HomeMy WebLinkAbout032-540-35-1102-LUP-1994-021 Application for Land Usc Permit �;� �
County of Sawyer o{
The undersigned hereby makes application Lor a Land Use Permit and agrees that d�
all work shall Ue done in compliance wiCh the requirements of the Sawyer County o
Zoning Ordinance and the laws and regulations of the State of Wisconsi_n. r*� '
PRINT - USE BLACK INK OR PENCIL
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Owner Builder `�
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Mai�g Address Mailing Address
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City, Sta e, Zip City, State, Zip
Building Land Use Zone District �-( r �
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(�New ( ) Filling � �o
O Addition O Dredging Lot size LaI.Q(�' x �2�7 �', �
( ) Alteraeic�n ( ) Grading (
O Moving On O Acres ;Z O �
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New Construction p,.
Size � 2 ft wide ' wide ' wide �`x
�? b' ft long ' long ' long �
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Floor area ,�,j'� sq ft sq ft sq ft
tb f _,
Total hgt �L to peak ' hgt ' hgt x' � �
Stories %
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No. of Bedrooms --- �
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rear 1ot line o�e o
(year round) or (seasonal) ° ' ` / � rt
Type of Bldg, Addition, Use a o
(_ ) Dwelling � rt
( ) Garage (1) (2) car �' �
(,�' Storage Building o•
( ) Boathouse p
( ) Livingroom
( ) Bedroom I
( ) Kitchen-Dining y� {�•
( ) Porch (enclosed) (roofed) ? k
( ) Deck - open
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Type of Construction � ° , (�'
(✓f Frame ( ) Block "' ,J� `
( ) Log ( ) Concrete �" � �` �
( ) Pole ( ) Steel `�� _ �% -�
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( ) ( ) Po1e/Metal � �' � z r„T,,._; -� •� ' �
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Construction Cost $ r, u °� � _so � ' ,��i ?
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Cer. Soil Test 85-2/� � � ' �
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Sanitary Permit �{-!`If5 ____ �____ �Lliroad -----z�------- z
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Issued 15 March 1994
Denied � �
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SCALE : I INCH = 4 DD FEET FOR ASSESSMENT USE ONLY NO'
2 DRAWN BY : D. M . E DATE � � � - i b - � 9 7 S INTENDED TO SHOW GONCLUSIVI
COLON (:) INDICATES GOVT. LOT EVIDENCE OF OWNERSHIP OR
BOUNDARY LOCATIONS
�I D I L H R APPLICATION FOR SANITARY PERMIT
SAYUY�R c�urvTr '�
(PLB 67)
oECAn.menroF UNIFORM SANITARY PEHM:T �rF'
TWSTRV.LRBO 6MLlTRf1RELRT10115 �
CST 85-214 65275 -_
—Attach complete plans in accord with s. H 63.05, �Vis. Adm. Code for the system, on paper not less than 8%x 1 7 inches in size.
—See reverse side for instructions for completiny this application. PLEASE PRINT
PROPERTY OWNER MAILING ADDRESS
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PROPERTY LOCATION CITY:
V AGE:
1/4A'� 1/4, .�, T ys N, R ,�E (or owry o � � 1^�
LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER
d
TYPE OF BUILDING OR USE SERVED
i�l 1 or 2 Family Number of Bedrooms�. � '� Public (Specify�:
THIS PERMIT IS FOR A: � � �
❑ New System LSi..�� Tznk Replacement �J R�eRair �
� Replacement Soil Absorption System L Revision ❑ PFidy
❑ Aliernate SYstem LJ Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
� Seepaye Bed ❑ Seepage Trench � Seepa�e Pit ❑ Holdiny Tank
❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing, For Which A Previous Permit Is On File, Permit = issueci _
❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
� Total =of Prefab. Site Sreel Fiberglass Plustic
Gallons ;nks Conerete ConsVucred
Septic Tank Capaciry — )('
Lift Pump Tank�Siphon Chamber
Holding Tank capacity
Manufacturer. —
IF THIS IS AN ALTERNATNE SYSTEG4 C01�1PLETE THIS BLOCK: 'u Mound J ImGround Pressure
Total =of Prefab. Sire Steel Flberglass Plastic
Gallons Tanks Concrete Consvucted
Septic Tank Capaciry
Lift Pump/Siphon Chamber '
Manufacmrer.
PERCOLATION RATE ABSORPTION AREA �ABSORPTION AREA �VATER SUPPLY: �
(Minutes per Inchl: REQUIRED (Square Feet): PROPOSED ISquare Feet):
� �%D (?f y�s /� �' Private ��. Joint � Public
I, the undersigned, hereby�assume responsibility for installation of the private sewage system shown on the attached plans.
Name of Plumber (Print): � Si9nat re: MP/MPRSt�r,No.: Phone Numbec
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Plumbe/r's Address. . Name of De - ner �
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COUNTY/DEPARTMENT USE ONLY
Sign re of Issuing Agent: Fee: Date:
❑ Disapproved
y� 9 S . Q� 11— 4— g$ �� Approved � Owner Given Initial
Adverse Determination
Reason for Disap vaL .
Altemate coursels)o(Actlon Avallable: .
DILHRSBD-6398 (a. SB2� DISTRIBUTION: Origlnal io County, One Copy To; Bureau of Plumbing,Owner, 7lumber �
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DOCUMENT NO. I STATFi I3AR OF �VISCONSIN FOR�f a� � I9BEi!I T��IS SPACE RESERVED FOR REGCFDING D�'�
'I QUIT CLAIM DCED �
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qu�t-claims to .__... J_oa_n_..E_..__ Ew_a 1 d___an d_._6 ar r _.._D_..__Ew_a 1_d _ ..___. �, ��
_.____ h_usb_an_d__ ancJ__w_i_ fe_.�.__as___� o_in_t ._ t_ena. nt.s ________ ____________ ; ��
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the followin„ descr�bed real estatc in . S_dYJyE_C______________________ County, ;'
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State of Wisconsin : ; �ETURv ,o
�; ,tr. and �irs . Barry D . Ewald
i 11623 High�vay 70 ,Jest
South Half of the Northeast Quarter of the �� P�inocqua , WI 54548
Northeast Quarter ( S 1 / 2 NE 1 / 4 NE 1 / 4 ) ✓
of Se ct i on Th i rty - f i ve ( 35 ) , Townsh i p Forty Taa ��,�•�ei No : _.....__..__._.____.______._
( 40 ) North , Range Five ( 5 ) West , and the
�Jorth Half of the Southeast Quarter of the
Northeast Quarter ( N 1 / 2 SE 1 / 4 NE 1 / 4 )'�of
Section Thirty - five ( 35 ) , Township Forty ( 40 )
North , Range Five ( 5 ) West .
Subject to all easements , exceptions and reservations of record .
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This ..,._ 1 S IIOt homestead property.
(is) (is not)
Dated this ------3O-th---- ------------- --- ----- day of --------..a_d.Cill.dl",Y --- -�---- --��- ---- ---� -----------� is_86...
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" �='L-�� --- �_-- - �- `� � � ----.- �SEAL
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, . , -�Joan E . Ewald
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AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN 1
--------------------•-------------------•-----•-•----------- (
/ ss.
-------------------------------------------------------------------------------- 0 n e i d a �
--------------------------------------count�•. --------- -
authenticated this __._____day of___________________________ 19...__. Personallp came before me this 3 � t h d<<}• of
---- J_a n_u a ry----------------------- 19.s 6--- the above named
�--�---------------------------------------------------------------------------• J o a n E . Ewa 1 d
.
-------------------------------------------------------------------------�------
------------------------------------------------------------------------------ ---------------�--------------------------.._....------------------------�------
TITLE : biEniBER STATE BAR OF �'ISCONSIN
.._..--•--•---------------------•----------------••------•----•-----•----�---•--
(If not, _-------------•----------••---•----------•-•---•--•-•------
--•-••-•---•-----------------••--.._..--••-•-------•--•---•---•--...•---•••-----
nuthorized by § 70GAG, Wis. Stats.) to me known to be the person _____....... n•ho executed the
foreboing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY '� i i� � "� %/ � /
------..P.k_eY.__ Law---Of f i_ce s S . C . _..--------�---`-J=�-�-.��_t.��---�--- --�--=---L----;�.__�'..�.-------
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.-- * F 1 ar'E-ri'c�- �1 . � h m e
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M ' oc ua WI 54548 _ Nota. v �;br� __. . Gn � ida
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(Si�.*natures ina,y be �uthenticnted or acknowledged. Both nI�• C��i�ini��i�, �ib, �e�m«nent. �If not, state esPiration
:�re not necessary.) � :. � s �
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