002-840-17-5114-LUP-1988-209 Application for Land Use Permit �
County of Sawyer y �
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The undersigned hereby makes application for a Land Use Permit and agrees
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that all work shall be done in accordance with the requirements of the Sawyer M �
County Zoning Ordinance and the laws and regulations of the State of Wisconsin. �
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Owner Builder
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mailing address mailing address } �
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E'C�� �'�R/a�2�E_M� '�5�4�c Mp�S t��a, SS 44Z
city, state, zip city, state, zip
Building Land Use Zone District Ci�.-'Z
(�Q IVew ( ) Filling t.
� Addition ( ) Dredging Lot size �O o X 3�v'L X\o O K �j'1,Co rt �
( ) Alteration ( ) Grading N n
( ) Moving on ( ) Acres �"78
( ) ( 1
New Construction �►,l�,p.V`, �I
Size Z Z ft wide ft wide
'Z 4 ft long ft long
Floor area S'Z,� sq ft sq ft
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Total hgt � (o to peak to peak K�
Stories \ �
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No. of bedrooms � � — rear lot line or waterline
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(� or (seasonal) � F _ ,. _�w.�c` i
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Type of bldg or addition i �� � I i �m�C
( ) Dwelling � �� i �, rt
aQ Garage +� (2) car � ' i a t^
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O Storage building 4� i 83� '� i C rt
( ) Boathouse `^'��� i . o,ao2ex � �'
( ) Livingroom � � I Ztti� -- � ~
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( ) Bedroom _� � _ i
( ) Kitchen-dining � � i i
( ) Porch - enclosed/roofed i 1�j(�ST G w.� �Z-� � i
( ) Deck - open N
O Z 4 i I ca�o 2� z4 i G M i � i
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Type of construction �20 � iQ a� t " � ,
(� Frame ( ) Block , � '� � � U � � '
O Log O Concrete rJ� I y� � �
( ) Pole ( ) Steel �� � � � '�
( ) Metal ( ) �\.-. ._ � U1
M � Z55 '
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Construction cost $�Dv� i � �� - �'� F-'� ' I �
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SCALE 1��=100� _ �iL � � �•o m y s '
M O N U M E N T S � SET 3/4°X 36�� IRON ROD � . � . '`' ��. J �
� FOUND 5/8�� X 36° IRON ROD p� \' " -' '�
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BEARINGS BASED ON SOLAR OBSERVATIONS. '9,� �,9° W,�_
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AUGUST 18, 1975 � '- �o, m`g
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�"0 W N 0 F 6A�� S LA �C E �_��_�_,
SEC I7 T1�VP 40 N R 8 W
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GRINDSroNE
CHRISTNER .
LAKE ;�,�
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�' L B 6 7 State and County State Permit # 5144
� .�. t Permit Application County Perm� # ,
— cou�c �awy e r
�, for Private Domestic Sewage Systems Y
�DENOTES STATE APPROVAL REQUIRED
CST 9 - 064
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailiny Address:
_���L C 9s1��„�rr�.►��.1N 11 �4F� yY1i�,� i 5� i Pj 1�2 • �.�Y�ww� n�+� �'�L.. �3e�
B. LOCATION: Y4 ;4 , Section � , T� N, R � � (or VJ Lot#Q,�IlCity
5ubdivision Name, nearest road, lake or landmark Blk# Village
1 . � Township �
fL�' �� Gc,� . I.D�' l � Z
.,. TYPE OF OCCUPANCY: `Commercial ` Industrial 'Other (specify) "Variance
Single family _ � � Duplex No. of Bedrooms � No. ot Persons�
�• SEPTIC TANK CAPACITY �JQ Total gallons No. of tanks _�_
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete Poured-in-Place Steel�_ Fiberglass Other (specify)
�Jew Installation �_ Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
- -- -- ------- -- - ---- --- ----- - -- ---- — - '-
'� EFFLUENT DISPOSAL SYSTEM: Percolation Rate Id Total Absorb Area � �ft.
L New�—Replacement Altemate (Specify)
Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Trenches
Seepage Bed:�_Length 2� � Width..�r Depth_��Tile depth (top)�r No. of Lines �
Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits
Percent slope of land � Distance from critical slope
JATER SUPPLY: Private �1 Joint ❑ Community ❑ Municipal ❑
�wners name as listed on EH 115 if other than present owner:
�, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
.Nisconsin Administrative Code, and that I liave sized the effluent disposal system from the EH-115 prepared
by the ified Soil T/es�te+r, ��
,VAME 1�e• �► V� 1"Li� �vi'2�i�1`tiZ_ � � ' C.S.T. # �� -- ��]Q �] and other information
obtained from (owneribuilder). }
?lumber 's Signature p� ��j�-2,. Phone #lo �—�T�p
�'lumber's F,ddress ' � - ��#r �
� PLAN VIEW: Provide sketch below of system (include direction of slope and ali distances in accord with H62.20. Well loca-
� tion shall be included on the sketch. Indicate or dimension location of all welis on the property or neighbors
iproperty. If well has not been drilled please indicate.
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Not Write in Space Below - FOR COUNTY AND STATE DEPARTMENT USE ONLY
�e of Application 7 - 31. - 79 Fees Paid: State 10 . 00 County 15 . 00 Date 31 Ju1X 19g9 _
rmit Issued/f���s� (date) ,_ 7 - 31 - 79 Issuing Agent Name 1 ai n . N .hr 1 i n �,
pection Yes No State Valid# Date Rec'd
county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
state (pink copy} 4. plumber (canary copyl
Revised Date 7/1/78
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Department of Zoning and Sanitation £
Sawyer County p
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Inepection Report
OwneT Jeri J. and Delbert E. 1Visc}imann �
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Address 11648 Mississippi Drive Champlin, MN 55316 �D
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Name of business r�
Builder �
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Address �
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Plumber Robert LaBarre °'
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AddTess Route 6 Box 222 Hayward, IVI 54843
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Inspection �
(X) Private ( ) public Property Sanitary-inatal ,°�
Dwelling Setback - lake
Violation Mobile Hm Setback - road
Garage Setback-lot line w
( ) Sanitary ( ) Zoning Privy y
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Discussed with owner yes no �
Discussed with builder yes no
Discusaed with plumber y( yes no °D
Discussed with yes no •
nate 3 l T,t 7 9
Signature of Officer _�;,Q�i�,;,,,,,'�,;f',,,,,,��
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I, Ronald L. Peterson, Wisconsin Registered Iand Surveyor, hereby certify
that in compliance with Chapter 236:34 of the Wisconsin Statutes and under
the direction of James Hunt, owner and agent, I have surveyed, divided and
mapped the land herein described, that said survey is correct to the hest
of my knowledge and ability and that said land is located in Govt. LoCs
`� 1 and 2, Section 1'7, T.40 N, R.8 w. and that part of this division en-
compasses Lot 4 of Certified Survey Maps Volume 2, pages 2']9-280, all of
which is described ae follows;
Commencing at the Southwest corner of said Govt. Lot 2, being an iron rod on
the top of the bank on the Northeasterly shore of Grindstone Iake, Thence
S. 39° 36'40" E, 45•89 feet to the meander corner, Thence N. 30° 18'10" W,
along the meander line 303•03 feet to the actual point of beginning, Thence
N. 35° 40'40" W, along the meander line 299.06 feet to the end of said meander
line, Thence N. 38° 40'S2" E, z69.98 feet to the Westerly right-of-way of
County Trunk Highway "E", Thence along the right-of-way line of County
Trunk Highway "E" as follows; S. 44° 26'15" E, 180.23 feeb, Thence
S. 54° 22'S8" E, 186.96 feet to the end of said right-of-way line, Thence
S. 51` 34'S0" W, 347.78 feet to the point of beginning, and including all the
land between the meander line and the waters edge of Grindstone Iake between
the parcel lines extneded. Subject to all existing easements and reservations
of record.
This instrument drafted by-
Ronald L. Peterson
August 18, 1975
� �� � �� ��
Approved this 1jLday of August, 1975 by �Lkt : ti i c�. �
� Sawyer County ning Administrator
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RONAI.DL ��`, Page 2 of 2 pages
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