008-937-19-5203-LUP-1990-118 . Application for Land Use Permit
� County of Sawyer x
o�
The undersigned hereby makes application for a Land Use Permit and agrees
7
that all work shall be done in accordance with the requirements of the Sawyer °,
County Zoning Ordinance and the laws and regulations of the State of Wisconsi�. I
PRINT - USE ONLY BLACK INK/PENCIL }\ '
I
Robert W. Medwetz ancj Carol J, P4ed�etz . / 'j�
Ci:7 r;:l �f�L��ot�7rar�' w�n'v(/(- %„<; r�/ i��i�' i�r�' /I�i Y�J/1 :i
Owner Builder
Y�� �'�% z re ��,i H�;��;�h �`�� -������ �� ��
mailing address mailing address
Hp`���^.`r'LY 1 C, Y� � °�//0.30�� /!�'G /. �/lC w/J'C� ���.�� 5
city, state, zip� city, state, zip
Building Land Use Zone District /f���,fj"-� �f �/-�
(�(j New ( ) Filling , , ,
( ) Addition ( ) Dredging Lot size '!''��//�jQ � X�j1�jJ� . /S �
.� j.:.,,,•,.�
L
O Alteration O Grading l m n
( j Moving on ( ) Acres ,�/
( ) ( ) S
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New Construction �-,.
Size 3�, ft wide � ft wide -
��'�� ft long � ft long i
{-
Floor area �_~L-' sq ft sq ft d
� m
r�
Total hgt �,h' to peak to peak x_1
Stories _� �
No. of bedrooms -r-ear 2ot-"Ii7rE'�r waterline ��
(year round) or (seasonal) �--i �� � � -�`. � �� �-«" -�i�� <;
i
Type of bldg ar addition i -� i o
O Dwelling � r,�: i m <
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(X) Garage (1) L2}� car � � i a ��
O Storage building i � � i c r+
( ) Boathouse � � � �X '��'� - i m
( ) Livingroom -- � �
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( ) Bedroom � ' �p� r � � �
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( ) Kitchen-dining i ~ � i
( ) Porch - enclosed/roofed , �� � i
( ) Deck - open �_ i i ,�
( ) ��i i
( ) }�i �'\ �
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G,�i � '; `'"
Type of construction �;�� ��� �
(�(5 Frame ( ) Block ',,,.I,_. ).._���J __.__.- � . . ,� � 1
( ) Log ( ) Concrete i � ' i
( ) Pole ( ) Steel i �' �'�' � � i �
( ) Metal ( ) i � .- � i ���
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� i m
Construction cost $��.._`:�� � i � o
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Sanitary Permit 7�-`��, �C Z �if. ,� o I�
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Issued ql T7a� 1990 Denied I�
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er+»et Zoning Administr tor
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� \ \ o-Denotes 1"x24'� Iron Pipe Corners
•-Denotes 1"x30" Iron Pipe Corners
I, Frank A. Havel, Wisconsin Registered Land 3urveyor horeby certify
that I did survey at the request of George J. Ful{a, James Fuka and Helen
Fuka, owners, Parcels No. l� 2, 3 and 4 described as follows :
Parcel No. 1
A parcel of land located in Government Lot 2, Section 19 , Toivnship 37
North, Range 9 West, Sawyer Cozmty� Wisconsin deseribed as commencing at the
North Quarter corner of said Section 19 ; thence I1 84"00� E alon� the Section
line 1200.00 feet to the intersection of the centerline of C .T. Highway '�F° ;
thence continuing N 84"00� E along the Section line 646 .2 feet to the place
of beginning; thence continuing N 84'00� E alon� the Section line 15F3.00 feet
to the meander corner located 21 feet from the waters edge of Lalte Chetac ;
thence S 22 "00� E along the meandar line 104.03 feet to a point located 37
feet, moro or less , fr�m the waters edge of Lake Chetac ; thence S 84°00� W
parallel to the Section line 186.68 feet to the intersection of the East line
of a private roadway; thence N 6`00' W along the East line o£ said roadway
100.00 feet to the place of beginning, including also all lands lying
between the meander line and the waters ed�e of Lake Chetac between the
parcel lines extended and containin� approximately 0.46 acres ; together with
an easement for inaress and e�ress over the 66 foot wide private roadway
connecting with C .T. Highway F" .
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Parcel No. 2
A parcel of land located in Government Lot Ido. 2, Section 19,
Township 37 North, Ran�e 9 VJest, Sawyer County, Wisconsin doscribed as
commencing at the North Quarter corner of said Section 19; thence N 84°00� E
alon� the Section line 1200.00 feet to the intersection of t}ie centerline
of C .T. Highway "F" ; thence continuin� N84°00 ' E along the Section 13ne
646.2 feet to the intersection of the East line of a private roadway; thence
S 6°00� E along the East line of said roadwa� 100.00 feet to the place of
beginning; thence N 84°00� E parallel to the Section line 186.68 feet to the
intersection of the meander line at a point 37 feet, more or less, from the
waters edge of Lake Chetac ; thence S 22 °00' E along the meander line 104.03
feet to a point located 25 feet, more or less, from the waters edge of Lake
Chetac ; thence S 84°00� W parallel to the Section line 215.35 feet to the
intersection of the East line of the s�id private roadway; thence N 6"00� W
along the East line of said roadwa,y 100.00 feot to the place of beginning,
including also all lands lying between the meander line an3 the waters edge
of Lake Chetac between the parcel lines extended and containing approximately
0.53 acres; together with an easement for ingress and egress over the E6 foot
wide private roadway connecting with C .T. Highway °F" .
Parcel No. 3
A parcel of land located in Government Lot tdo. 2, Section 19,
Township 37 North, Range 9 NJest, Sawyer County� P�isconsin described as
commencing at the North Quarter corner of said Section 19; thence N 84°00� E
along the Section line 1200.00 feet to the intersection of the centerline
of C .T. Highway '�F° ; thence continuing Pd 84"00' E along the Section line
646.2 feet to the intersection of the East line of a private roadway; thence
S 6°00 � E alon� the East line of said private roadway 200.00 feet to the
place of beginning; thence N 84°00� E parallel to the Section line 215.35
feet to the intersection of the meander line at a point located 25 feet,
more or less, from the waters edge of Lake Chetac ; thence S 28°38 � W along
the meander line 125.00 feet to a point located 82 feet, more or less, from
the waters edge of Lake Chetac ; thence S 88°24� W 177.33 feet to the
intersection of the East line of said private roadway; thence N 14'00� E
alon� the East line of said private roadway 95.00 feet to the place of
beginning, including also all lands lying between the meander line and the
waters edge of Lake Chetac between the parcel lines extended and containing
approximatel9 0.57 acres ; together with an easement £or ingress and e�ress
over the 66 foot wide private roadway connecting with C .T. Highway "F .
Pa rc e 1 IJo. 4
A parcel of land located 3n Government Lot No. 2, Section 19,
Township 37 Nortti, Range 9 West, Sawyex• County, Wisconsin descri.bed as
commencing at the North Quarter corner of sajd Section 19 ; thence N 84°00� E
along the Section line 1200.00 feet to the intersection of the centerline
of C .T, Highway °F° ; thence continuing N 84°00 � E al-ong the Section line
646.2 feet to the intersection of the East line of a private roadway; tlience
S 6°00� E along the East l�.ne of said private roadway 200.00 feet; thence
S 14°00� W along the East li.ne of said private roadlvay 95.00 feet to thc: place
of beginning; thence N 88`24� E 177.33 feet to the Intersection of the
meander line at a point located 82 feet, more or less, from tha waters c;dge
of Lalce Chetac ; thence S 28°38 ' W along the meander• line 1.27.35 feet to a poini
63 feet, more or less, from the waters edge of I,alce Ctietac ; tlience iV ti4`00� W
140.00 feet to the intersection of the East line of said private roadway;
thence N 14"00 � E alon� the East line of said private roadwa� 95.00 feet; to
ttie place of be.einninu, incl.iiding also a]_1 lands lyin� betwean the meander
line and the waters edge oi Lake Chetac between the parcel. l.i_nes extended and
contairiing approximately 0.62 acres ; together with an ease�petit for i.ngress
And egress over the 6fi �opt roadway conneci;ing with C .T. Hi�Y�tivay "F" .
I further c�e�,�if '�that in malcing the above survey I complied witk, the
provisions of Ch��terr236. of tbe Wisconsin Statutes re3ating thereto.
, , ,.. � '� �
August 30 . 1965�: � � „ '.. �-� _�c �-f' � s�c;,2 �•� <_,
� � � � ! Franlc A. Havel, Wis . Re�. Land Surveyor
i Hice La]ce, Wis . ,�
\
Sheot 2 of 2 �
A� APPLICATION FOR SA[JYER COUNTY
1 �° SANZTARY PERMIT
Q Applicattion #�r� Date C-'_ �,� '-: �
� Fee of SZ0. 00 received - � , " r , ! % �,- f ' '
M Date ` Courtty" C er �"" '�"
„ 1 ,o B��-T W , CY1�.D UJ��t"�.
Application is hereby made for a Sawyer County Sanitary
Permit for work to be done on the premises, described herein.
�J 102�2 N�W N�mPsH-iR� I�Rmmor�D �7�icu�tsrl
�0� ���GYIn/EfZ �-r���/ S_ dLc323
Owner Address TeZephone
vov-r 1_o-c' 2 ' �.o� 3 '
The o f the � Sec. �_ Twn. �� R. 1�- '�.(� : 2.3
or �
Lot BZock Sub-division �01l,�,,� F,�/� , �� ��(--�I�JAT�
._ .__ . _ .
_ ._.
_ . P�<15F1.�/.4Gt�.:. SiJ<' fr"ti�l /Y �/I . P<. � -r, c��^
Work c�ntemp ated '-' To be performe � by
Is'umber of Bedrooma �% Number of Bathrooms �
Dish�asher n/() Garbage Grinder �n
Automatic Washer �_
Soil Deseription —��-�-�E—r'p—� /
Septic Tank Size �'��_ gal.
Seepar�e Pit �ght Diameter �
Seepage Trench �_ Length 1 /zpi�idth � Depth ,�
Septic Tank Permit # � �� � �
—r
Percolation Test Form PLB 43 attached _�
Yes No
'Contemplated compZetion date 'L�,,�/�G/�
�y/� /
Application Approvedl Permit 1h i�,��
�7
Santitarian�` ,- " � ` i . '���,� � �. �,> _ `t ;
� �. Owner g �o�a ie TDate
Remarks
Final Inspection ,
Sanitarian �R„rc,���v,;,Q�E, ..4uJ S- /0 -7 �-
Owner/Agent Notified (Date)
Remarks � �(
—
*** Send oriyinat-�and three copies with . '� ** �•-
fee of $Z0. 00 to -Gounty Clerk
< <
�;�� �7 �hi
NSsoonaln Departu�nt of Health and Sonisl Servio�s
� Oivieion oT Hea1Eh
SEPTIC TANR PERMIT APPLICATION
TYPE OR USE BI.ACK INK - PLEASE PRINT
A, ONNEA OF PAOPERTY
Neae Addresa (SLl�sL, City� Zip Code)
2 {�� �� ,8 re`r cr/a a���, 5� 7
B, L�ATION OF PROPERTY NNERE SYST HILL BE CONSTRUCTED ALTERED OR EXTENDED COUNTY ✓//t�(/ ��
Cheok Onet
CI17 YILLAGE LEGAL OESCRIPTION
TONttsxir (sioox, wc, sao.��L', Tl�liV.j /� JnUJ ��rV�'�ot
,
C, IS LOCAL PERMIT FiEu RED FOR THIS HOIiKP YES No �v Q PERMIT N[f�ER
D, SEPTIC TANK CAPACITY /���0 GALLONS NEN INSTALLATION� REP[,ACII'gNT_ ADDITION�
HATERIALSs� PAEFAH CONCAETE POUjIED IN PLACfi_ STEEL%1 01'HER�
NClIDEA OF TANKS TO B& INSTALLED� _F
E� TYPE OP OCCUPANCY �/
Cheok Onas One or 11ro PemiLy Residenoe^Cortimercial_Industrial_ Other_(Specify)
Number of persons to be Aooa�odated� Number of Badraoms O'�
F, APPLICkNCES, ETCi Food NasLe Grinder _YES �NO Autamatic Clother Hasher YES X NC
Distefasher YES �NO Automatia Potato Peeler Y&S �NO
OTHER (speclfy� YES �tl0
G. MASTER PL ER MAKING INSTALLATION �
Names �fJfi��A/�C'S/�P r Addreass
O
SIGNATURE OF APPLI�ANTi �/
� A Ltoeme Nwaber� n2 �
ADDRESS , MP ASW
t{, (TO BE COMPLETE➢ HY ISSUWG AGENf� ..A�
' Da{e of Appliostion -.)" �r' � `! � Fes Paid �/'
�- i� - �� �-
Permit Iesued (date) �� —/ ` � � P�rmit Nucb�r �^
U
AgenS (nms�� r� r, ���..� �i: ".! , For� _� �-.a � 'T T;� • �
� O o �; � }� `� tam� villag�, olty,��coun'ty� �ta, epeoify)
� ��^- G�J'(111.rJ ',I_[,�,C:,S`J.:IlI/�,:A.T,J
UTEt 'Phe�pplioation oazutot Ds oonaids»d for filing un'Eil all of the ebws questl�s ansnT�d
and the fse pa1d. Agents elll fo�ard application� She te� oP ;1,00 for eaoh aeptio tenk and
the third oopy ot ths ps�it (osaary) to Lha Uivialon of Hsalth, Cheoks and money ord�ra should
b� mede yeyabl� to the Mvleloo o! Henith. �
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NkM�s: �i,
COUNTYt
SEP?IC TANK PERMIT NUMBERt
REPORT ON SOIL PERCOLATION TEST
AND SOIL BORINGS
TO
DIVISION OF HEALTH �► PLIJMBING SECTI�1
P.O.BOX 309, Mndison� Kis. 53701
Pursuant to H 62.20, wis. Administre.vive Code
P T R C 0 L A T I 0 N T E S T
?EST DEPTH CHARACTEA OF SOIL HOURS HATER TEST ?IME DROP IN WATER LEVEL INCF�S MII4lJTSS
NU!ffiER INCHES THICKNESS IN INCHES SINCY HOLE IN HOLE INTERYAL SECOND ?0 EXT T0 LAST TO FALL
lat NETTED OVERNIGHT IN MINUTES LAST PERIOD LAST PERIOD PERIOD ONE INCH
EXAMPI.E
P — 0 36�� TOP SOIL 10" CLAY 26'� 25 YES OR NO 30 60
1 ,� ,, �lq �� o �I/o ia 3 3'�
z ,� ' D D /�� 3 3 3�
- � ,
s / ' U !� /O -'
RECORD DATA FROti HINTMUM OF 3 TEST HOLES
COME�UTE SIZE OF ABSORPTION AAEA IN ACCORD WITH H 62,20 WIS„ ADMINISTRATION CODE.
S 0 I L B 0 R I N G S — MINIMUM 36�� BELOW PROPOSED ABSORPTION SYSTII'I
BORING TOTAL DEPTH DEPTH TO GROUND WATER DEPTH TO BEDROCK
NUM3ER INCHES OBSERVED ESTIMATED OBSERVED ESTIMATED CHARACTER OF SOIL WITH :HICKNESS IN INCF�S
EXAMP
g � p r n / 1 f' ���� K 0 OI „ C g�u e�c p u
1
n/ /� �� '/ �FIC I� �i /�
p ���� �, �t �� L"/9 ��C ��
3 �•-,i � �/ // / ' � �ii i� �` /
�f> Q
REC A A � 0
TYPE OF OCCITPANCY: �
RESIDENCEe NUMi3ER OF BFDROOMS� OTHERs (SPECIFY) N@'lBSR OF PERSONS�
FOOD WASTE GRINDER: YES N0�DISI�IASHER: YES NOl� AUTOMATIC CLOTHES NASHERs YE5 NO
EFFLUENT DISPOSAL SYS'FEMt NEH� EXTIIdSION ADDITION: --REPLACEPlENT
' TILE SIZE N0. LIN. FEET - TRENCH WIDTH DEPTH NUMBER OF LINES �
0 �� � i� �}
SEFYAGE BBDs LENGTH� ilIDTH�i DEPTH� TILE SIZE�N0. LINES o�
SEEPAGE PITt INS7LE DIAMETER LIW7ID DEPTH
I, the undersigned, hereby eertlfy that the percolation tests reported on this form ware made by me or under �r super—
vision in saaord Rith the proaedures end method specified in Chapter H 62.20 (3 ), Wisconain Administrative Code� aad
that the data recorded and location of test holes are correet to the best of a�y lnioxledge and belief.
NAME��='�N ��s ��e� TITLE
—��TYPE oT INT � r
REGISTRATION N0. OR MASTER PLUMHER LICENSEfNO.
ADDRESS���/ �? XC� �'a�1� //� � �' ,�
r
DATE SIGNATUAE
DO NOT WRITY IN SPAC D P USS
DATE �tECYIVED ACCfiPTED BY REIVRNED
FEE R�CENED VALID N0. PERril? IiO.
AEWIEIiED BY----_---- APPROYED � DA1T