002-940-23-5204-LUP-1989-053 James M. Clark v
1508 East 84th Street I\
Bloomington MN 55425
�pplication for Land Use Permit
County of Sawyer `�
0
T}�e undersigned hereby makes application for a Land Use Permit and agrees � '
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 Wisconsin.
PRINT - U5E ONLY BLACK INK/PENCIL
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mailing address mailing address �
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city, state, zip city, st te, zip
Building Land Use Zone District �{/2 7
(� New ( ) Filling
( ) 1lddition ( ) Dredging Lot size 1 O O//b a X 6 F�l /7 O 1 � ��
( ) Alteration ( ) Grading �, �
( ) Moving on ( ) Acres /, S� /����5
( ) ( ) L� �
9
New Construction `} �
Size a�f ft wide ft wide ('�v
----�— �
3� ft long ft long � �
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Floor area 8,(� sq ft sq ft � �
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Total hgt � 3� to peak to peak x ��
Stories _�_
No. of bedrooms � rear lot line or waterliiie
(year round) or (seasonal) ��5775�✓b Gf�KE
i /o a'�oG '' ; c�
Type of bldg or addition � i a
( ) Dwelling i � i � rt
� Garage (� (2) car � 7� • � �� �-+
( ) Storage building i r
� R, O
� c rt
( ) Boathouse � 3fo � �'
O Livingroom i�.(q� �4'� i t�4' N-
( ) Bedroom i J� ,� ,} s' ;7.'t� i'�' � q-'
( ) Kitchen-dining i 'y , �� o
O Porch - enclosed/roofed � � y i`1 0
( ) Deck - open � �' ���' '� �� N
( ) _ � �`� �o' �� � �
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( ) y,�i 36 i N �
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Type of construction �
(Xf Frame ( ) Block �! �� �� N
( ) Log ( ) Concrete �.. i ay � o C�
( ) Pole ( ) Steel � �
( ) Metal ( ) � i i �
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Construction cost $ �j U i i �
429 � _ s,�= �
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Sanitary Permit g7�/bS GL�4�2/C) ----CL road ------------------- o 0
/�GG�S oF (�OSS �O�
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zssued 03 May 1989 Denied ` �
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�r ey ar owner zoning Admin stra or
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SAWYIIt COUPITY CERTII'IED SUFtV':sY MAP NO
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I.P. SET BY
N p R. PETERSON
s � Depury
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SURVEYOR�S CERTIFICATE
I� LYLE ELLIOTT, registered land surveyor, hereby certi£y that by the direction of ILIA ANDREI�
I have surveyed and mapped the land parcel which is represented by this Certified Survey Map:
That the exterior boundary of the land parcel surveyed and mapped is described as follows:
A part of Government Lots 2 and 4 and part of the Southwest Quarter oS the Northeast QUarter,
Section 23, Toomship 40 North, Range 9 West, Town of Bass Lake, County of Sawyer� State of
Wisconsin and more particularly described as follows:
Commencing at the Southoaest Corner of said Government Lot 2; thence along the West Line of said
Government Lot 2 N 0° 33 ' 35" E 374•99 feet to an iron pipe; thence S 67° 00' 55" W 109.08
feetp thence N 0° 33� 35" � 632.58 feet; thence N 30° 26� 50�� 1�7 201.70 feet to an iron pipe
being the point of Beginning;
thence continuing N 30° 26� 50�� W 100.85 feet to an iron pipe;
thence N 67° O1� lj" E 671.55 feet to an iron pipe on the shore o£ Grindstone Lake;
thence along said shore on a meander line S 35° 55 ' 05�� � 102.60 feet to an iron pipe;
thence S 67° O1� 15" W 681.Li2 feet to the point of Beginning; said parcel contains 1. 55
acres, more or less� including all lands between said meander Line and the waters edge of
Grindstone Lake, and subject to any easement of record.
That I have £ully complied with the provisions of Chapter 236-31� o£ the Ylisconsin revised
Statutes in surveying and mapping same.
u�n��n.,,
��11SCONSj�,,�
N .�� EIS.IOTT, la surveyor
: i�1is onsin Registration 5-1300
�r�e � iDate: June 30, 1980
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TOWN o� BA�S
LAKE :, � NUT _
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SEC. 23 TWP 40 N . R . g w �SEa
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'1� �ILHR SANITARY PERMIT APPUCATION I �°�,"T� �:,
�- In accord with ILHR 83.05, Wis. Adm. Code � a
� � ��•��� STATE SANITARV PERMIT# :� I
CST 80- 337 86183 � o
A•tach complete plans (to the county copy only) for the system, on paper not less than srare p�qN i.o. NUMeeA � V'
&Y, x 11 inches in size.
See reverse side for instructions for completing this application. pEnnON
APPLICANT INFORMATION - PLEASE PHINT ALL INFORMATION. Foa vnRinNCe ❑ vES ❑ NO
---------- --- -------- --- —
�rOPERTY OWNER PROPERTY LOCATION
Mr . & Mrs_ James Clark SW '/e N� Y<,_S � _ T�Q, N, R _ � E�(or) W
iJPERTY OWNER'S MAILING A�DRESS LOT NUMBEF BLOCK NUMBER SUBDIVISiUN NAME
1508 East 84 th . Street L 2 & 4 -
'V, STATE ZIP CODE PHONE NUMBER CITY NEAREST ROAD, LAKE OR LANCMARK
❑ VILLAGE �.
TYPE OF BUILDING OR USE SERVED:
aumber ot Bedrooms if 1 or 2 Family_ 2 OR � Public (Specify):
I. PURPOSE OF APPLICATION: (Check onty one in #1. Check p 2, 3 or 4, ii applicable)
1. a. L^1 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 Existine� 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.
. TYPE OF SYSTEM: (Check only one in #1 and only one in q2�
1. a. � Comentional b. L Alternative c. ❑ Experimental
2 a. ❑ System- b. ❑ Holding c.❑ Pit Privy d. � Vault Privy e. L� Mound L ❑ IGP
In-Fill Tank
. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. �Y Seepage Bed b. ❑ Seepage Trench a L7 Seepage Pit
PEfiCOLATION RATE � 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM EIEVATION76. WATER SUPPLY�
(Minutes per inch)�. REOUIRED (Square Feet): PFOPOSED (Square FeeQ�.
7 410 420 Feet �Private ❑Joint ❑ Public
�. TANK CAPACITY Site
in allons Total # o� ManufacW rer's Name Prefab. Con- Steel Fiber- p�astic Exper.
INFORMATION New zistin Gallons Tanks Concrete glass . App.
Tanks Tanks structed ,
;r4icTankorHoldic •Tank S _ 8�� 1 RHSRIUSS2Il � S ❑ �
lPum Tank/Si honChamber ❑ i
ii. RESPONSIBIIITY STATEMENT
tlie undersigned, assume responsibility for installation of the private sewage system shown on the attached plans.
�mber's Name (Prini): Plumber's SignaWre: (No St s) MP/MPRSW No.: Business Phone Numbec
,ndry Rasmussen 715 798-3355
urnber's Address (Street, Ciry, State, Zip Code�: Name oi Designer: � �
. 0 . Box 66 Cable WI . 54821 Dennis Rasmussen
II. SCIL TEST INFORMATION
•rtified Soil Tester (CST) Name CST$
L . J . Quinn 47
''s ADDRESS (Strael, Ciry, State, Zip Code) Phone Number:
Stone Leke . WI . i ( )
COUNTY/DEPARTMENT USE ONLY
1 IQ DisaUP�ovoO SanitaryPermilFee Groun�watnr ��e Iss - yAgenlSiynaWrelNoStamps)
J Approved i [] Owner Given Initial Surcharge Fee
AOverseDe�erminahon �� . �� 25 . �C �- 1�— $�
COMMENTS/REASONS FOR DISAPPROVAL:
__------ -- - ---- -- --- --_ - — ---- __
u39B (�ormerly Plb�ll IR. �13i86) DISTRIBUTION- Original to Gounty, OneGopy To �weau ol Plumbing Owner. Plurnber
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[� FD_ I.P. SET Reqiyter
R. PET gY
u a ERsor,i
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v' Deputy
SURt/BYOR'S CEFtTIFICATE
I� LYLE ELLIOTT� registered land surveyor� hereby certify that by the direction o£ ILIA ATIDREI�
I have surveyed and mapped the land parcel which is represented by this Certified Survey Niap:
That the exterior boundary of the land parcel surveyed and mapped is described as follows:
A part of Government Lots 2 and k and part of the Southwest Quarter of the Northeast Ruarter,
Section 23, ToUmship i�0 North, Range 9 PJest, Town of Bass Lake, County of Sawyer, State o£
4lisconsin and more particularly described as follows:
Commencing at the Southwest Corner of said Government Lot 2; thence along the West Line of said
Government Lot 2 N 0° 33� 35" E 374•99 feet to an iron pipe; thence S 67� �' 55" W 109.08
feet; thence N 0° 3" 35" E 632•5� feetp thence N 3�� 26� 50�� l^7 201.70 feet to an iron pipe
being the point o£ Beginning;
thence continuing N 30° 26� 50�� W 100.85 feet to an iron pipe;
thence N 67° Ot� 15�� E 6']1.55 £eet to an iron pipe on the shore of Grindstone Lake;
thence along said shore on a meander line S 35� 55' 05�� � 102.60 feet to an iron pipe;
thence S 6'j° 01� 15�� W 681.1�2 feet to the point of Beginning; said parcel contains 1.5>
acres, more or less� including all lands between said meander line and the c•raters edge of
Grindstone Lake, and subject to any easement o£ record.
That I have £ully complied with the provisions of Chapter 236-31� of the {•lisconsin revised
Statutes in surveying and mapping same.
�```VS�SCOIvS��.,�,' .
ELLIOTT, la susveyor
i l?is onsin Registration 5-1300
�•�E�. :Date: June 30� 1980
� ��uort _
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���INI�111���,
. TOWN OF BASS L
AKE :, , NUT US�
SEC. 23 TWP 40 N . R . g �/. Q
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