HomeMy WebLinkAbout024-641-14-4107-LUP-1994-095 Applic��ion f-ur La:zd Use Permit
County of Sawyer ` � o
The undersigned hereby makes application for. a Land Use Permit and agrees that �
a]_1 work shall. be done in compliance witli the requirements of the Sawyer. County o
Zoning Ordinance and the laws and regulations of the State of Wisconsin. �
'_,t 1 a�� - I c�C��:� PRINT - USE BLACK INK OR P�NCIL � �
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Owner Builder r
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Mailing Address Mailing Address 1{1,
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City, State , Zip City, State , Zip
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Building Land Use Zone District �"k'- �
�1 New ( ) Filling � �
( ) Addition ( ) Dredging Lot size � K
( ) Alteration ( ) Grading I�
O Moving On O _ Acres � . `' i O
( ) _ ( ) �G
New Construction m
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Size � q t ft wide _' wide ' wide jm
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rj,�1 1 �_ f t lon.g ' long ' long N
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Floor area 2.�,2�,p sq ft sq ft sq ft � �
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Total hgt � b to pealc ' hgt ' hgt %�'
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Storic s _ � _ L
No . of Bedrooms _'--""i rear lot line or waterline o
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(year round) or (seasonal) G rt
Type of Bldg, Adclition, Use °i, o
( ) Dwelling �' `*
( ) Garage (1) (2) car �J• �
()() Storage Puilding r• ��
( ) Baathouse °
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( ) Livi_ngroom
( ) Bedroom �
( ) Y,itchen-Dining , �
( ) Porch (enclosed) (roofed) ���
( ) Deck - opPn s,�.,� - N
( ) - ���
( )
Type of Construction ��� ���
( ) Frame ( ) B1ock �
( ) Log ( ) Concrete , F�F,
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Cer. Soil Test '~ ' � �
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Sanitary Permit __________ C road ~
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Issued _ 12 Ma� 1994 _ Denied
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DEPP�TMENT OF � APPLICATION � SAFETY& BUILDi?JGS
INDUSTRY, FOR SANITARY ��visiotv �
LABOR AND PERMIT P.O. BOX 796� �
HUIVIAN RELATIONS (PLB 67) MADISON,WI 53707 �
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Attach plans for the system on paper not less than 8Yz x 11 inches in size. Inciude a plot plan that is dimensioned or drawn to scale. Horizontai
and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter
H-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
Plumber, the date, signature and license number must be shown. A legible reproduction of the soil test report or the owner's copy must be
included.
iielen J. � Robert W. McKee
P perty Owner: Mailing Address:
O
P � ocation: Ci ,Village or Towns ip: Count
� F'/4S iT NiR � W � � � v�
�ot Num er: Blk No.: Su division Name: Nearest Road, Lake or Landmark: State Plan I.D.Number:
(If assigned)
TYPE OF BUILDING
Number of
❑ Public' ❑ Variance* ❑ Other (specify)* Bedrooms:
�1 or 2 Family "State Approval Required.
' TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT (Specif )
SEPTIC TANK CAPACITY '
HOLDING TANK CAPACITY '
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER:
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feet): ❑ NeW ❑ Replacement ❑ Experimental �Seepage Bed ❑ Seepage Pit
Q s, ❑ Alternative (specify) ❑ Seepage Trench
�
Water Supply: Owner's Name as Listed on Soil Test Report (If other than present owner): �
'� Private ❑ Joint ❑ Public
I,the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber: Signature: ., MP/ No.: Phone Number•
�,�-v�iniY ,�' � `S .� f/-�z �� ��y�'6.�:
Plumber's Address: � � Name of Designer:
�
COUNTY/DEPARTMENT USE ONLY CST 8 3-10 3
Sig r of Issui g nt: Fee: Date: � APPROVED Sanitary Permit Number:
60 . 00 7-1- 8 3 ❑ DISAPPROVED 39 336
Reason for Dis roval
Alternate course(s)of Action Available:
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in-
stallation. Failure to comply will void the sanitary permit. '
DISTRIBUTION:White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
DI LH R-SBD-6398 (R.07/81)
D:PARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY& BUILDINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS � oivisiory
P.O. BOX 7969 BUREAU OF PLUMB�NG
MADISON,WI 53707
�CONVENTIONAL ❑ALTERNATIVE s�a��P�a�I.D.Number.
111 ass�igned)
❑Holding Tank ❑ In•Ground Pressure ❑Mound
NAME OF PERMIT H LDER� ADDRESS OF PERMIT HOLDEFi'. - INSPECTION DATE'.
� b w . ����. �_ � � �� �r� o �t� �a.�-� � - 1 - �'3
BENCH MARK(Pr.rmaneni reference poin�l DESCRIBE IF DIFFERENT FqOM PLAN REF.PT.ELEV.' CST HEF.PT.ELEV
N:i�n�•nl Plu���t�er MP/MPRSW N�� Cr�u��ty Sanitury Permit Number�.
L.�v �.a-�v � . ���v N',s � � � � S p �; .e,,-� �a 3 -- 0 9�
SEPTIC TANK/HOLDING TANK:
MANUFACTURER LIQUIU(:APACITY TANK INLET ELEV TANK OUTLET ELEV. WARNING LABEL LOCKING COVER
1 PHr-O�V.�IOED� � PROVIDED�.
�ONCf'�r( '� 7 � � 9�� 9� � � �-I,YES C_�NO ❑YES ❑NO
HEDDW(7 VLNT UI��. VL NI Ml111. 11IGH WnTFit NUMBER OF� HOAD: P�PCRTV WELL�. BUILUWG VENT TO FRESH
�/ r ,�� ALl�HM FEET FROM LINE ` `� IAIR INLET
❑YES ❑NO J ' �� ❑YES C�NO NEAREST �Z I
DOSING CHAMBER:
Ml�NUFACTUREH BEDIJING LIf]llll)(:/1Pl�CI�V PUMf'M()UFI PUMP'SINki()NMANUFACTUHE�i WANNINGLABEL LOCKINGCOVER
PROVIDED PROVIDE��
❑YES ❑NO C�YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMPANDCONTfi()�SOPERATIONA�. NUMBER OF �... �fi(1PEHTY 'NELL BUIL�IN(i IVENTTOFHESH
(DIFFERENCE BETWEEN FEET FROM ` ��NE �iR iN�Er
PUMP ON AND OFF) �JYES I_�NO NEAREST--�
--- — —
----------- ----- ---- -
SOIL ABSORPTION SYSTEM.Check the soil moisture at the depth of plowinq ��n��,��� ninti�i i i i� ��.�ni i�iin� nrvn rnni�Kirv��
or excavation. (If soil can�be rolled into a wire,construction shall c�tase until FORCE
the soil is dry enough ro continue.)
MAIN
CONVENTIONAL SYSTEM:
IVIDTf1 I.fN(�T/{ NOn� U1SIF� NIPf.SP�1(:IN(�, C(�VFii INSIIJEIJIl. =P11S ��OUID
BED/TRENCN � j rt+crvci�es / ! �i��.t i in�: P11. oEprii
DIMENSIONS I p2, � 5 CD b��d,�
(;17l�VFL!)f V'�fli {ILL I)Ef'lll IlItiI1� �'IV'f L115iH PIPE UISTR.PIPF MAiEfiIAL NC) Ul�ili NUMBER OF �'F�uPEf7TV WELL BUILDING VENTTO FFtESH
f3[L�)VJ�'ll'�' l��()VE C()VL�i E I f V INLE f ELEV END Nlf'tS �LINE. � YO AIR INLE7.
t� �( � � GS.• � p � F E E T F R O M
/ � __- l !S'� P. V,C, c�L� �� � NEAREST--►1 S _
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
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 ❑NO
SOILCOVER ttxiuree r�e�+MnNErvrmnF+KE�s oi;,[o-�vnnorvwe��s
__ CIYES ❑NO ___ ❑YES ❑NO
uFPT�I l)vfVi rriEN(:��eeu �i[.r'ul ovl H twLNc���iEt1 u[Pni oF �r)r'sui� s��uu�u 5Eeoeu Mu�G1F.D
CENTFH E[)C�ES
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTfON SYSTEM:
WIDTH �.ENC��111 NO.OF LA�EfiAL SPACINC� (;NAVLL I]tPTH BELOW PIPf FILL DEPTH ABOVE COVEH
BED/TRENCH rRErycNEs
DIMENSIONS
� ".A1NIF()L-) Pl1Mf' M(�NII()I I� UlSlli NIP[ Ml�NII l)t I)Ml�II 171!\L N(7 UISTH UISTR PIPE UISIIIIHlJ1ION PIVE.Ml1TEftIAL$MAFiKIN(;
FLF.V. ELEV Uir1 ELEV. �'��'ES DIA.:
ELEVATION AND
DISTRIBUTfON
(NFORMATION ��OLESIIE 41pLESPl1CIN(; L'�;ILLEI)(;�)HHECILV (;()VFHMl�7f:Hll�L VENiI(:l1LLI�TCORRESPONUSTOAPPR(�VED
PLMiS
❑YES ❑NO ❑YES ❑NO
COMMENTS: PLf�MANENTMAHKEI2S'. 06S�f7VATIONWELLS. NUMBEROF PROPERTY WELL�. BUILDING�.
FEET FROM ��"E
❑YES ❑NO ❑YES ❑NO NEAREST '—
Sketch System on Retain in county file for audit.
Reverse Side.
$I(��N/1T tE TITLF_
DILHR SBD 6710 (R.01/R^� �s/.�/(,�,Q,t� �� Q..Q,r,_
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pOCUMFNT IJO. STATE RAIt OF `VISCONSIN F\/1�111 1�1.�82i Tk115 bPACL RESEHVEU FOH HlC(�RDII7Ci UATA
WARF�ANTY D�En •
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-- -- ----- - -- Reqlrtei�C�ftice C � -
Z'illl3 Deed, �ti�ado betw..on Sewy�c County
, OBERT_W....McKEP:..and iIGI.I:N J.
�-•••'••• '• A«� vod Iqr }acord the
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.-----------McKEI:,.--h1s..W�.��„__ats_�oint__tenants--------------_---------_- '�A D 19 ot�� clocl
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- ----- ------ - ---- -----._- ------------ - -- ._--- - -----------_.. �--- -- -------- --- ivf nnd recorded In vol L ��
--------------•------------ -----------�------------------------•--------- --- - --- , Grantor�
and_______.ELI�AB�TH._�T,__.VOGEL,___an__adult_ w�man_bein�_a non- oi Reoo�de on Fa�e�
- -- -
------ -.resid�nt__of__Wisconsin-•--- -- -------- ----------- ----- -
- - - --...__ R eter
-- -- -- ----- ---------------- ----------------------._.-- --- ------�- -- - ----- -- -- � ,
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--- ---�--------- -----� ------------ -- ------- - ---- ---. , Gr�uitee,
•--- - ---- --- --- -- Ir
Witnesseth, That the said Grantor, for a valuable cousiderntion .__
_ _____..nf__one_.d9��ar__and__other_valuat�le considerati.on _:_ ___ -__._-__- --_-_--- --__.__-.-
Saw er_ __ _-- - kE,��t��, To
conveys to Grantee the following described refll estate in _ Y _ _... ____._ ,�1, �,���
Cot�nty, State of �'Visconsin: y�i""���(�,� �� �
�; y
Ts�x Parcel No: ----------------•--•--------- ----
That part of the South 20 rods of the North 42.2 rods of the North One-half (N�)
� of the Southeast Qtiarter (SE�) , Section Fourteen (]4) , Townshi.p I'orty-one (41)
North, Range Six (6) West, lying West of Moose I.ake and Last of the Town Koad,
excepting therefrom the following described parceL• Commencing at an iron pipe
at the intersection of the West shore of Moose Lake and the South l.ine of the
North 42.2 rods of the Northeast Quarter of ttie Sotitheast Qi�arter (NL'�SE�) ,
this being the point of beginning; thence Northwesterl_y along the water's edge
of Moose Lake, a distance of 71 feet to an iron pipe; thence N76°W, a distance
of 424 feet to an iron pipe on the East right-of-way of a present and existing
Town Road; thence South along the East right-of-way of said road a distance of
203 feet to an iron pipe; thence East along the South line of the North 42.2
rods of said NE�SE� , distance of 442 feet to an i.ron pipe on the West shore of
Moose Lake and the point of beginning.
TRANSF��
4 ..L`LSI, v.�
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This _._.____�S................ homestead property.
(is) (is not)
Together with all und singular the hereditaments und appurtenances thereunto bclongin�;;
And---��antOrS--------------------------------------- - ----- - -
-- • - -- --- - __ - - -- --- ----- -
warrants that the title is good, indefeasible in fee simple and free nnd clear of eucuinf�rances excel�t
all easements, exceptions and reservations of record.
and will wari•ant and defend the same.
� ,� ���� � �
Pated this ------------�----�l�'---------------- day of ------- - -- ' � `".�/� �� - ----_..__. ., 19��.
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--- ---- -- -� --- --------- -------------- - r --
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--- - -- -- --. .. ._---- -- --- ------• -- -- -- - _ - --
RQBER� W, Pc
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. _ .(SFAL) +- �.i-.1C YC��� �:: �._-� -�SEAI,)
* --- - --- - --� - ------------ - ---------- - ----- ----- * H�I�F.N _.T._r1cI�EE__ _-
AUTHENTICATION ACI�NOWLEDGMENT
Si�nature(s) ----------------------------•---------------------•-------- S1'ATL Or^ WISCONSIN
�:' n f / n SS.
'---------------------------------------------------'------------------------' -----S��CG-`./-�4���/1.._----COUlIti
-- - y'
authenticated this � ���
-------day of---------------------•---, 19------ 1'�i�o��al y c:�tr�� before me tl�is _�`�-------.day of
_ ,;
.a,-,'"`��1e19�11r.�----- --1�'�L�1 C-f�`>-�-----------� ]3i��.l. tl�e above narued
------ -----•---------•------ -------------••--•---------------- `� . ;�, ,,t--.�
.4�".- .
b�`\�' ..�e,iv:.:.oy .IS>.` "�-'/"/�__�"' _ __ _ �i.. . �___..___"'_ .____ _"""___
"--- ---- ------------ - - - --- ------- - ---- - �`� =` _ °`: �'�"t,; � �� } C j, � r ,1�'"' --f�lLfc�. -
TITLF: 11tP;hil3Elt STATl: T3AR OI� �VISCO�S�'�i •• ' !� : ... .� �- �t="�C�-�-�- -�`-��I�CC-----------------------
„ � <<(� 1 ,'�,E � „��
(If not, � � ,.v - -�-- ,,l +I r t' (-- - - __----- -- - --- I
--�-----"
- ----- ----------------- ------ -
--- - --
anthorized by § 70fiA6, 1Vis. Stelts.) :: ° �l �::-� -- ----•-- -- �
:�',� ° to �ae�lft i,� n t> }c, tii�•'}c� ni ..�?._ _. _ n ho executed tLe
, �7�� ���..��,o��;oili�;• instrwueut .in�l �•lcuuwlc�lgc thc s.in�c.
-- "
�'��: �.� / 1
THIS INSTRUMEDlT WAS DR4Fl�ED �Y �',+,.�J��f- ��o, �,�`1;%�C� � / �•
.,
•Ir�� �' �f �^!�:f(� , I - - - - - - - - --- -�-- � -----------
-� !
- -Thflmas._.td.--Du�fy---- ------ -- ------ - --------'�� ,- ) ,� _� , ; C�. t � ����__ _/
'�1tlflFill.�'�_G �_�"�_."__'__ _�!'_'_.__"" ' ___"." "_'_"'_"'_"___"_' '_ "
,< __
Ila ward,-.[1�--- 54843--------------- ---------------- --- I .
Y Nok.iry PuLl�c _ /,��LL_�;[ -�.�-------_.County, �'Vis.
(Si�;naturea may be �iithenticated or acicnowledgcd. Roth nT�'�' �'�>»'»������� � Pern�ajie k (iP n�t, state ex�iration
nre not necessary.) dat� - �' � ������--- > 19 ------•)
--•Natnes ol Peraons eigning in uny ewn���'i[y ahuul�l be lyucd m� printed Lelo�v thcir si�;unt�n�:. �OL�1 � �l P'� �191
LVARRANTY DEED S'1':►7'F: 1{AR O1� \VIti/;OT]�IN 11'i;�•„n in L�•c+�l lil+�uk Cu. Inc.
1'IHC\1 Nu. 1--19N: AIiI��.,�i�L�•��. W'is.