010-841-35-5113-LUP-1990-065 � X�
Application for Land Use Fermit �
County of Sawyer y
0
The undersigned hereby makes application for a Land Use Permit and a9rees �
that all work shall be done in accordance with the requirements of the Sawyer � 1
County Zoning Ordinance and the laws and regulations of the State of. Wisconsin.
PRIN'P - USE ONLY llLACK INK/FliNCIL -��
.��(/C��D � �
��o��M Sr�a�a��o�v�� I�IEN'��?5 _ �
Owner Builder
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mailing address mailing address
i-l/I��tip�2n I,(i1 S`{g`�� (� k�-T�n�, I`�1N, .�.�7i�
city, state, zip city. state, i�
�uilding Land Use Zone District _���
(X) New ( ) Filling —� p
j � nddition ( ) Dredging Lot size/�O/�I��j n n Sy�>5,� S �
( ) 111teration ( ) Grading �n n
O Moving on O Acres �.(`� v vni
( ) ( ) ��
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New Construction ' �
Size ��� ft wide ft wide �
�— ��
�] ft long �� ft long
Floor area �O� sq ft � sq ft ��
/ ��-
Total hgt �� to peak � to peak x'
Stories ( �
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No. of bedrooms rear/�lo,t l.ine,p;, waterline
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�f�0,i ,il �i �i l(�O
(year round) or (seasonal) � � i �
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Type of bldg or addition j � N �
( ) Dwelling � 7� � �y
O Garage (1) (2) car � � � �'s
i �
� Storage building � r}OUS�.. � � `�
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( ) 6oatliouse � � �I
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( ) Livingroom � � � �
I 7
( ) Bedroom i � � �� \,� j
( ) Kitchen-dining i � , � �� � �
O Porch - enclosed/roofed {� j' �' . ��K�` �'--t- ���pi
( ) Deck - open ,� icoc � � �-�L_ �':V j �
( ) �\�� ��' y�-rck ��_ �
( ) vti h� � � ' . ���<< � i\ �...
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Type of construction i ` i j ��
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( ) Log ( ) Concrete L �� ���
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j>Q Pole O Steel i 1�-r �SrcRR4c � i
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Construction cost $���(//1�C, i � �
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Vol �J`� Pg� of deed � � i , �
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CSM Vol /� p9 ��� � `� i H �
Cer. Soil Test ��-��a' i ��✓ � �—'�-'�
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Sanitary Permit Gb'���� �R�p�N �cl • �
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owner Zoning ndministr tor
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I, Ronald L. Peterson, Wisconsin kegistered Land Surveyor hereby state
that in compliance with Chapter "G36 . 39 of the Wisconsin Statutes I have
surveyed, divided and mapped the land herein described, that to the
best of n�y knowledge and ability, this rnap is a correct representation
of the survey made. I further state that this survey has been made
under the direction of THOMAS DUFFY and RICHARD WAkDEk, owners .
Tfiis land is located in Govt . Lot 1 , Section 35 , T 41 N, R 8 W,
described as follows :
Commencing at the North 1/9 corner of Section 35, Thence S 0°O1 ' 31" W,
along the West line of said Govt . Lot 1 , 899 . 65 feet to the actual
point of beginninq, Thence continue S 0�01 ' 31 " W, along the 4:est line
of Govt . Lot 1 , 493 . 59 feet to the Southwest corner of Govt . Lot 1 ,
Thence S 89°06 ' 15" E, along the South line of Govt . Lot 1 , 343 . 64 feet ,
Thence N 0°59 ' 49" E, 12 . 90 feet, Thence N 64°44 ' 03" E, 395 . 07 feet to a
rneander corner on the Westerly shore of Round Lake , Thence alor,g the
meander line of Round Lake as follows ; N 37°42 ' 49" W, �Ei . 93 feet ,
Thence N 19°37 ' 40" W, 139.72 feet, Thence N 19°11 ' S7" E, 152 .47 feet
to the end of said meander line, Thence N 89°43 ' S6" W, 674 . 17 feut to
tl�e point of Leqinning, and includina all the land bet4;een the meander
line and the waters ed9e of Round Lake, betvreen the parcel lines
extended.
Subject to all existing easements and reservations .
jto-p::,:�e C,!h� �/ ti: � � � � . "
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This instrument drafted by
Ronald L. Peterson
June 30, 19$6 .
-�u���� �� �/ � �
Approved this /Y�day of ct u 7� , 1986, by ��*+/����___
Sawyer County Zoning Admin .
Page 2 of 2 Pages .
� �y
. . .
�' DILHR SANITARY PERMIT APPLICATION COUNTY � •
In accord with ILHR 83.05, Wis. Adm. Code SAWYER �
'�""'"""�""^""'�"'�" STATE SANITARY PERMIT #� ; + �
CST 86 - 122 86164 �
—Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER °'�
8'/� x 11 inches in size.
—See reverse side for instructions for completing this application. pEririoN f�
1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. � � FOR VARIANCE ❑ YES f�l No
P ERTY OWNER PR P TY LOCATION
� oW� �'/a '/a, S �'S T �( > N, R E (o W
PROPERTY OWNER'S MAILING AD RESS LOT NUM ER BLOCK NUMBER SUBDIVISION NAME
/07 �.y�' �� Ev�1 � � ���
CITY, STATE � ZIP CODE PHONE NUMBER CITY : NEAR ST ROAD, LAKE OR LANDMARK
� �� / VfLLAGE : G✓ �✓
!
II. TYPE OF BUILDING OR USE SERVED:
�
Number of Bedrooms if 1 or 2 Family � OR ❑ Public (Specify):
III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2, 3 or 4, if applicable)
1 . a. � New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an
System System Septic Tank Only an Existing System Existing System
2. ❑ A Sanitary Permit was previously issued. Permit # Date Issued
3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements.
4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy.
IV. TYPE OF SYSTEM: (Check only one in #1 and only one in #2)
1. a. �Conventional b. ❑ Alternative c. ❑ Experimental
2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP
In-Fil I Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1 . a. � See a e Bed b. ❑ See a e Trench c. ❑ See a e Pit
2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUI ED (Square Feet): PROPOSED (Square Feet):
�/ �l� � 'A� CU Feet Private ❑ Joint ❑ Public
CAPACITY
VI. TANK Site
in allons Totai # of Manufacturer'sName Prefab. Con- Steei Fiber- plastic Exper.
INFORMATION New xisting Galions Tanks Concrete glass App.
Tank Tanks structed
Se tic Tank or Holdin Tank vQ@ r r.�/ r ❑ ❑ ❑ ❑ ❑
Lift Pum Tank/Si hon Chamber ❑ ❑ ❑ ❑ ❑
VII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans.
Piumber's Name (Print): Plumber's Signature: (No Stamp MP/ o.: Business Phone Number:
� , � d i
� � ,� . ,� �'� .� ;�� C�4�-.��
Plumber's Address (Street, City, St e, Zip Code : Name of Designer:
d
VIII. SOIL TEST I FORMATION
Certified Sqil Tester (CST) Name � CST # � �
_r c
c.�.
CST' ADDRESS (Street, City State, Zip Code Phone Number:
�. C� C �,�` � '
IX. COUNTY/DE ARTMENT USE ONLY
�] Disapproved Sanitary Permit Fee Groundwater a?e Is g Agert Signature (No Stamps)
� Approved ❑ Owner Given Initial Surcharge Fee
AdverseDetermination $ 70 . �� Y25 . 0� 6- 23 - 87
X. COMMENTS/REASONS FOR DISAPPROVAL:
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S5D-639E �rormerl�� F�'�b-67j (R. 03/861 DISTRIE3UTION�. Original ?o Ccunty, Gr�e Gcpy To� Bureau of Plumbing. Owner, Plumber
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