012-740-36-1306-LUP-1992-292 Application for Land Use Permit
County of Sawyer � �
The undersigned hereby makes application for a Land Use Permit and �
agrees that all work sha11 be done in compliance with the require- o �
ments of the Sawyer County Zoning Ordinance and the laws and regu- � 1
lations of the State of Wisconsin.
PRINT - USE BLACK INK OR PENCIL S�
/�o ��'� � l�a c` �i QG�J%I c�l� � �
Owne Builder I
��y � � �
J 4 / �.
Mailing Address� Mailing Address
r
���:� ��� , � � r,�� �/�'�/�',
Cit , State, Zip City, State, Zip
Building Land Use Zone District �-Z. o �
( ) New ( ) Filling � �* �
�C} Addition ( ) Dredging Lot size L�L��x L+-�L�- v� -t
(� Alteration ( ) Grading
( j Moving On ( j Acres �.�t:>'� ��
�
New Construction
Size �8 ft wide ft wide it�
���
_�L� ft long ft long ,�
Floor area �332 sq ft sq ft �
� ��>
Tota1 htg ��j� to peak to peak �
Stories � Stori�s
No. of Bedrooms rear lot line arwa�e�lise c�
i o
(year round) or (seasonal) ��0 �
G rt
Type of Bidg or Addition a' r'
( ) Dwelling a o
( ) Garage (1) (2) car r,
( ) Storage Building � N
( ) Boathouse o�
�` .� S�i'�� -
( ) Livingroom -- �
( ) Bedroom _ _ �- _ - -
( ) Kitchen-Dining 30 '�� � � �
( ) Porch - enclosed/roofed --'�'"� Ow `, � �
Deck open , ZLl-`,�'�/o ;�,_`_ -' �^
� )
t r�"
��_ ra��,f n�,����C ., ,,X , ;
c ) : � �
� ?o, � _ -C
Type of ConstYuction � � �; �
(,�s Frame ( ) Block _ I r,, ,r�,
( ) Log ( ) Concrete j
( ) Pole ( ) Stee1 i _ �, �
( ) Metal ( ) ' i, �` n
/ i �
Construction Cost $ � � �� �
���• � � ��
Vo1 3(p�{ Pg 3 Q� of deed I
CS Vol ` Pg — ; ro �
; w
Cer. Soil Test �' � �
�
Sanitary Permit -]tl.-�(y(� ----------CL Road ---------------
r, G
z
0
G �1�>._ �('�f z
1,'� T— �
Issued Z�) Y��q�Q(�- �( Z Denied
\.
_ .�'
i� O'1 t.e ����:i� . . � 1 �l lti4k�- �c Tc-r E
� Owner Zoning Adminis rat r
��- -_A
a O •
- oL �
� � .
� � � �36A} • 3
N ;�� � � ,o n � ��
p , , � ,
� � w � .
� ti
� ;D ,;�3 6
� � N � ,o � �36�
N �� D o� •� � 0 w3 t�
.
C7 ��•
0
r ��
� -< � •A
''1 � L ' 1� �l 4,�6 A ��,°
J � � � �, N
M�J�:-'<:7A,E'E 7' ,;�U�� :a �
y �f
�
36 f�
� X �'' �o -rl �36.
, . 1 � - A
- -r� �r� .
� C!
� � i/�6�� w3�'.A �
n ��_/ � �'� •� �f � �3 �p
� _ � A
� - -- � .
4
� w36
C �
C �� �� Z 4.3 ,A
J ", � o
�
�
�?
—� /�3 .t� n 4,3�' . �GA �--+ 4,36
o� (J / w � �---, �
_ � G .
'\-� �• �. � • � �177 �,� .
�
<. � �36\
� � �
.=�<:7 � .� 7'. '
�. �
- - - 3 �
•'4 •i
�36 �3 -�A 36 � _ � �.c
--� _ ,o � . •� Cp o' -ta
� L �L.o � � . rv�
i �
�
i
,�36 i
N �O i , ��
I ^
.,
L �36 ✓�,"��` �`"�i �
�, �A i.:;,
� L, r . ��'�,�
,�; ' �3
36• � ..��' � :-� �.�A •�,
;p o � � w � , u��.
L
N � s - 36`�: ' �
A -� 1
` , o � �� '_ `A3 �� 3 i
� ,-, � � �. � o �
s�• �
.\ / �
� �36� � i
n ,� - o
� 36 � � :'-_� ;
r �� � -� L ';-� � �
m �, � ; ,.�-� .
_ �_ / �_.��� -_
� , 3 6 � / �=�, .\ �6.p
\ , w _�. � � . \� . 0 Q`,o
—
� � - � c� �
n � � �2 �`�� (�
;
� �360 � s� ' � �36�
!I -� ,, 4�� - � �'/ � � , 36 � w�-o
J� �. .A
'� //,� ;- � . � \ r'�-� . 36
O ' � -� � -.�
� �36 ' � �-�--------�-� � -�. � -
,
� � - `-�
i Q) z � �,f � � \ ��
� ��` ( `
�- \
m - ., t ���, , �
�t � � \ ��--�\- ��-,.�
�t . � �` 3 � ��, ,,.;�; �_ _�"
� . � _ .__
o � �, .
..\;°M..�i � � . . . - .
Plb 67 - ��=
,_�`- ' State of Wisconsin and County
� ��� ' Uniform Permit Application
for Private Domestic Sewage Systems _
State Permit County Permj�, �O / �
Number Number T �a
A, IOCATION OF PRE SE U�HERE SYSTEM WILL BE CONSTRUCTED,ALTERED OR EXTENDED
LEGAL DESCRIPTIO sW /v� Name One:
(Sec., Lot, Block) y �
�� r,�� t� CITY VILLAGE
��C �'�� �; yD (,�j TOWNSHIP
B. OWNER OF PROPE Y MAILING ADDRESS �aa (.��Ck� �S 1
Name (Street,City,Zip Code) �'� P�� �N SS��
C. SEPTIC TANK CAPACITY Gallons NEW INSTALLATION � REPLACE ENT ADDITION
MATERIALS: Prefab Concrete Poured in Place Steel�_Other ; No.of Tanks � -
D. TYPE OF OCCUPANCY '� �
One or Two Family Residence No.of Bedrooms
Commercial Industrial Other No.of Persons to be Accommodated_�—
(specify)
E. APPLIANCES, ETC.: Food Waste Grinder YES �NO Automatic Clothes Washer �YES NO
Dishwasher YES .�NO Other (Specify) —�,��(�rel�
F. EFFLUENT DISPOSAL SYSTEM NEW� EXTENSION ADDITION REPLACEMENT
Seepage Trenches: No. Lin. Feet Trench Width Depth Number of Lines
Seepage Bed: Length—��dth �� Depth �� Tile Size � No. Lines
-' Seepage Pit: Inside diameter Liquid Depth �
G. Percent of slope of land % direction
�
H. Indicate Slope of Land &direction of slope on sketch I. Tile Depth
PERCOLATION TEST
Indicate Soil map number And Soil Type
Hours Water Test Time Drop in Water Levef Inches Minutes
Test Depth Character of Soil Since Hole in Hole Interval Second to Next to Last To Fall
Number Inches Thic ss in Inches st Wetted Overnight in Minutes Last Period Last Period Period One Inch
� d �� k � , � ` � �
� t '' � O .2 `
,� k ,� v � ,� � �
� 4 � �o � r
RECORD DATA FROM MINIMUM OF 3 TEST HOLES IN THE AREA IN WHICH THE SYSTEM IS O BE INSTALLED
S O I L B O R I N G S—Minimum 36" Below Proposed Absorption System •
Boring Total Depth Depth to Ground Water Depth to Bedrock
Number Inches Observed Estimated Observed Estimated Character of Soil with hickness i Inch s
b Q ' O � /a v ' 9'( �'
, � a / N N r
� � � � � k Y �
� ,�o' �, � �
R CORD DATA FROM MINIMUM OF 3 BORE HOLES IN THE AREA IN WHICH THE SYSTEM IS TO BE INSTALLED
(COMPLETE OTHER SIDE)
Name of Owner � County Permit No.:�.�,�
PERCOLATION TESTS
� I, the undersigned, hereby certify that the Percolation Tests reported on this torm were made by me or under my supervision
in accord with the procedures and method specified in Section H 62.20 (3), Wisconsin Administrative Code, and that the data
recorded and location of test holes ar orrect to the best of my knowledge and eli f.
NAME ���/� e�S �G��-Q��• TITLE
(Type or Print)
REGISTRATION N0. or MASTER PLUMBER LICENSE No.����
�
ADDRESS
DATE OF TEST �/��/ �� , SIGNATURE '
MASTER PLUMBER � KIN APPLI ATI MP
Signature: License Number: MP RSW
For. Provide sketch below of system
( ployer) (Include direction and percent of slope and all applicable distances►
f _ � I i i . _ i � I___ I _ � I I � i _ � _( i _ i _. � � i ,_
,_ � _ , ion est& 5oil�Bore Hples _. �._ i _ � __.
-20' PLAN �VI�W ( ocate Percolat
,
� I 1 _ I_
. .._ .. � � � i I � � �.
. ` . 15' . � : _ � i_ i _ �__ , . _ _ . _
_ I. .
_ , i J I � , 1 ; I
,o � ,_ _ ' � I � �I .�__ __ � - _ _ _ _ __ ,_ _
_ _ ; , _ , : , , I .
. ,
; , , � . � � �
5` '
� ,
� ( � . _ _
; _. _. _ _ _ __ ;.
' �_ _ J � _ _� �
-
.
; ,
� . .
.
� ' .
_ . �'
o ,: � � � , �
� � � � �
� , , , , � , , , �
5• , ; , _ . _ _� 1 2' ! ����' � ,
I � I ' I c��°� I �� I I ! I
10; __ . _ , _, . _ _ _ �_ _ � I i __ _ _ � _r _ � _ j ` :
, I , _ � _ 1 � � I I ��L
�5� � ,_ ; _ �
,
- -� , - - -_ _ ___ _ . , ��/°','�' �
� � I � � oz�, �ro f � ,
_ , `
� � _ I � � �
� _ ___ _ ` i � I
� __
Z�J i I , � I ' ' , _I ,/� I ' r ,
, _.
�
� _I � � � _ _ i �=u�, � , ; _�
� � y � �
. , , ; . ,
1 . ,
_ _ .--
_ _ __._ PRO�I L (In ic te ro nd �ate�'or bedrock w ere�applicable)i�. � _ � !
� � � � I J 1
. � i
. �
,u .,,__ � S_ u c , ,.. _ _.. �'c� � __. �
,, _ . __ , _ __ ^ t �,-� : __ _ ! f
2�-- o- . ��; _ _ __ E'` __S �L . � _ [ , , �C�:'F' /�"�=k.,�,� 1(.r�t- ��- i t
3►- - _ - ! - - -_ _._ cs � . � �_ _. _ `_ _. _-_ � � — -. _ _ 1 l
�
_
_. � I
i . ---. _ _._�___. --- _ _ �.. -� . - _.. _ _ �__ ___ -___ _. _ ._ ___ ___-}--- I �
4. ; E , � , � � � ;
, .
.
5:. . _ _ _ , __� __ _ � y, ��„�,��,� ,3` � _ _ --- � _ - - - -�
I
i
. ... ... . .." " " ..
1 . I �� � I � � . � �'
6' _ i � .
� � ; � ,��' �t,,� , � I �_ ,
� - ; � � ; ',
. _ .. � � ^ ; _... �. . � I � ; , �
� � �� � � � � ' I f l �' �
�
g�, _ _ ___-- _ �I , ; ; _ _ , _ , _ _ _ _ ,
I ' ' I i ' I
g. _-------- .__ __ ___ ; ._. j _ .. � __ � . � � _ _� _ _ ___ _ _'-- I .. _. ._ - -' -_ I _
� . ___ --__ __,1 _ ._ 1 ; � 3 � � , _��� . _: ___ __ _ _ � I _ I __
1� _ _ _ __� -�.___ _ _ � l _I____�_ _l _I_ �_ __ 1 __-- . l I_ ____ I_ _ __._ � �_ �---___ � ___! _ .
11
' Note: The application cannot be considered for filing until all of the above questions are answered and the fee paid.
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Do not write in space below— FOR DEPARTMENT USE ONLY
Date of Application Fees Paid State ��� County �1.�O
Permit Issued/R�ed (date) �UN� � �q�Tq- Inspection Yes No � ���
Issuing Agent Name �'2�YN K��l�A�(2-i- O�'Pv'1.�' Valid No. Date Rec'd
DIVISION OF HEALTH,P.O.BOX 309,MADISON,WI.53701 —Revised 4-1-73
�
i . �� �'I
, DOCUMENT No. STATE BAR OF �VISCONSIN FORM 3-1982ii THIS SPACE RESERVED FOR RECORDING ��7�
QUIT CLAIM DEED
l � � o � i � .
-- - . __. _ _._ - _ _.. _- Reqiefe�'e Ofboe
- -- - - �
_--- -------- --- - -
-_ -- -- ---- --_ _- - ,
,I . _. .. ' - '�-' ' ' - ' ..•..- - ""-.._._._._�__ . . � ' """"•' �� SAwy�if C�,c?lV1f'f
"' ' """ "' ' ' .. . "" """"' �
� Arnold Ode ard._and. E_unice_.S . Ode ard his wife, I �'3y��j ��� rcwx'Kj the_L_ �7 �
• • •--- - - •
�� --- A C`1?�� at��_�c d zf
and._in__her.__o�rn_righ.t�- ----�------ ---------------------------�------------------- i�
ht �nd recorded 1n vol.��
'� ------------ - ' -------- - ----------��Ch�---------•--•---------•--•-•-•-------------•---•••- �! OI F•a.n�•In cm pegd �
qu;c-��a�m9 to---------Ragez_..D_..-- -.
• _
� � -��
, .zc�y �
----------------------------------------'-� ---------------------------------------------------------------- II �'f"`
�-------------------------- ----------�------�--------�-----------------------------------------�
-----�--........ ,�
--------�----------------------------------------------------------------------------------------�------------ i �c�+�
� the following described real estnte in ._._.._...S3�P..r_______________________ County, �
� - _ .. .._ - - -- - ---
State Of WISCOIlS1Il: I RETURN ,o
�( G � � �� '
�
� Tax Parcel No: _..---•-------•------•-•--•---
Tract "EE" located in Chip Flo Acres being a part of and located in the
, Southwest Quarter of the Northeast Quarter (SWa NE4) of Section Thirty-
`" six (36) , Township Forty (40) North, Range Seven ( 7) West.
Exempt Wis . Stat. 77. 25 (8)
This ...._._.15............... homestead property.
(is) (is not)
Dated this -- -----------1_Ztl'1-----•-------- --------- day of ------••-- ---�.11�,Y----- ----� ---• ----- ---�---- ��---------, 19_84---•
� (� ,y�
......-- -�- ---- -- �- �- �-•--- �............... .. �--(SEAL) - Gi�%1�22.���.....`-.'.�t-_ �" " :"...(SEAL)
._ �-�-------- -
* ...-�-------...--�------------� ---------------------------------- ' ----Arnald..Ode.qard-- -- ........
� �-�-----....._
--�--- -- -- - �-•-- --�--------�--...------•---•-----------•-�--•(SEAL) ��(;�,li�L4G:�,���~.��`i�"-�:C�Cl�t.2�.---•-----.(SEAL)
* ---- ---�---�---------�------------ --�------------ ---�-------�- * .._.E_un_ice- S�---Ode_ ard-----------------
�-� ---
', AUTHENTICATION ACBNOWLEDGMENT
Signuture(s) ---•----------•-------•---•---••-------••-----------•-•-•-•• STATE OF WISCONSIN
•----•-
•----------------•------••------•-•--•-------•------••-----------••---•-• ss.
Sr�Wy�'�._..._..•---•--County.
authenticated this _.___.__day of___________________________ 19._.___ Person�lly came before me this ___.__17thda}• of
---•----•-•--•--•--..�ILl�.�_.._..-••---, 19.._$4_ the abo�•e name�l
--�---�-------------------------------------------------------------------------
__._._A.�nQ_�d___Q��gard__,and___Eunic_e._S_,____.
« ..
�---- ------------------------------ -------------Odeqa�df---h.i.s___�ri.fs_R----------._.------�--
---------------------�--------------------
TITLE: hiENiBER STATE BAft OF WISCONST
-•-----•-•-•-----•-------•------•------•--------...•----------------------------
(If not, -----------•--••---------------------
authorized by § 706.06, Wis. Stat � � `-"-'-"�"�"�""�----'--��- _..
--------------------•---•--- -
- ---- -•----•-----•-
� to me known e th e
�. .... ........"9
0 ' � ---------.- o executed the
THIS INSTRUMENT WqS DRAFTED Y��� N0�'q�, �2NZ oregoing ' rume _ no e the same.
---Howard---E-�---H_anson, at� �ne "`'� � • --- ----- -;.- -<'� ------- -- ---- -
- �- - -- �
- ------ --------�. •�:,---,� ----- --- --- - -------- _
---- --Ha�-ard , WI 548�r��^ . L�j-'�I�v � -------H - -.ard_.E- ---- -ns_on. ----
- - -� ------------------------- •---=-------------- � ------ ------------ - -
� :' •. �>'Notnr, Pubiic ----- .- - �er--
(Si�,natures ma be nuthenticnted or ack �o � ��- 11'ty Commission permnnent.(IfX}ib{xp$�{��}{���,E�
T Y ` q edged. o s.
:�re not necess�r,y.) .� ��
'>�. t_ ,,.. 2Sa`€c�C .
�~`. --------�---� �-_-------- ------ -------�-----------X���---- •)
_ �� � �, 1� � 390