002-840-18-5311-LUP-1989-094 D���5'�^^?,���_
1lpplication for Land Use Permit ��
, cou��tY of Sawyer �MAY 2 21g89
The undersigned hereby makes app:ication for a Land Use Permit and �- ��
aQN��courvrr �
that all work shall be done in accordance with the requirements �¢� t� °
Counly Zoning Ordinance and Chc laws aud regulaCions oP Che State oE Wiscoi�inR�TIOIV �
PRINT - USE ONLY BLF�CK INK/PENCIL � O
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k�iTNL��N Rr.l� �
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c�,o.r�Y a. P��Gi2Ac� o.,.�ti�c�
Owner Builder p
I 7 Co�S l�r. 8 4 No rf,T7-� ��
mailing address mailing address
E-AST Mo�.iNE � IL— (oIZ`{-�
city, state, zip city, state, zip .
IIui ding r..3tid J�� �(� !
} Zor,e G:isCricC
(�rJ New ( ) Filling t+ p
( ) 1lddition . ( ) Dredging Lot size LjOQ� K Zr7tJ' 1 X 4rj01 � ;
( ) Alteration ( ) Grading -� �
O Moving on O Acres � �2� � ry
(✓) L4t2L�C�E ( ) v �
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New Construction m
G�
Size Z�} fl: wide ft wide �
'3 O ft long ft long �
Floor area 7 2 O sq ft sq ft /�
1 p� V�
Total hgt ��i to peak � �. to peak x �
Stories � �
No. of bedr.00ms r r lot line or waterliiie I�
(year round) or (seasonal) � �
�
Type of bldg or addition � �
( ) Dwelling � � �' <
(� Gara e � � �
g (1) � car I �
i as
( ) Storage building i <fr
( ) 6oathouse � r'
i m
( ) Livingroom . � �'
( ) Bedroom �s i 7 w
i
( ) Kitchen-dining Q i � �
( ) Porch - enclosed/roofed i �
( ) Deck - open \ i (v
( ) \ � i �
( ) — p \ �x i
�
'Pype of construction �4 ar �2 � i I
(Vf Frame ( ) Block �m P�Po�� i � �
( ) Log ( ) Concrete � ���C�� i �
( ) Pole ( ; Steel EX�ST�NC7 �� 2Q, i � "'"
( ) Metal �xY� i
�yy - IOS — PCliK. � � ��� N
c7 L T � ` �
Construction cost $ /Ot�, ;�`� $�7 � �
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Cer. Soil '1'est Sw�6 �=1�3' i m �
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Sanitary Permit 82„—�12 �� o� ��} E o O
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Issued � q g Denied � �
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L �7r� ��;�-Ic� -f�r�Ury
dT egracke owner —T 7oning Administr or
� TOWN OF gASS
SEC, I � TWP. 40 N .
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C SM VOL 4 PG 246 —1, SEc" CSM 1/OL.3
PG /f�9 � /90
GRIf���IDS TONE
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EPARTMENT OF E'�`�j APPUCATION `�'A SAF�TY & BUILDINGS
�ousTRv, FOR SAN�TARY on�isiov �
ABOR AND PERMIT � P.U. BOX 7969 ��
UMAN RELATIONS (PL8 67) MAUISON,WI 53707 �
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ttach plans for the system on paper not less than 8'h x 11 inches in size. Inc!ude a plot plan that is dimensioned or Arawn to scale. Horizontal
�e' vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified i�chapter
�63, Wis. Adm. Code, must be shown. An index page or each page must be signed,sealed and dated by the designer. If designed by a Master
��umber,the date,signature and license number must be shown. The owners copY or a legible reproduction of the soil test repon. must be
cluded.
'!^perty Ow/ner. /�� Mailiny Address:
�.�'aRY ` �YA��� /�iE2iRRGKC �7G/S �T g ¢ III E /�olin�/E , I4L (r/Z�
. :perty Lbcution: - QierrViWgaor Township� County:
'/e Y,S /r� iT 40 NiR � (or �RSS LaK� ,s�4W 1/E�
.crt Numbec Blk No.: $ubdivision Name: '� � �Nearest Road, Lake or Landmark�. State Plan I.D.Number:�
4,4 /, Uf assigned)
`!PE OF BUILDING
Number of
'��� Public� ❑ Variance' ❑ Other (specify�' sea�oom�.:
_�. 1 or 2 Family 'State Approval Required. �
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEN REPLACE- OTHER
GALI_CNS OF TANKS CONCRETE PLACE INSTALLA7ION MENT 'Specifyl
�EPTIC TANK CAPACITY _L �_� �
�,OLDING TANK CAPACITV
.i�T PUMP TANK!SIPHON CHAMBER
�'"�NUFACTUR[R: � ASHU.SjE7� _
�-PLUENT DISPOSAL SVSTEM
'�'�CCLATION NATE ABSORPTION AREA
:^Ainutes per inchl: PRCPOSED (5quare feeti: � NeW ❑ Replacement � Experimental L� Seepage Bed L:' Seepage P�t
3 �/o ❑ Alternative (specifyl ❑ Seepage Tre�ich
Na[er Supply: Owner's Name as Lis[ed on Soil Tesr Report Uf other than present ownerl: �
� Private ❑ Joint ❑ Public
, ?he undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
aame o(Plumber. Signo MP/MPRSW No.: Phone Number:
�/DRY �PA�s'MUSSt�/ _ �3938 �7iS� 79�'-at�S
",.mbei'S Address: Name of Dasigner.
A GE l</�S. S�d.z/ _ n! �AS'MusSEn/
COUNTY/DEPARTMENT USE ONLY CST 82- 061
:;igna r f Issuing gen . Pee: Date: � qppqOVED Senitery Permit Number:
�O . 00 C7- IH- SZ ❑ DISAPPROVED 2�'�Z4
icason for DisapO ai:
Alrernats eourselsl of Action Aveilable:
nanqe of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to im
..,f!ation. Failure to comply will void the sanitary permit.
�ISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
:LHR-SBD6398 1 N.03/81)
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ANDRY RASMUSSEN & SONS, ii1C.
Pl�. • Htg - Concrete Septic Tanks
Cable, Wis. 54821
SbI1M'1 � 211768 • Ph, 715-798•3355
Maater Plumtie , 3938
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PARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
�BOR & HUMAN RELATIONS pRIVATE SEWAGE SYSTEMS DIVISION
:. BOX 7969 BUREAU OF P�UMBiNG
1DISON, WI 53707
� CONVENTIONAL C� ALTERNATIVE StalePlan � oN�mbe,
u� a::�q��i
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
>ME OF PERMIT MOLDEH ApDHE55OF PERMIT HOIDER� iNSPECTIUN �ATE
- ��_- R � 1 r �lo �tk � r � �21 SuK � 2
'�CH MARK (Permaneni .e�erence poin�l DESCRIBE IF DI�FERENT FNOM PLAN REF. VT. ELEV.: CST HEF PT. F'� k\�
! G� / O F F.000� ��`' IC� �. �' GI�NL—�_ ------ --- 0 ---
. . � P6n��Lnr MP'MPq$W Nu ('rnn�iv Snniia�y P��rm� Numl•�.�
_____I�._�S NL� s� S FN _ � A� '� ��_ � 4�
'T1C TANK/HOLDING TANK:
�,i:I�FACTUHER L I(IUID CAPACITY TANK INIET FLFV TANK OUTIF T k Lf V W�+�NING LABc'l LOCKING COVGR
PHOVIDEU PHOVIUED.
Rr�s MtV-SS E l�( ��� �-YES L�NO L�YES ❑NO
DUWG VEtiT DIA. YENf MA7L HIGH W4TE N NUMBER OF ROAD�. PHO�tHiV WE�I dUILU1NG VENT TO FRESH
� ALAHb1 � UNE1� � NQT AIF WLET�.
�YES CJNn � ❑YES ❑NU LNE/.1REST �__ _yI00 '7� � N � `
?s!NG CHAMBER:
�vufl�CTURf.R BEDUING ll<]Uli� l'.��'�i]�v PUMVMUDEL PUh�P�SIPHONM1IANUIl1CTUHER WARNINGLABEL LOCKINGCU'JFR
� PFUVIDED-. PFpVID'cD
❑YES ❑NO I nYES ❑ NO �IYES CJNO
�\LL.ONSPERCYCLE: �'uM� nrvocorirHo�soPEanriorvn� ���BER, Gj� f'Nf)P(�11v WELL BUILD�N(� VEfJTTOFR[SH
IFFERENCE E3ETWEEN FEET FROhS � �v� '�P iN�ET
1MP ON AND OFF) L�YES ❑NO NEAREST _
lLABSORPTIONSYSTEM. Checkthesoilinaistureatthedepthofplowing � " ' ��� i�i��Mrrei+ �.+nrFNin� nraoMn�+Kirv<,
excavation. (lf soil can be rolled into a wi�e, cvnstructio�� shall cease until FORCE
MAIN
� soil is �!ry enough to continue.) _
)f�' ��ENTIC�l�IAL SYSTEM:
�i"-UITRENCH �ti''ur"� �E�a,rH rvo or oisTa vive svacin��- covE�+ irv?�ue oin � avirs uouio
j r�aENCHFS � �UATEHIAI_'. p�� CEPiH
1IMENSION� � 5 �� S MtRAF/
— --
. �:'-1 DEVT�� � il '. UfP7H I�i`�IH IPf UISTN PIPF DISTR. PIVF MATERIAL NO DIST��� NUMBER OF P"�P�-HTv '.tiEll HUILDING� VFNTTOFRESH
� �-u�r . �ii.�vrq cnvi �+ t i : �� ivi t i t i F�� erun r��'E s FEET FROM � �aF/� Q� ' ��T � niF iN�er
-- �� � `L � � -- �� --��._ ��✓C. - ---- 3 -- fUEAREST — --_IV lk _ �� _ _�
iUND SYSTEM: _�
1-1ound site plowed perpendicular to slope �heck the texture of the fill material for PROVIDE A DIAGRAM OFSYSI EM
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 C�NO �
�. ---- -- ----- - -- -- --- —.... -- -- --
)IL COVER rExr��+e vtFrn;innr �tir M�wr�r�s ���i+sErsv.+n��v �:E i �s
❑vEs __ ❑rvo _ ❑vEs Or�o
�1 OVER TRENCII HF[) UFPTH OVFF TRENCI� BED UFPTN OF TOPSOIL �1UDED � SEEOFf� MULCHFD
;I i H f P r�E S
❑YES ❑NO C�YES C�NO ❑YES ❑NO
ESSURIZED U15TRIBUTIUN SYSTFM:
�AIUTH �I i 'v�,TH NO. OP IATERAL SPACING GRAVEI DFPT11 kfEl(�lV PIPF FI�� UtPTH 4BOVE COVFH
g��1lTRENCH � TRervct�es
: i�v1ENSI0iVS
�
� � ���'.A+�' MAMFOLD DISTR PIPE h1AMFOl li M14ATEHIAL N�] 111STH �IS7.� �'IPE ,�ISIN!BU;I�)N FIPE MA1FV'1111 & MAf-MING
' �.I'� .
- � � � ��� . �. FV UTA ELEV PIVk S UIF�
LC..VA"I'iCJN AND
:>TRIBtiTION _
.i�:JNh4ATION � t- sirE �u>�t svncirvc, e�,�i , f u r.o�+r+Ecru� coveN Mn1E���n� ve��,�cA� u�1 cr�HaEs��oNus 10 nF�vaovec
v�ar:s
UYES ❑NO ❑YES ❑PJp
1MMENTS: PERMANENT MARKEHS OBSFRVATION WELLS. NUMBER OF PROPEFTV WELL BUILDWG�
FEET FROM `�"E
L_�YES UNO ❑YES ❑NO ____ NEAREST ___ ___ ___L
etch System on Retain in county file for audit.
averse Side. — --- nrie -------
;i,Nnru .�,�
�HR SBD 6710 (R. G1/82) ,��ry / 'l�l/F�i/ti � /� �/'r
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F.pp'ica�ion for Land Uae Yermit o
County oP 38�+er �
The under.igned hereDy makea applicstion for e Iand Use Permit and �°e
agraes thet all work ehall be done in sccord3nce with the requiTe- �
m�nts of the 9a�ryer County Zoning Ordinance snd the lsws and reg-
ulatione of the State oS 911econstn. �,
PLEASE PRIIR' - tlgg BLACIC IHK OR PENCIL c9n '
�n
Kathleen and r
a _'
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Gary B . Yregracke owner ""
er — er �
17615 Route 84 North
n ress e ess
East htoline Illinois 61244 0
Building I.and Use Zone District RR- 1** �
ex Filling A
Add�tion Dredging Lot aize 500 ' x 255 ' x 450 ' �
Alteration l[ining
Moving on Qrading Acrea 1 . 29 ro
-�-T�-
rn
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Aex Construction (�!�'!'�� (seasonal) -conetructed
llwclling Deck
Size 26 ft Kide Z� ft vide
30 ft long 12 ft long �
FloOr a2'ea 117o sq Pt 312 eq tt �
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Total height 22 � to peak - - - - to peak ''' '
Stories 12 - - - - I
lfo. of bedroome 2 rear lot line or xaterline I �
� o
� �
e oP etruature ' �*
Dwelling � �
Garage 1} (2 csr � `�r
3torage building � ; W
Boathouee �
L3vingroom ZL�S ` �
Bedroom z5 �,
Utility room
�itchen-dlning ' �i2 �'csk a�r m
Porch - enclosed � � p, �
ek - open �os � �
o�' � m
e of construction _ � �
e Block 7� � .
Log Concrete
Pole Steel �
Metal �
Estimated coat $ 7 ,000 . 00 I �, IA
(� I
C� 82-061 �
Vol 340 P6 1�0 of deea � �d
C3 001 - - - - - PB- - - - - - -
Sanitary Permit : 82 -072 pbe
-------Cy road ---------- - c�i �
*" Rezone D. R. Thorp ����-T o� �� � F,
18 June 1982
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IBeued 21 June 1982 Deried '
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Dennis Rasmussen, Agent ��""�=1��,� ~
�