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HomeMy WebLinkAbout026-179-03-0301-LUP-1998-386 IC� .^� ����1 ' / ' ,�✓ c/ � I . Application for Land Use Permit �`'� ,� County of Sawyer � � � PO Box 668 -Haywazd WI 54843 � 715/634-8288 The undersigned hereby makes application for a Land Use Permit and agrees that all work shall be done in compliance with the requirements of the Sawyer County Zoning Ordinance � and the laws and regulations of the State of Wisconsin. � PRINT—USE BLACK INK OR PENCIL � , � �Owner Builder �: � p �Mailing Addtess Mailing Address � City,State,Zip City,State,Zip Daytime Phone Daytime Phone Building Land Use � , • �,�New ( )Filling Zone District � �� , � ( )Addition ( )Dredging ( )Alteration ( )Grading Lot Size _ , ( )Moving On ( ) � ( ) (� ) Acres � _ ; � _j � c Primary Structure Accessory B n Addition ;� �Dwelling �Gazage attache detached O Deck � O Year round �#of car stalls ,QC}Porch r ( )Seasonal ( )Storage Building ( )Enclosed O Frame built on site O Screenhouse O Living room �� ( )Modulaz/manufactured ( )Greenhouse ( )Kitchen ( )Mobile/manufactured ( )Other ( )Bedroom � ( )Other primary structure ( ) ( )Relocate/enlazge ( ) ( ) ( )#of new � Type of Construction . (�j Frame ( )Log ( )Pole/metal ( )Block ( )Concrete : � ( )Other � ro � Construction Cost$ `�:>� ? � H Vol ��a_Pg /�S� of Deed Certified Soil Test# �8-�,3� � CSM Vol Pg Sanitary Permit# �1$ l8(� Plat Envelope Or: z Condo Vol Pg Yeaz Installed � Aff of ex septic V P Owner When Installed: � . ����o / Application for Land Use Permit-Page 2 Describe Construc6on:List dimensions of each siructure,story,addition,or alteration. #L �?nJ t���Jf #2. scv�+,�::,�-��`� #3. (�ann��;:., #4. Size �� ft.wide �fr.wide �`1 ft.wide�s� ft.wide Lpuo/ �� ft.long �` ft.long .35� ft.long ft.long Floor azea�sq.ft. sq.ft. �sq.ft. sq.ft. Hgt fivm giade to peak ft.hgt. ft.hgt. fr.hgt. Stories� stories _stories stories #of bedrooms� L,'t.:_- ' reaz lot line or waterline of °=- ---------- lake/river In the box sketch in: - � __ � ZO -- _ _ Location and size of all existing and proposed structures. Location of septic system. Indicate distance to: Waterline Road J � ' Lot lines " - '�-'' ` pW�ir,„S If Sep6c system � � � Po�rh r z 1j , Distance between structures. � � -- s�/ ` `,' �°��-�- ,N' � Psai��``�� � , Indicate North. � �Fire Number: �� � � � � :1 � ��,l� `..—�_--� _ `� � _ /�� _� ,�� � � Signature of Owner '� I � -------centerline of road------- IssueDate July 23, 1998 ExpireDate July 23, 1999 Office Comments: "���t���(./ ��!''r��2� _� �I�C�QR� � � � - � � � � � � � !i � � � � � m : � � O o � � � - � 0 _ c� _ � . � � w SCALE: I INCH=100 FEET DRAWN�BY: DATE�6-26�4 COLON (:) INDIGATES GOVT. LOT ,,..; � i I Document No.: (Recording Data: ' 2556� � � � Repister's Oflice }ss n SawYe� CounN .� / �Y of � ReBrve �or retord 9ibls--_y— o.G� WARRANTY DEED ( -C�A D 79/L--at � ( and recorded as vol. � ( ut pec ds on pa0e _...-.— ( Reqiuer � ( DEpuO' Retum to: Lein Law Off' s C���,�,�� PO Box // � Ha ard, WI 54846 PAUL B. ECKERLINE, an adult man, Grantor, conveys and warrants to THOMAS J. TURBENSON and SUZANNE M. TIiRBCNSON, husband and wife as joint tenants, Grantee, the following described real estate in Sawyer County, State of Wisconsin: Tax Parcel No.: �I"hat part of Lot Three (3) of Block Three (3), lying West of Volume 6 of Certified Survey Maps, page 170 in the Plat of Victory Heights, being part of Government Lot Three (3), Section Three (3), Township Thirty-nine (39) North, Range Nine (9) West. This is not homestead property. Exception to warranties: Subject to easements, restrictions and reservations of record. Dated this 3� day of April, 1996. 7�c1���./���c�2tQ (seal) rPAUL B. ECKERLINE 1�tpNSFER C�•v, (seaq / � �� � STATE OF MINNESOTA } } ss. -� • COUNTY ) Person�before me this ��� day of Aprii, 1996, the above named Paul B. Eckerline to me known to be the persons who executed the foregoing instrum��j, �paac owledge the same. ,. �� D��,j"a, n � w Notary Public � �auniy, M My Commissio� e � � 7 Sir— y :l' �"Yc. �+�r'f . . �M�O� �'y�' � � '"E'f��li5ti�� :P:.. THIS INSTRUMENT WAS DRAFTED BY: Lein Law Offices Post Office Box 761 Hayward, WI 54843 V�-5 g 2 ��' 3 95 �� ,, / � � � Safey aM BuAdnps D' � ' 5C0115%11 SANITARY PERMIT APPLICATION zo,e.w���a,n,re� F,, P.O.Bo:7969 .artment ot Commerce �n accord wi[h iLHR 83AS,Wis.Adm.Code �d�� � �707�� � t CST 98-131 ' t Attach complete plans(to the county copy only) for the system,on paper not less cou�cy than 8 i2 x 11 inches in size. Sa ei � See reverse side for instructionz for<ompleting this appli<ation scace sanica�y ve.mic N�mbe. 308119 information you provide may be used by other governmentagenq progmms ❑Greck ii revisbn m previous applica�ion. . acy Law,z. 75.04(1)(m)�. State Plan ID.Number aPPLI TI N INF RMATI N - PLEASE PRINT ALL INF RMATI N �ert OwnerName � Pro e ocation � i�a,S T ,N, R E(or �erty Owner'S iling Addr s Lot Number Block Number . _ � � � St te 2ipCode PhoneNumber SubdivisionNameorCSMNumber . ... . ( � _ TYPE F B ILDING: (che<k one) ❑ State Owned � !�� Nearest Road ❑ Vil age � Public 1 or 2 Famil Dweilin - No.of bedroo z _� rown oF � ' ParcelTazNumber(s) - - -� '� � � � BUILDINGUSE: (Iibuildingtypeispublic.checkallthatapply) 026-179-03-0301 . �! ❑ Apartment/Condo 4 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 0 Outdoor Recreational Facility � ❑ Campground 7 ❑ Merchandise:Sales/Repairs 11 ❑ Restaurant/Bar/Dining � ❑ Church/School 8 ❑ MobileHomePark 72 ❑ ServiceStation/CarWash ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: spedty i TYPE OF PERMIT: (Check only one box on line A. Check box on line B,if applicable) �) �. � New z. � Replacement 3. � Replacementof q. � Reconnectionof 5. � Repairofan ' ___SYstem _ __SYstem __ ______ TankOnly __________ ExistingSystem __ Existin�SYstem � t) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued ( 4 TYPE OF SYSTEM: (Check only one) f on-Pressurized Distribution Pressurized Distribution Experimental Other ' �Seepage Bed 21 ❑Mound 30❑Specify Type 41 ❑Holding Tank ' �Seepage Trench 22�In-Ground Prersure 42�Pit Privy 3 ❑Seepage Pit 43❑Vault Privy 1 ❑System-ImFill ABSORPTION SYSTEM INFORMATION: � �allons Per Day 2. Absorp.Area 3. Absorp.Area 4. Loading Rate 5. Perc. Rate 6. Sysiem Elev. 7. Final Grade � Required(sq. ft.) Proposed (sq.ft.) (Gals/day/sq. ft.) (Min./inch) � Elevation �� � feet Feet �, Capauty i. TANK In JdIlOf15 TOtdl #Of Prefab. Site Fiber- plastic Exper i INFORMATION Gallons Tanks Manufacturer's Name Concrete co" sceei qiass A�v � New ExisLn structed i Tanks 7anks uc Tank or Holding Tank $0� � � � � � � Nump Tank/Siphon Chamber � � � � � � II II. RESPONSIBILITY STATEMENT ' I, the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans. II mber's Name:(Prmt) Plum r'S Signature:(N mps) MPRv1PR5W No : Business Phone Number '. � _ 6_ � � �ber'sAddress Stre t,Ci ,State,ZipCode)� .b d COUNTY/ DEPA TMENT USE ONLY i p�d„a�,c�o��awaie� ate ssue isswng nt5ignat re No t m s) i, � DiSdpproved San$lyO .mOOee s�.<na�yeree� 7�22� �� �Approved �Owner Given Initial � Adverse Determination CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: IMPORTANT NOTICE: Wisconsin State Statute, Chapter 14 .245 (3) , states you are required to have your septic tank pumped/inspected at least once every 3 years. _— ois�aieunuN odqi�a�mco��rn^e��rv�� sa�.ryseu�mi�q.ol.�vnn.o.,oe,.owi..be, , � '.' . . S `I. ..��fh r�..`4�.✓+F�t 1' �'1�� .RY �`� - JZ I:s� t��� 1 . . -~/Y ^Ii V � � � 1 �A—o ,. Y ti.� u. , ~ � (1'�GO� � ���t4�° �. � . �y, � . ,+e ,�.+,q4,• �, ? '�Yk,"�4k � . . p �. ..w+ `� ..Y � � �`��h� �a >...`.a*� �� � {�'i'� > '�w .'�'�`'fY^ �:{� . °r:etv � ��� -}1��� ' � i v ` � (4.e ,,,sc,� ,�' P , �1.��;�:� '' ., �, F � __ �' - � . 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