002-940-12-5104-LUP-1992-134 /
Application for Land Use Permit
County of Sawyer o
The undersigned hereby makes application for a Land Use Permit and x �
agrees that all work shall be done in compliance with the require- o �
ments of the Sawyer County Zoning Ordinance and the laws and regu- H'
lations of the State of Wisconsin. �
PRINT - USE BLACR INK OR PENCIL �
�' �
�o�.n ta,/ C.a�rns �Jr RAD Mv.r�le�n�. �'�j ' Cr..('�11-' !i� 1_ �
Owner Builder :,
.�"d�e O��a u�o v� I��r. t . k-_ '.�' � q I ..'.,..,�
C.D�'
Mailing Address Mailing Address
QP �aVan �l� S3/1S N��iWqVv WI S�'}�
City, State, Zip City, State, Zip
Building Land Use Zone District � 1� - � o �
( ) New ( ) Filling rt
(� Addition O Dredging Lot size o1 � 3 � X yo y � N n
(v�Alteration ( ) Grading
O Moving On O Acres �, 9� f�
( ) ( ) t�
New Construction �
�
�
Size ;L� ft wide ft wide
L
�2- ft long ft long
�-
Floor area : �:' sq ft sq ft 5
m �
Total htg 1 >�' to peak to peak x _
Stories / Stories �-
� z
No. of Bedrooms - rear lot line or waterline o
(}�e�at�rd) or (seasonal) d 9 3 ' G rt
Type of B1dg or Addition i`� Q' r'
( ) Dwelling � a �
( ) Garage (1) (2) car r.
( ) Storage Building � �'
( ) Boathouse o
( ) Livingroom �
( ) Bedroom I
( ) Kitchen-Dining �'
( ) Porch - enclosed/roofed �
O Deck - open a�� � i �
��� (Z�e�.�rl C e x nc'� <�fJ(Y\D�`J��e I
� ) �/ri2.
' W p '
Type of Construction � W � �
(i/J Pr.ame ( ) Block d � ��-
( ) Log ( ) Concrete ,sd
( ) Pole ( ) Stee1 • rY <— �B� �—% �. �
( ) Metal ( ) � i -._.._.._A _ _ �
D
Construction Cost $ Sa•aa
Vol �y� Pg �_S of deed ,�;�'` �
CS Vol Pg w �
n
Cer. Soil Test � / - o a8 y �
-- N �
C Road -
Sanitary Permit �/ - 0 3 G ---------- L � � z �
C T I-I � �, ° z
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Issued `�1�1�u� 1 q9 Z P Denied ,_s 1�� �
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r,
� � � �u �� .'I�d�—�t'-� �
Owner 7.oning Administ ator
TOWN OF BASS l
SEC. 12 TWP 40 N . R. �
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s��'�� I.4 SPRING
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DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1 - 1982 THIS SPACE RESERVED FOR RECORDING DATA li •
216 9 3 3 WARRANTY DEED
I� _ _ _ _ ----- --�_ _. _ -- --_ _ _ - . , .,,,�: , . , '
_ ., � � .
. . _ _ �- - - --- - ---- , . �
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Z'��� D6eC1 made between ---••-••---••-------- -•------ •---.._... p� � �tiy �,
, ._. ..---•... ..-- r: . •n.. l ilie�
William Marsden and Carol J . Marsden A i > i �, �U, q� . $ 4 . :1:,,.y
. �-t�,
-- husband --an,d _.wife ------ - ----- - ----- ---- ------- - ------ - -- -- --- ---- ---- - �} t� �,. J, ::,,.,i._<i �., y„����
-------------------------------------------------------------------------------- -- - - - -, Grantor� ,{ i . . ,, . i , .�., � �,�+� p�
and _ John_ _W_.__Cairns_�___Jr_. _ __and_ � , • � p � � —
------ --- ----- --- - --
Maril n J . Cairns husband__.and wife � �'-'�`"��`�``--
..� . _ .
----- --- -•- -- •- --•--- • - -•-- ---• - -• � - --- ------ ---- - - - � - - - -- --- H��l�ia.
- -- - - --- -- - - --- - -- ------ ----- ------- --- - - - -- ----- ----- _ . _ - - - ---- � - - -- ----- ----- -- -- -- �»..,.,.--.,..._�-
----- ------•- - -••----- � ---------•-------- •--- ------------•------- ---------- ------- - - ---- --, Grantee, [��u+lr
Witnesseth, That the said Grantor, for a valuable consideration__.___ , I
- - -- ------- -- - - - ------ --------- -- -- -- - - - --- ---- - ---- - ------ - - - - --- - -- - ----- - ----- ------
� I
RETURN TO '� �
conveys to Grantee the following described real estate in ___SdWyeY' _ _ �-j
County, State of Wisconain :
-_=----=__--- -
_ . .
002 - 940- 12 - 5104 _ - li
�All that part of Govt . Lot 1 , Section 12 , �e7w��i� � 40---�0�-�1�-j--------------
Range 9 West , Sawyer County , Wisconsin , described as follows : ;
i � Commencing at the IVorthwest corner of said Govt . Lot 1 , thence
South along the west line of said Govt . Lot 1 , 331 . 8 ; feet to the '
I northwest corner of Henry Cairns property . Thence South 84 24 ' '
� East along the north line of Henry Cairns ' property 1279 . 23 feet
� to an iron pipe and the actual point of beginning . Thence South �
5 36 ' West 293 . 0 feet to an iron pipe , Thence S . 84 24 ' East i :
462 . 78 feet to an iron pipe on the westerly shore of Spring Lake .
; �
� Thence in a northerly direction along the waters edge of Spring �
I Lake 330 feet more or less to the north line of the Henry Cairns
property , thence north 84 24 ' West 46 feet more or less to an �
iron pipe , thence continue North 84 24 ' West 358 . 52 feet to the �
point of begining . .
Subject to easments for County Trunk Highway " E " and utilities i
along the east side of the above- described property .
INo building for the purpose of inhabiting shall be erected or
I� ' otherwise located east of the present location of County Trunk
� Hi�hway " E " w�thin the confines of the above described parcel . '
' his --- - ---15_._110 •----_- homestead property. 7� (sj�� `���
� (is) (��C}{df) t fl
Ij All subject to easements and reservations of record . � / f'i Sd
i Together with all and aingular the hereditamenta and app urtenances thereunto belouging ; ,�,,,,,,,,,o,,,..,,,w
' i Wi l lima Mars den an d Caro l J . Mars den �
: And - -. .. -- - - � --- - -•- ----- - - -- -- - - - ---- - - - -- - ._ .._. . .- - - - - - --. . . ._ _ _ _ . . _ _ _ _ _ _ . . - - -
� I wurrants lhat tLe title is good, indefeaaible in fee simple und 1'ree iiud cleat of encumbrauces excepl �
; �nunicipal and zoning ordinances , recorded easements for public utilties
' ilocated adjacent to side and rear lot lines , recorded building and usage
estrictions and covenants , general taxes levied in the year of closing . �
and will warrant and defend the same. i
7 }� December---- -- � - - ----- ---- -- ----- - --� i9.8-9 -• '
DateQ �tt3'---------•-------------------•--------- -------. day of ------- - -- -------• - -• -- -- -- -- ,
�
/� ' �
----------- (SEAL) - - -�L�,C�E��4'-'- - ��G�yScZsx:�"1 - --- - ------ ( SEAL)
: « William Marsden
---------------- ----------._._._...---�------- ---------------- -- - - -- -- - ---- --------�- - �---- --� - - - -- -------- ------- --
- --- --- - - -- -- ---•------•--------- -•------- --- --------------- -- (SEAL) - - - . C.=..CG.�..�L . �_ . . -- -����r�._C<L��-- -- --•- - (SEAL) I
,,
* . Carol J . Marsden
-�-- ------ -� -- --- - --------- �--�- ------ ---------- --�---- --� - --- - -- . ._. . . -- �- - -.. . . -------- - --.. . .. -- - - -------�--- --
AUTHENTICATIUN ACKNOWLED (3MENT
, �
I ,
' Signature(s) ---------------•--------------------•---•----•--------•--•-- STATE OF WISCONSIN
as. I
------------•-•------------------•------•-----------•--------------------•------ �
, ______.__Kenosha_-____._.___county. � �
I authenticated this _.._..._day of___________________________ 19____._ Personally came before me this _.__ 1_3tY�._day of �
I December . _.__.____ 89 �� ,
- ------- -----•---•-�--- • -- - - - -------------------
I -------------------------------------------------------------------------------- William__ Marsden----and-- -
---------------------- . --, 1 ----. e a ove name �I
! I '---------------------------------------------------------------------------- -------Carol__ J . __Marsden---------------------------------
TITLE : ➢ZEMBER STATE BAR OF WISCONSIN
- --- _ _. --------- ----------------------------------
- - � „C
( If not. - ----------- --- ---- ---- ---- ----- -- - --- - -
- - - ---- -- _ - - --
authorized by § 706.06, Wis. Stats.) t� f r o�i __ s _ ____ ���l�o executed the
fo;44 ci: owledge the same,
�/�� \ �
THIS INSTRUh1ENT WAS DRAFTED BY - � -
' - '' ' ' _ _ ' ' '
-
Joseph F . .Madrigrano , __ Jr . • ��,;
. _
, ----------- ------------- ----------- --------- - . p _
*_=�t`�xiit_� .� __Mcilur_tey -- --- ---------- ---------- -----
I ----------------------------------•------------- ---------------- • --• Nota:•v�'���p�.l�e . .,=_- -�- K �nosha --------- -----County, Wis.
�� � (Signaturea �uay be lnthenticated or acl:no�vledged. Both �11' Cumn�7s�yn �t�s permanent. (if not, state expiration
' ! �re not uecessai•y.) , • 19
; , n /� �y atc . , -------•)
;
�1.��.� �: � `S' 1 u � - _ - -- -- ------- ---------- - ----- ------------ I
•Nemea oP peryony siguing iu nny cuPaeity ahould be tYPed or printeJ bcluw lheir ai�nutin•es. � I
i ;
WAIiRANT'Y Dlilill `JPAS1�. 14A1I Ql� W19CON51N \1'i ,r���r,iu L��rnl iilt�nk Co. Inc.
��ILHR SANITARY PERMIT APPLiCAYION -�
s In accord with ILHR 83A5,Wis.Adm.Code couNn --1G
��`�-"'p Saw er ' '�''
rn
CST 91-OZH STATESANITARYPERMIT�f
-Attach complete plans(to the county copy only)for the system,on paper not less than 1510 7 0
8'fl x 11 inches in size. ❑Check If revision to Orevious application
�ee reverse side for instructions for completing this application. s7nTEP�nN i.o.NUMeea
1. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. ,�
PROPEflTYOWNER PROP RTYLOC TION
Qr �.f— � %<�/s,S !�T <(/J,N,R E(or�
PROPER OWNER'S MAILING ADDRESS � LOT# BLOCK#
�a /J van r D.� 4 tra t.�. :I .4
CITY,STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
5'iy �z�s�
��TY NEAREST ROA
II. TYPE OF BUILDING: (Check one) State Owned v S / �� �� P( � '�
�7�-� �.R
❑Public L_IlOf2FdR1.DW2IIlfly-#OTbedfOOfllS— PARCELTAXNUMBER(S)
III. BUILDINGUSE: (Ifbuildingtypeispublic,checkallthatapply) 002-940-12-5104
1 ❑ApUCondo
2 ❑Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑Outdoor Recreational Facility
3 ❑Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ RestauranUBar/Dining
4 ❑Church/School 8 ❑ Mobile Home Park 12 ❑Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑Other: Specify _
IV. TYPE OF�RMIT: (Check only one in line A. Check line B if applicable)
r-�/
A) 1.Lvf New 2. �Repiacement 3. ❑Feplacement of 4.❑Reconnection ot 5.❑Repair of an
System System Tank Only Existing System Existing System
B) ❑A Sanitary Permit was previously issued. Permit#— Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 L�"Seepage Bed 21 ❑Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑Seepage Trench 22 ❑In-Ground 42 � Pit Privy
13 ❑Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1.GALLONS PER DAY 2.ABSORP.AREA 3.ABSORP.AREA 4.LOADING RATE 5.PERC.RATE 6.SYSTEM ELEV. 7.FINAL GRADE
REQUIRED(sq.ft.) PROPOSED(sq.tt.) (Gals/daylsq.ft.) (Min./inch) /j/� � /JELEVGA/TION
3�0 �� l Q `Z`i i ry Feet `Z e / Feet
VII. TANK CAPACITY Site
in allons Total #of Prefab. Fiber- Exper.
INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel ylass Plastic APP
Tanks Tanks structed
Se ticTankOrHoldin Tank 2.5 � �
LiftPum Tank/Si honChember �
VIII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibiiity for ins atio of the onsite s ge system shown on the attached plans.
PI ber's Name(Print�: /� Plum r's Si ature:(No St m ) MP/tv�P9SN�Ne:- Business Phone Number:
GU/"-C!?a��N'! K&t �Gldcl�c- a /67 ?l.s !03 -�l�
PI b s A ress(St�q t,Ciry,S te,Zip Code): ��
Gc/ Q_- C3 ._3� --� -a.• c� t�`
IX. COUNTY/DEPARTMENT USE ONLY
�DisepproveA SaniteryPermltFee(InclueeaGrounewater fle ssue IssuingAgentSignature(NoStamps)
�Approved ❑OwnerGivenlnitial SurcnerpeFee) • ,/
AdverseDeterminauon $11$.�� 5-2-91 K
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398QormerlyPlb-67)(R.11/BB) DISTRIBUTION:OrigineltoCounry.OneCopyTo:Safery&Build��,ngsDlvislon,Owner,Plumber
' DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILLZINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS oivisiory
P.O. BOX 7969 BUREAU OF PLUMBING
� MADISON, WI 53707 ,�,�
LJCONVENTIONAL ❑ ALTERNATIVE StatePlanl.O.Number.
(1� assigned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER: ADDfiESS OF PERMIT HOLDER: INSPECTION DATE:
.-�O`"1 �, 4lrn �Z�O D e I4v�q �f . ✓�2 1at14h l.Jl 5 311,� � ��� - � �
BENCH MARK (Permanent reference poin�) DESCRIBE IF DIFFEFENT FROM PLAN: REF. PT. EIEV.: CST REF. PT. EIEV.�.
'Td � -�- b o� b � pc � - S� Cor�c r `TCL.; �-e r S� or�- l fl o�
Name oi Plumber: MP/MPFSW No.'. Cnunry�. Sanrtary Permn Numben
L`� C `-4 �^�- h�4r 10 ScCw er /5"(070 9l - 03 (a
SEPTIC TANK/HOLDING TANK:
MANUFACTURER�. LIQU10 CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WNRNING �ABEL LOCKING COVER
PROVIDED: PROVIDED�.
I F'1C — S� �—Q ( —ISQ 4 �7 , Z. Qc1 ❑YES ❑NO ❑YES ❑NO
BEODING: VENT DIA.�. VENT MATL.�. HIGH WATER NUMBER OF ROAD: PROPERTY WE�L: BUILDING: VENT TO FRESH
ALARM. LINE�. IA-F INLET:
❑YES ❑ NO y �� C l FEET FROM � i � i
❑YES ❑ NO NEAREST T �S > �O 7S0 S �
DOStNG CHAMBER:
MANUFACTUREfi BEDUING�. LIOUID CAPAGTv PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER
PROVIDED: PFOVIDED:
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
. GALLONS PER CYCLE: PUMPANDCONTROLSOPERATIONAL NUMBER OF PHOPERTV WEI.L� BUILDING. VENTTOFRESH
(DIFFERENCE BETWEEN FEET FROM ��"E AIR INLET:
PUMP ON AND OFF) ❑YES ❑NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING
or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.)
MAIN
CONVENTIONALSYSTEM:
WIDTH�. LENGTH NO. OF UISTN. PIPE SVACWG COVEN INSIUE DIA. stPITS�. U�UID
BED/TRENCH rHervcHes � tiinreRiA�� P�T DEPTH:
DIMENSIJNS f 1 2 34. S —. (o 'T qr —
GRAVEL DEPTH FILL DEPTH DISTH. PIPF DISTR. PIPE DISTF. PIPE MATERIAL NO. DI A. NUMBER OF PR�PERTV WELI: BUILDING: VENT TO FRESH
BELOW PIPES ABOVE COVER EL`eV. INLET ELEV. END PIPES LINE�. AIR INLET:
c� i� „ FEET FROM � � �
p a0 qa. 'Z q $, 1 {�t/C ,303 Z NEAREST--► 77 7S0 3S > YS �
MOUND SYSTEM:
Mound site plowed perpendicular to slope �heck the texture of the fili material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
❑ YES ❑NO
SOIL COVER TE%TURE PEHMANENT MAHKEHS. OBSERVATION WEL�S.
❑YES ❑NO ❑ YES ❑NO
DEPTH OVEF TRENCFIr'BED UEPTH OVER THENCH;BED pEPTH OFTOPSOIL SODDED SEEDED�. MULCHED:
CENTER. EDGES�.
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH W'oTH LENGTH TREONCHES LATERAL SPACING GRAVEL DEPTH BELOW PIPF. FILL DEPTH ABOVE COVER i
DIMENSIONS I
� . � � . MANIFGLD PUMP MAMFOLD DISTR. PIPE MANIFOLD MATERIAL NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL& MARKING�. �
�� ELEV.. ELEV.. DIA.. ELEV.- PIPES: DIA.:
ELEVATION AND �
DISTRIBUTION �
INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVEfi MATERIAL: VERTICAL LIFT COfiflESPONDS TO APPROVED
PLANS�. �,�
❑ YES ❑NO ❑YES ❑NO
COMMENTS: PEFMANENTMARKERS: OBSERVATIONWELLS: NUMBER OF �� �� PROPERTY WELL: BUILDING:
FEET FROM ��"E:
❑ YES ❑NO ❑YES ❑NO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
SIGNATURE�. � TITLE:
DILHR SBD 6710 (R. 01;821 1�-��,�i . ` � � 1/�, � (Aj� � � ' I
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