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016-637-03-3303-LUP-1994-260
Application for Land Use I'ermit �� , -County of Sawyer �"' o � � The �nder.signed hereby makes application for. a Land Use Per.�rnLt and agrees that � all work shall be done in compliance wilh the requirements ot the Sawyer County ' o � Zoning Orciinance and the laws and regulations of the State oI Wisconsin. 'fi PRINT - USE BLACK INK OR PENCIL 5 t 7 � � �:� . P � , 11--�L r `�=� � �,,. 1 � ` ', � �.-�- v� � `Y'��}_�<_\4, � Y ; �t�'"�_` 1 f i i- �` Owner Bui der C .� � � � `�� r��.,� � Mai ing A ress Mailin� Address g, �X�-1' C�...�'1�1 �,c 1� , ��� I �', ..�-�— �;�,.�, ..��, �, 1��;{,_ . l� , �- City, State , Zip Cit , State , Zip Building Land Use Zone District ��, � ° � ��Aew ( ) Filling � �o ddition ( ) Dredging Lot size � '� ( ) Alteration ( ) Grading ( ) Moving On ( ) Acres ' ` ( ) ( ) 3 ; New Construction ,� Size � ft wide ' wide ' wide ! �� ft long ' long ' long � I � � � Floor area L'�� U � sq ft sq ft sq ft � � i Total hgt �7� � to peak ' hgt ' hgt x' ; i ' Stories l z No . of Bedrooms �---- � � rear lot line o������e o (year round) or (seasonal) ��' � � , Type of Bldg, Addition, Use I a o ( ) Dwelling 5��. �• rt ( ) Garage ( 1) (2) car - ��° 7 , �' ( ) Storage Building _,�`� /,�A�N �� Qr" , �,. ; ( ) Boathouse � �" 1 0 ( ) Livingroom ��____. � ( ) Bedroom `� � � �6/� '� c� �, i �� ��� ��_ ( ) Kitchen-Dining � �.'�'� : _,_._..._��_� ` - ( ) Porch (enclosed) (roofed) • � •, - �y ' � �:y � � I � ( ) Deck - open i i��U < I �s�'' '� �-_ � ; � �-� ���j � ` :_:�--.',. `V �,�►°r' ,�;f� N � Fw � ; �� { � ��� �__ � Type of Construction , , i { � "" � ( ) Frame ( ) Block ��`� .' �ti, ( ) Log ( ) Concrete ��.' ' � r�� �-��`�, Po 1 e O S t e e 1 ( ) ('Q Pole/Metal . cn m , a ,_ s ���� � Construction Cost $ ('� j,�i_), ; �_— Vol Z-� � Pg � (C = of Deed �` CS Vol �" Pg ro � , w Cer . Soil Test '� I` ( I ;_ � L, � . � �� ; Sanitary Permit - � C 1� _________^ �L road --�-��-Z7--- z ' 0 _ • z Denied ` � Issued 11 Au�ust 1994 __ . � � C�� 1, t�l —� l�t' � � Owner Zoning Administ ato � \ — ----- ----�..,K. N ,........._....�......._ �..�..�,..m., ......�:.. .._..--. ......_ _ _..�...� V - -- - -___ � , �l� �3 .� � �3•�, � � � �� � � � 1 I ���— � �// � � � � i � � 1 �i N �3'w o 3'v� � �� .� . ;s: i �. �9 � g ,; � � i y � c � �, � � -----__ ----------------- _-- - --- - _----------- ----- ----- �.. �� --� � � � � ;�• ��•t;,� ! rV � � �Ji � �� �/ � � —-- ---- — ------- �� — � � � � t+) i� � � , 3 3 � � ci' � �A 't,� � � 9�' � n � �3 � � � � -- � i;� �o� .� � � ` ' �•� Oi 'w1 c;� u,'i _ �,� _�; �� L B 6 7 State and County Statf; Pcrmit # _Z 2�40 ___ � � Permit Application County Permit # _9'018 for Private Domestic Sewage Systems County _ _ SaWyer "DENOTES STATE APPROVAL REQUIRED CST 9-037 Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPE�iTY Mailing Address: � � �o /� Route 1 Exeland, Wisconsin 54835 B. LOCATION: �i���XY4, Section ��, TZ N, R� E (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village __ Sw4 Of the Sw� Township _� --���c!�'—'__��r�_�— C. TYPE OF OCCUPANCY: Commercial "Industrial *Other (specify) *Variance Single family �' _ Duplex No. of Bedrooms '3 No. of Persons _ � D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder YES NO # of Bathrooms_— Automatic Washer YES NO Other (specify) E. SEPTIC TANK CAPACITY /C� n Total gallons No. of tanks __L_ "`Holding tank capacity Totzl gallons No. of tanks New Installation Addition_ Replacement_ k` Prefab Concrete _ _ , 'Poured in Place Steel }�' Other (specify). __ __ F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) <..• 2) l,;�3) �,�Total Absorb Area _��� sq. ft. New_ Addition Replacement�*Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth _ No. of Trenches . --- Seepage Bed: Length�o Width �S/' Depth d� Tile Depth �,S'�� No. of Lines Seepage Pit: Inside diameter Liquid Depth Tile Size y �� _ Percent slope of land�� Distance from critical slope_�p �7'L I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I Fiave sized the effluent disposal system from the EH-115 prepared by the Certified Soil Tester, NAME D a�i a� ��s ��n C.S.T. # �,�_ �j/ �� and other mformation obtained from '���P�-�- "�` - �.,y�, �y3 c�;.l (owner/builder). Plumber's Signature��.,,,.u,�n '�1p,�-�S G�•� p��MPRSW# -=� �'� �/ Phone #��t�— � �'� Plumber's Address �� r µ--�L� � ��-2-%� PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord �vith H62.20, including well). ��c>-c_^ a-��,.-� � ,� J \� V � � ,v W,,t �s � _��� � ; /��� � � �., �� �� � _ _ �, ..______ ___._ Do Not Write in Space Below - FOR DEPARTMENT USE ONLY Date of Application 5- 0 7- 7 9 Fees Paid: State 10 . 0 0 County 15 . 0 0 Date 0 7 Nla� 19 7 9 Permit Issued/@te�$��I (datel 5-07- 79 _Issuing Agent Name Elaine Nehrling Inspection Yes�No _ Valid# Date Rec'd_ 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4, plumber (canary copy) Revised Date 6/1/76 Department of Zonin� and Sanitation o Sawyer County � � � Inspection Report Owner Robert Thompson Address Route 1 Exelan�3 Wisconsin 54835 Name of business Builder N 0 � Address Plumber ponald Thom�son Address Route 2 Box 102 Winter, Wisconsin 54896 H O Inspection � � (X) Private ( ) Public Property X Sanitary-instal � � Dwelling Setback -- lake Violation Mobile Hm Setback - road � Gara,ge Setback-lot line Q, ( ) Sanitary ( ) Zoning Privy � � � � t-+ o , U O (�, �,i, � n �+ x -, c�� � � `�:; I ��� j,/C: I \ � / � ��` 1 �;�--�� !��I_. � � �n , , � � /r_�"�- L � �:� I � �,�. ?�� . r �� G� I ;�t). � �, ,�;, ,� �k � � 7,i � � , x x� I -�. � I � ,,� � :- •� ' � ,,'..�4; -� e I� I v � � C/l ^�-- �U v �'�' � -• � '��,��,�%� � , � � r�� v�^�� �`" ,/ / �� � / C - �- ¢ � �. � ��'' �- -� c c� ---_ , 1 I' ' ,' �• ----- �n _ - � o w ,L�R�I tt� W R f � -- _ � ___----�-�---____ --—_ __ y _ � � � r�, „ . � � W ' � ,� V I Discussed with owner X yes no � Discussed with builder yes no Q, Discussed with plumber yes no Discussed with yes no � Dat e y /v�rl�j' �-, �; „ Signature of Officer �j'�,��� ,,;;,,,,. l�% '� � DOCUMENT NO. � �' . QU�T CLAiM DEEO ' ` � STATE OF WISCONSIN-FQRM 13 ' �� .:. TNIS S�ACS RESP3V�POR RECORD;t{C DATA q ' M � I � I I1 N / R � � Regiater s Offico � � ii � THIS INDENTURE Made b �p s � Savryer Courity , �_ . ii � y O �14- � rn(Lae n ceivc�d tor record th/� _ �'Y �� �� '•. e n a du�,t , �t�tJ �D iaG��rt 9 i.3 V� jl ` ti �M aad reccrded�ir. vd._a � '... of corda on pn o_/.,�/.�_ I granton,._.of�� •. �- � ( ��- ��-' Coun y,Wisconsln,hereby quit�laims ���l� C p�f' , � � ' , . i1 l , to �C)b N_,,.x � 1� KY a).' 4ti-4� �e . :�( �— L�ster i � � . — ,��� ._ V` � ����iti--, .1 - ,C� ,� � � ' Deputy IL,�.�•y�tLUi� '� ' �°��-- /ETURN TO � of -~ ' County,Wiaconain,for the sum of ' ( �\ c��,' C4� � �� .� ,_l��s � � the tollowing tract of land in �- � � County,State of Wisconsin; ( � � , . J-t � c-c --`Z��-,.�C r '`����,u o� � '��'J�-�-��\�-�cY� f �ct- L�a\oC1;•i '���,c` ; . � `I� r. � � .... �j . � �1 . .__ (p . � `�� � - �L . . 3 --- �'1 -._....., : �� � � . c� � _c�,�,J _.... ,.... _� � �� �_ � , + � c� : ..._._ _. .. . ... � � � : ; � .. . tJ � `� -� . v� - . � �; E - � w .. . ... . . .... .o`' ' .—, 3 `1' — � �, . _ . . , � � �'� E . . . . q - � �`� � _ � . . . . `� � _ . _ �J �. __ .....-. � _. � � `l _. � � • " � � � - � � ----. 10 � �...�_ ` �. � , ', ��� � 1 \ ' : _ � � _ !U UJ —..-.. . 1 O ..�. �� . ...._ �, � — __.... . � � : \ � � N W � � ,: _ I O � 3 '1 1p ' , . . ;. . �, . , . - . . ; ' ,� 'I' , , � _ , , ' . ��� .� . � ; ; ' . � : ' � i, � . ,. ' ; , . ;, . --.. _ , . IN WIINES3 WHEREOF.the esId grantar____ ha S hereunto eet `��.a �dand aad eeal�thia %t �' ' , daY o! � �A. D.. 19 �2. � ,�; ' i SIGNED AND SEALED IN PRESENCE OF C (g�q�,� '. .. ; �� A -� � ^ Roh@r . Thamnsn " . ' J� -C � . __i.�..4l � �L.L~� ., . . _ ` r T� � � . (SEAL) G E,Phillips � (/.-C+—�r ,c� _ cZ�t,o._n—,�c./ . . ., , '(SI:AI,) � � Verna Pearsoan � , � , (SL�AT.) bTATE OF WISCON3IN� • � ��� G ey�rg:` CouatY. . , ' Peieonally came before me,thL 26� day of FAb. ' ,A. D.� 19 68 the above named Robert Thompson, an adult � to me{cnown to be the person_who e:ecuted the toregoing i��etrument aad acknowledged the eama . . ..�;w��'��,�1, ; ' �!�� � �� • `�� NOTAR�f �G.E.Phillips _ � `,' 'BEAL� ' ��. � Thi� ln�trument dtaf ted by G'� : ''' Nocary PubBe Sawyer County,Wis. Elaine Thompson •"��,�,�-��• r �'�� ! My Commiesioa(Expirea) (Is) ��25l�0 � � A I --__--_ `�—(�_�,L1\�``-_ ----_-- — ($ecdon 3�.S1 (1) ot the W4coa�ln 9t�tute� p�orldei'th��rU In�trumeut� to M r�rd�:ul�h�e�uln���:� q� �enrltten t6oreon tho n�ma ut the Qnnton, Qrauteee, r►ltneuw �od uotrry). n�n•r r� n�n� Illrl�ll-CTATIr. nR VI/IS!'(1NSIN r�rner.r �m �� �/ P CJ