HomeMy WebLinkAbout024-741-03-2104-LUP-1994-468 Application for I.and Use Permit ; �
County of Sawyer
�Che' �mdersigned hereby make.s application fc�r a Land U�e Permit and agrees that �
all work shall be done in compl.i�nce wi_th the r.equir.ements of the Sawyer. County o
7.oning Ordinance and t.he laws and regul_ations of the State ot Wi.sconsin. �
PRINT - USE 13LACK INK OR PENCIL � �
CY\P.+rt�� �. °�' �lC���� �,
.�"lE►, �c�l�e�-
Owner_ " I3uilcler
Mailing A���g Mailing Address
�Ll �"���3
Ci y , State , ' Zip City, State , Zip
r ��
T3u lding Land Use Zone District — � �
r
� New ( ) Filling %, m
O Addition O Dredging Lot size �`��� � �j
( ) Alteration ( ) Grading
( ) Moving On ( ) Acres __���,�_�12,. �'�
( ) ( ) �
New Construction
Size �_ ft wide _ ' wide ' wide
�_ ft long _' long ' long
Floor area sq ft sq ft sq ft
- �
� f
Total hgt to peak ' hgt ' hgt x'
Stor_ ies
No . of Beclrooms �"`�' ,-�
— — �-e�x _I_r�t 1_it,A��--���--e-�-�Yl� , ��
' ear round or (seasonal) -�
� t
Tyne of 131dg , Acldition , Use � �
O I)we 11 i n g r-�� rr
�( Garage (1 ) (Z) car � N• �
Storage Iiuilding ; �'.
( ) Boathouse ; o
( ) Livingroom �
( ) Bedroom
( ) Kitcherl-Dining
( ) Porch (enclosed) (roofecl) �
( ) Decic - open �" ��� N
( ) r�r,
( ) I
�
Ty e of Construction
Frame ( ) Block � I �
� 1.og ( ) Concre te
Pole ( ) Steel ,��d �� r � `\~
( ) ( ) Pole/Metal /o��
�.c�,q � v�
,-* , �o
� ,�� N �
Cons truc t ion Cos L $ /J.)b0' �e . �
� P'' c 60` �
Vo7. �1, l Pg ZL I of Deed °'t�
CS Vo 1 ?� -_-
g � 'd F
Cer . Soil Test �s� /�/a' � �
_� �
Sanitary Permit 7p - 1038-1 C '-' -
----------��� �,�,�----------- o
� • �
Issued _ 24 October 1 4 llenied _ � �
, �
� s�
Owner 7oning Administrator ,�
J
APPLICATION FOR SAiJYER COUIVTY -
� S��VI1'ARY PF.Xt�r�T
� Apptication #��_ Date �—��0'7� "
a
Fee of $ZOe 00 received ���J�Z6 ,� �,�
mi � ` - Date Coun Ci,erk
� \�' ,
� �`� Applicatian is here�� made for a Sar�yer County Sanitary
��Permit for rvori� to de don� on the premis2s described herein.
/�;cK �yrprvc�. ���/ �y� �va�� .
Ou�ner Addr s� Te Zephone
T�e N1,�/ o f the ��� Sec� � Twn. ��� R. �
or
Lot _ BZoc�; Sub�division �-�L)N� L I�-�
,(/,��,[� �NS-�p GC l4-�i O�tI �U r.0 A 2 D ��9�6I��'�'�
�,�ork c�ntempZated To be perfor.med by
Alumber o f Eedrooms � Numl�er o f Bathrooms �
Dishr�asher Gart�age Grinder
� Autom,ati.c Washer �_
Soi Z Des crip tion 5��1� � �ir�/� � �
Septic Tank Size � gaZ. �
2 — Seepage Pit �_ HezSht �o� Diameter �o
Seepage Trenc"n _ Length _ l�idtYc Depth
Septic Tank Perm.it i�
Pereolation Test Form PLB 43 a�taehed �
Yes 1Vo
Contemp�ated com.ple�ion date /0 -l� - 70
AppZication�Approv�� Pe»mit #����
S a n i t a ri a n � c-- � ,, f-, �� �� •- - --;
� ' Or.� aer Agen ���ot2 2ea Date
Re r,ra rk s
Final Inspeetion
Sanitarian
O�raer/Agent Ploti fied (Date)
Remarks
*** Se�a� orig�naZ and thz�ee copies �ith . * ** ' -� .
fee o f $Z0. 00 to Countz� Clerk
� SSPTIC 3ANK PSRMI? N0.
R = PORT OI7 SOIL PtFtC OL ♦ TION ? eST
� � TiD S OIL BORINGS
TO
DIYISION OF HEALTH � PLl!lBZNG S�TFl�1
P.O.Box :i09, Mediaon, it1s. 5:i701
p�u�suarrti to H 62.20, iiia. Adoiinistrativ� Code
P E R C 0 L A T Z 0 M T P S ?
?eat D�pth Ck►araot�r of So11 Hours ifater Test ?irs� Dro in Water Level Inohes utos
NumDer Inohes Thiolmess in Inohas Sinea Hole in Hol• Interval S x ond to Next to I.a�t To Fsll
lst ilatted Overni in ninutes Iast Perlod I�►st Period Period Onk Inah
E�wnple
P - 0 36�� ?o Soil lON Cla 26�* 25 Yas or No 30 1 2 1 2 1 2 60
� , � ,ta�. ,; �.� ,.� " � � �
� �:� 1 ��:tt t .:.,e}ni�' j` '1�' �t`' �� J t.
E
.�.. �(, '� ,. --� ��i.f . ., F �
� �f /� � . .. . •-� ` _-.. , r� e� '
t,�,'��
RECORD DATA FROM MINIMU?S OF 3 'IT�ST HOLES
Computs siz• of absorption arsa in aocord with H 62.20 Wis. �deinistrative Code.
S 0 I L B 0 R I N G S - tiixiimum 36�� Hslo� Pro oaed Abao tion S staa
Boring Total Depth De th to Ground Nater De th to Bedrock
Niaober Inahes Observad Ystimated Obaerved Eatimated Chsractar of Soil with 'fhiokness in Inahs�
E�ple
B - 0 72'� 72" Blaak To SoSl 12" C 18" Sand 18��• G�`avel 24��
) ��; �' r ` ' � _ - . �
��-� � f 1 L:% � `e , %� J.;r! ' r,' �J,i.�: `!yt r• � �f.
J��
L i �I �i �.f�: i� .. .. _ ,.
�-C � �'� �� � �/� �r �/ /� . � :l , s:
�;_, e
RFJCOAD DATO FROM tiIN1MUM OF 3 BORE HOLES
PE OF QCCUPANCYt
RESZDSNCEi N�.mber oP Hedrooms � OTHERs (Speoify) Number of Persons �
D WAS'�E GRINDERt Yes No Distnrashert Yes .�^ Ho Automatia �lothe� Kashers Yes x. No
�..�
FFi1TENT DISPOSAL SYSTEM: NEW '`� EXTENSION ADDITION REPLA�a1ENT j
Tile Sizs No.Lin.Feet Trenoh width Depth Number of Lines I
Seepags Bed: Length Width Depth 7ile Size No, Lines �
- Seepags Pitt Insids Diameter Liquid Depth ' I
I
I� the undersi�ed, he nby oertl2y that the peroolation testa r�ported on this foz� wera made by me or under �}r super-
vision- in aaoord vrith �a-,pr.ocsdures and method speaiPied in Chapter H 62.20 (13), Kisoonsin Adtinistrativ Code, and
that�h�;data reoorded d locabion of test hotes are aorrect to the best of a�y knowtedge and belieP.
N� '��1}�. - � _�'- f•a��= :� . . ` TITI.E il`lit�.�.'tC� �. ��.:�r.- ��i..-. � .
, `
Typa or Print , `�� '
REGIST R�IO�I A� or MASTER PLUl�ER LICIIiSY N0�r Z��}
ADD ��'k. �� �" U�.��w� � t�,,.���,�. , � `� !`_�"yT n
DA�f_: t SIGNAN ` L`1�C?''�,.`"`'����. �-C..�.._;�� �,
� • Xiaaoasin D�partasnt of Health aad Soolal S�rrio�a
Plb. �67 3��p Divliloa o! Hcalth ,
� . SEPTIC TANK PERMIT APPLICATION
� ?YPT or U5E BI.�CK INK
A. E%l1tEA OP PROPTRTY
Nam� Addrtas (Str�et, City, Zip Cods)
�-� ,•--,
,;` .:'- Vv���,?.� _.-_: . � 1-' " f {---� { , _z ' ; . _ `_` `1 �'��
;
B. IACATIdl1 OF PAOPERTY WF�AT SYSTrM WILL BE CONSTRUCTED ALTERED OR EXTENDED COt3NTY 1 i�
cneax one: 5sc•'' 3
CITY VILLAGE LEGAL DESCRIP?I�I
�(_ TOWNSHIP-- , ---- , .
t �"
�,. ,, �.� �...;;i�t. >� _ •.� ! � �.� • �;� ; ,.
C. IS LOCAL PERI�IIT REaUIRED FOR THIS WORK? �_ YES NO `�" PERNIT NUMBER
`-' v/
D. SEPTIC TANK CAPACITY �'�`,S /1 Gallons NE4I INSTALLATION �_ REPLACFTIENT ADDITION
MATERIAISt Prefab Conarete Poured in Place Steel `[ Other
�r•.�
HUMBFA OF TANKS ?0 BE INSTALI�Ds �
E. TYPE OF OCCUPANCY
�heok One= One or Two Fami�y Residence _� Coamercial Iadustrial Other
Specify)
Humber of Persona to be Acco�odated �� Number of Bedrooms j
F. APPLIANCES� ETC: Food Wasts Grinder YES NO Automatic Clothes WasheT �_ YF.S NO
Dis2vresher YT�S NO Automatio Potato PQe1ar YE.S NO
Other (Speaify)
G. MASTLR PLUMBER MAKING INSTALLATF�1
Nams: �i"�.11t�1 _.�'j �—rt',Vir�� • i�. Address= ��i'� � tt ��+; � -_.+�; Lioense Number:
.
�... � - ._--� _ !iP �-1 �j����\'
�r '��� `�.
Sigi�aturo of Applioants ��-y-�-�-k..:.-�',.__; ._...�"�..c-�-�\���e`;,_.. MP RSW
_--,. , .N. , : � `""`�"'"x:.��
Addresat 1._ -t:: �- ;—' �d tri "� ..
�
H. (To be Completed by Iseuing Agent)
'`�-!�
Date of Appliaation - ' _ Fee Paid ; �t,.�°
, �
Permit Issued (date) ! Permit Number �
, - �
Agent (Name) 1`, . %. ' : � -- Fors i ,;. ` �
� • - � ` • Town, �tllag'Y' e,O,itq, o� etc.
"�: , �, _ , �. � �^: l,, �.. �Sp�aify)
J
Note: The ap�ioation a�ot be considered for filiru3 until all of the above questions a nsxered ard the
fee paid, Agents Rill foresard appiication, tne fee of ;1.OG for oach septia taruc an� d�yQ third ooPY
of the permit (oanary) to tne Dfviaion of Health, Cheoks and money orders ahould bs me.de p�yabls to
ths Division oP Heaith.
Do not xrite in apace beloK - FOR DEPARTMENT USE ONLY
I. DATE RECEIYID ACCEPTED BY RE?URNED
i (Initie.ls) (Date) See Corres.)
I FEE REGEIVFD VALID. No. PERliIT N0.
I es or Ho
REVIEw�D BY APPROYED DA?Y
(Initials) Yes or No
COMPLETE 0?HEA SID6
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TOWN OF
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3� TO �c R,17. .
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DOCUMENT rio. STATE BAR OF WISCONSIN FOR114 1-1982
THIS SPACE RESERVED FOR REGORDING OA7A II
WARR�,NTY DEED j
��. -- �y (� I
�e J l3 J � Necti�er''�01tfo� -
- ----.______.___.___.__.. •
--- 6rwyar Gwu,lp /�
' KENNETH JOSEPH LUSTIK and ` x�""d�o: reooa� t6e � QsY a
Ti11S Deed, made Uetween --------•-----•------•------------•-•-------------•------• �_ 2 A D 19��et o'doca
_.__MARTHA__ALLISON LUSTIK,__husband__and__wife_________________.______ �-- ,f/
� M euxi reoo►�d tn vd.�1�
_ -------------------- --------�--------------------- -------------------- -------
- -----------
ol Rdoordn oa pc�r,� ��
-- --------------------------------------------•-------------------------------------------.._, Grantor, • _ � % �
and----M�_C.I�A�I{--.J_�---R�.LEX__1z1d_.��1�RXI,-l�,---RII��X�__hii�band_an�------- �. ,7`"�`"-, `� L
_�ri.��..as._suxv.ivoxsllip__max;�ta]__prop�r�Y--------------- ----- -------------- �rw
-------------------------- ----•-----------------•--•---•----------------------••----------•------, Grantee, _
Witnesseth, That the said Grantor, for a valuable consideration....__
Q�__an�__s�Q��az._and__Qthez__�ra�u�bX�__cons�dera.t�4ns--------------- �/c-T -
RETURN TO
conveys to Grantee the following described real estate in __._-_S�wyer_____________
County, State of Wisconsin:
Tag Parcel No- -----------------------------•-----
✓
That part of the West t�alf (W�) of the East Half of the Northwest Quarter (E�NW�) ,
Section Tliree (3) , Township Forty-one (41) North, Range Seven (7) West, lying
South of S.T.H. "77".
Description obtained from Commitment No. 27055 prepared by Hayward Land Title Co.
TRAN�FER
� 1Sa ��
��EE
This _._._is___________________ homestead property.
(is) (is not)
Together with all and aingular the hereditamenta and appurtenances thereunto belong�ing;
And---grantor-------•--------------------------
--------•-------•----- - -- ---- ---- -- ----------- •------ -------- ----- ----•--...- ------
warrants thut the title is good, indefeasible in fee simple and free and clear of encumbrances except
all easements, exceptions, and reservations of record
and will warrant and defend tl�e same.
L� ) —/
Dated this -- ------------•--�-•---�..----•--•-------•--. day of -------... ���1.�1�l�Ll-�--- --------------•-----, 19----�--/
----------------------------�SEAL) i!`�'�vC�yG J�G,.f=�`------`-�'�`�------..(SEAI.)
------ ---- ------ ---------------- - -�
* ----------------------------------- • _KeA�?etli- JO.�e�h_L�i_S.C�k --•------------------
----------------�---------�----
--------------------------------
----•----------•--------•--------�SEAL) --W�C�J�9.__�Q.�4�FY�•--�I�A:Z1Q-r--- ------�SEAL)
. . Martha Al.lison Lustik
---------- ------------------------------------------------------- - - -- --�----- --- ---------..... -�- -�-�--- --------------
AUTHENTICATION ACKNOWLEDC�MENT
Signature(s) ----•------------------------------------------------------- STATE OF WISCONSIN
ss.
-------------------------------------------------------------------------------- ��L�C yU�- County.
-------------- --------------
----- •
authenticated tliis .___.___day of___________________________ 19.___._ Personally came before me tliis ._____ .._..___day of
•-----•---•-•-----------•-------------------•-----------------------------------
--------------------------------•---------� 19----•--- the above named
_Kenneth__Joseph_.&__Martha__A1.lison_Lusti___.
s
------------------------------------------•-----------------•----------•------ --------------------------------------------•----•------------------------------
TITLE: MEMBER STATE BAR OF WISCONSIN
---•----------•-------------------•-------------------------------------•-------
.s•.•i:,,:�..qm..
(If not- ------------------------------•-•-------••------•----------- ------------•-------•--------•--p-- -.==------- ----
authot•ized by § 706.06, Wis. Stats.) � �'''"����m""��
to me known to be the erson��`..____.._ w�9�- cuted th�:
foregoing instrument an "acKi�ryled s�y�,i
THIS INSTRUMENT WAS DRAFTED BY � � •'••� �:aJ�
_� �
---'•--•-'------ --- ' -•-�'•� -•-----
_____Duf_fy.Law_Off ice = � � ; ii
------ '
----•-------------------------------------------------
� - .
Ha ward WI 54843 - -- �-�---------�-� ;r�:---{-�--- -----�-�---------
-------- ---
----------�'---------�------------------------•-----------------------------•--- Nota Puhlic ------ - � -�' � �� � .
----- - - -;-;}-'�--------- - • ---C,rb��ty, Wis
(Signatures may be authenticated or acicnowledged. Both n7)' �ntmission is permkne t:(�f �ot, �ate��xpi tioy
J- ''•....�.�•' • �
are not necessary.) � date: _ �� � � F,_, is.15_.�
-------------� ------------- -------- --- --
-------------- — --- �
— --------- _--=-------- --—
------ ---- — _ _
-- — — — -- ------- — ----
------
�--
•Namee ot perauns signing in any capacity shoul Le y�l o�rlt3ted bclo heir uignul c+s.
.,i.,.,nn.�•ry ,.,.r..� S7'ATIi ❑AR O1� WISCONSIN ��'i��.�����.� T.ro,J Hlr�.ik l:,� I.��