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HomeMy WebLinkAbout026-179-01-0500-SAN-2022-313 � � SAWYER COUNTY ZONING & CONSERVATION ADMINISTRATION � 10610 Main Street, Suite 49 , Hayward, Wisconsin 54843 (� (715) 634-8288 W sanitarian(u sa���•ercount��o��.org COUNTY SANITARY PERMIT APPLICATION In accord with Chapter DSPS 383,Wis. Adm. Code and Sawyer County Private Sewage System Ordinance APPLICATION INFORMATION—TYPE OR PRINT Property Owner's I�ame Property Legal Description NANCY M GORSKI �L �i4 �i4, Sec.03 ,Twp.39 N,xange o9 _w Property Owner's Mailing Address Lot Number Block Number 1028 DAIRY LN 5 1 City,State Zip Code Phone Number Subdivision Name or CSM Number INVERNESS, IL 60067 � ) VICTORY HEIGHTS ORIG PLAT TYPE OF BUILDING: (Check one) ❑ State Owned ❑��ri� Nea�es�aoad Public 1 or 2 Famil Dwellin No. of bedrooms 4 ❑v;llage vicTORv HEicHrs ciR � � y g �Town of SAND LAKE Fire Numbe 15404 PUBLIC BUILDING/LAND USE: [Expldi�rhe use�purpose for ih;s Parcel Tax Number: (12 digit legacy number) permit,(i.e.,cainpground,festival,recreation/entertainment event etc.)] � � � _ � 7 9 _ � � _ � �J � � TYPE OF PERMIT: Additional Information: � POWTS Reconnection(SAN#$$ - �65 > ❑POWTS Connection (SAN#_- ) *Attach a Plot Plan with all required information per SPS 383.21 ❑ POWTS Revision(SAN#_- ) ❑POWTS Repair(SAN#_- ) *Soil Test Information (CST#88 - 086 ) ❑ Other: ____ * Gallons per day 600 RESPONSIBILITY STATEMENT: I,the undersigned,assume responsibility for the installation of the POWTS activity for which this permit is issued. Plumber's Name:(PrinQ Plu er's Sig ire MP/MPRSW No: [3usi�ess Phone Number: Travis Butterfield 652879 (715)634 -8176 Plumber's Address(Street,City State,Zip Code : 14346W St. Rd. 77, Hayward I 54843 OFFICE USE ONLY: �D,ZY �. ❑Disapproved Revie�i�Date: rmit Fee: Date Issued: Issuing Agyent Signature A roved ❑Owner Given Reason for �p/�/%t�-Q� � pp Denial �� �� � ��(�� � �' �3� ��-� '�'1 �� COMMENTS: *xExpires 2 years from date of issue** Expiration date: /C I 3 � I �-���� CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: �:'��-'��"' �`15--� ��.. � R � � �i �j � ��� �!�_/:�i7lA� �# +�r� r� � Y, . �; � 0�3I � ���(,. , �I` `.-�°,____� r:. ��� . i� ` �'�� ' 3..fclic__�..._ . _..._ .....__,. . , � OCT 2 0 2�22 ;�-:�.�f , . �.�� �S� �p�O�b) ,�►�e�,,, _W.a r�� � 39�I ,�,qvvY��t CC�� .,,. .-- " Rev.04/2 IS _t Gf�C�lilVi;�i���;�r,�"i�Jid NOREFJNDSAFTER � ���� ISSU�OF PERMtT 1�1 c�.�n C, � C o rS� �1�c7 � �l�t�� l02$ Oa.� l� lY�Ver YL.Q SS,�(, l��J(P`1 � I 5'-f 0'-} vi C,ko� �2���h-I-S �-i r L`� Naywr�rd wZ �{8�13 5�3;I 3�N; (L��i �rJ � 1�w r-� o�- So,�c\ 1�.��- r�, � ��e.r �e�d m��s ��s2��� ..������ ,�',��� /� �. � r � .;,�� �__._�--�..__... . �� c �.�` '-^---._"""""^`-^_,.._.d.�_, —__ ____.. 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'�{ t ;�j �'+� .� ��r¢��� ,�} �'� � �,� . g����"�.� � .�r .,✓'r� 1�zA.`�"k� .�., ^�-a � �,� `'"� ��"'u��5 �'�,�'��tr,';G�'h� � ; � , �.�y��� �, ti- '^�>� �/_r ' �� c` �! ,>,..G � 10/24/22, 9:17 AM Real Property Listing Page R2al EStdte Sawyer County Property Listing Property5tatus: Current Today's Date: 10/24/2022 Created On: 2/6/2007 7:55:45 AM �Description Upda[ed: 7/21/2022 � Ownership Updated: 7/21/2022 7ax ID: � � 26998 NANCY M GORSKI INVERNESS IL PIN: 57-026-2-39-09-03-5 15-127-010500 NICO E GENET INVERNESS IL Legacy PIN: 026179010500 LAURA] &NINA GORSKI CHICAGO IL Map ID: -16.1.5 Municipality: (026)TOWN OF SAND LAKE Billing Address: Mailing Address: STR: 503 T39N R09W NANCY M GORSKI NANCY M GORSKI Description: VICTORY HEIGHTS ORIG PLAT LOT 5 BLK 1028 DAIRY LN 1028 DAIRY LN 1 INVERNESSIL 60067-4230 INVERNESSIL 60067-4230 Retorded Acres: 0.413 Calculated Acres: 0.455 � Site Address * indicates Private Road Lottery Claims: 0 15404W VICTORY HEIGHTS CIR STONE LAKE 54876 First Dollar: Yes Waterbody: Lac Courte Oreilles 'J proper[y Assessment Updated: 9/28/2017 Zoning: (RRl) Residential/Recreational One ESN: 423 2022 Assessment Detail Code Acres Land Imp. G1-RESIDENTIAL 0.413 137,100 108,300 �� Tax Districts Updated: 2/6/2007 1 � � � ��� � �� Stateof Wisconsin Z-YearComparison 2021 2022 Change 57 SawyerCounty �and: 137,100 137,100 0.0% 026 Town of Sand Lake Improved: 108,300 106,300 0.0% 572478 Hayward Community School District Total: 245,400 245,400 0.0% 001700 Technical College . Recorded Documents Updated: 8/23/2022 '� p�operty History QUIT CLAIM DEED N�A Date Recorded: 7/8/2022 440067 COVENANTS Date Recorded: 8/16/2022 440827 SCRIVENERS AFFIDAVIT Date Recorded: 5/27/2008 353838 PERSONALREPRESENTA7IVE5 DEED Date Recorded: 12/13/2002 306372 https:Ntas.sawyercountygov.orglsystemlframes.asp?uname=Eric+Wellauer il1