AREA FOR WHLN TIiE SYSTEM FAILS.
IF THE ADDITION WILL SUBSTANTIALLY INCREASG T}1E
WASTEWATER DISCHARGE, THL GXISTING SYSTGM WILL IIE
REPLACED WITH A CODG COMPLYING PRIVATE SEWAGE DISPOSAL
SYSTEM.
RETURN TO:
Sawyer County Zoning Administra[ion
010-941-33-2302 P. O. Boz 668
Parcel IdentificationNumber Ha ward WI54843
Owncr(s): ,,�avid and Michaele Lucca /�K1Q (-� JV11c,�1pG�P �—.�lCC0.
Mailing nddress: 16290 W Park Road Havward WI 54843
�
Propenydescripiion: Part of the SW NW Sec 33 , T41N, R9W
Lot 1 CSM 12/326
(D (V✓e) — plan to
(✓) Add�_bedrooms on to an existing dwelling; O Add bedrooms on to an ezisting mobile home
O Replacc an ezisting dwclling with a new dwelling/mobile homc containing _bedrooms
O Replacc an existing mobile home with a ncw dwelling/mobile home containing bedrooms
The present private sewagc has been working satisfactorily as far as disposing of wastes. If the present priva�e sewage system does
fail, it will be replaced with one tha[ is code complying.
�-1—YY� C Q n G—A Q 9 � � . C C_o�
Date
Date
I have inspected the existing private scwage systcm iank(s) and I have determined that iUthey mect �he requirements of ILHR
83A55 (3) (g) "De�crmina�ion on tanks" (i.c., Ieakage, condition o(baf(les, tank cover, and tank capacity). [ have also de(ermined
that lhe capacity o(the exis�ing tank(s)}�gallons and is/are sized for a Z bedroom dwelling per current
ILHR 83 rcyuircm��,t,s. , /
ti.� - �xi6�/G �8 � � o °
Master Plumber, Master Plumbcr Restricted Sewer, Septage Pumper Liccnse Number Date
Personally came before me this
�_,9�_day of�1,� C�• .� �O
��.t�.f ll� W(�C.C.e� � _.' .
Notary Public
��kC��.o County , Wisconsin
My Commissio�res � � -- ��{ — � �_
Lxisting septic system - Sanitary Permit �s/O� T (9° - 233 /
�
Date system installed -�— 2�— 9Z
L�2y/� /���i Zn or nZn
// - S— gb
datc
This instrument was drafted by:
sz�• t.- ��"`'� 1lOL i � � PG 4 9 '�