HomeMy WebLinkAbout002-940-19-2101-LUP-1992-167 Application for Land Use Permit y'
County of Sawyer o
The undersigned hereby makes application for a Land Use Permit and �
'agrees that all work shall be done in compliance with the require- o X�
ments of the Sawyer County Zoning Ordinance and the laws and regu- M
lations of the State of Wisconsin.
PRINT - USE BLACK INK OR PENCIL
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Owner Builder �s
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Mailing Address Mailing Address
�Vlu.�RD GJCS .SY�`{3
Git , State, ip City, State, Zip
Building Land Use Zone District �-�-Z- o �
( ) New ( ) Filling rt
(x) Addition ( ) Dredging Lot size � r�t
( ) Alteration ( ) Grading
( ) Moving On ( ) Acres �-O
(X> C'.aa?o2r To ( )
G.�R.�c �
New Construction �
H
Size /� ft wide ft wide �
�
� ft long ft long
Floor area ��Z sq ft sq ft �
m �
Total htg �Z � to peak to peak x �
Stories � Stories �
No. of Bedrooms �
rear lot line or waterline u�
0
(year round) or (seasonal) 3 3 a G n
Type of Bldg or Addition I` � r'
( ) Dwelling , a �
e• rt
( ) Garage (1) (2) car 7 r•
( ) Storage Building �4 N
( ) Boathouse � o
( ) Livingroom SEPf�c y I �
( ) B2dTO0t11 G��L� 1 .W
( ) Kitchen-Dining �p
( ) Porch - enclosed/roofed � �1
( ) Deck - open o '�' �ap�� �
(tn CA R 1'��z r �o Ga2.s�� d�G l�f� 13 --� �1, �w
( ) �,Lu�SG 3o O
6\ " �
Type of Construction � � � �
( ) Frame ( ) Block �� � � �
( ) Log ( ) Concrete
(� Pole ( ) Steel � O � �
�( Meta1Q¢F( ) c .�, -0 n
n_---.--- Q--- � d
Construction Cost $ ��. �
"izT' p �
Vol ?�1a3 Pg �� of deed i'�(,pRat.�: ��b �3,
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CS Vol --�g— ,p -^ ro �
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Cer. Soil Test 7(0 -358 ,� �
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Sanitary Permit 7 7 - �25 ----------CL Road --------------- z �
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Issued �� —�Lt/� (g92_ Denied •
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"i��-� �v �� -DcF�uT �
�' �� � Zoning Administrator
SEC . 19 TWP 40 N. `
COLBROTH LAKE ROAD :
6. 2
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. 7. I .8 . I .3
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. 10. 1 .9 . 1 �
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P L� 6 7 , State and County State Permit # ,
� Permit Application County Permit #—��
� � for Private Domestic Sewage Systems County Sawyer �
��' csT 6-358
"'DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailiny Address:
��' �i C��� 1��1'�-1 - `:�'%N `�1'���... �.�,`1G,..�.� � Z� �`tT� 't.�:.�r�iZt� 't�..�l� �`�g��3
B. LOCATION: �_�/� ,�„(„1 Y,, Section , T e N, R
��, � � (or) W Lot# City_
Subdivision Name, nearest road, lake or landmark Blk# Village
Township `
C. TYPE OF OCCUPANCY: *Commercial *Industrial_ "Other (specify) *Variance
Single family _� Duplex No. of Bedrooms ,� No. of Persons :�
D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder YES NO # of Bathrooms—�
Automatic Washer `Zi'�_YES IVO Other (specify)
E. SEPTIC TANK CAPACITY '� Total gallons No. of tanks ___(_
"'Holding tank capacity Total gallons No. of tanks ___
New Installation �x Addition ___ Replacement___ _Prefab Concrete��
"Poured in Place _ ___ Steel__ __ Other �specify) _ __
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1)9.4 2)_j_�3) �.�Total Absorb Area E sq. tt.
New�_ Addition Replacement "Fill System
Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches _
Seepage Bed: Length �l�;` Width ��-� Depth � ' Tile Depth �� No. of Lines �_
Seepage Pit: Inside diameter Liquid Depth _ Tile Size _
Percent slope of land d Distance from critical slope _
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 tiave sized the effluent disposal system from the EH-115 prepared
by th C �ed �oil Test
NAME ' ��., - �. C.S.T. # ��— ��1�? ) and other information
obtained rom ' ' � � • ^ i (owner/builder�� Phone #(a,3�t �d T�
Plumber's Signature r .` i Mp/.� �_�- 7
P►umber's Address � � WI
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
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Do Not Write in Space Below - FOR DEPARTMENT USE ONLY
Date of Application 08-22-77 Fees Paid: State ZO e 00 County 1�_�_Date 22 At1gtlSt �7
Permit Issued�+� (date) �8-22-77 _Issuing Agent Name Rob�n Kenha,r� - Dep�y
SQ "�Cw►ber 1q'� Valid# Date Rec'd
Inspection Yes�'�—�a� P �
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) �....:�,.,, n..... ai�i�F •
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Department of Zoning and Sanitation
S�wyer County
Inspection Report
Owner ��,��, Ya- IeSou Address �a ,����1 �� I�Yu/�-r(��u�l •
Descr ipt ion �. i, _ �v�,,� �, �e _ I�i Tw P �/� N 1Z 9 G�
Name of business
Builder �Q(�f�ti�v Address
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' Plumber ��26�rrr Address �i��/,4,-�w/s�
Inspection
( � Private ( ) Public ( Property � Sanitary install
� Dwellino Privy
V iola t ion Mob ile Home Setba c k-la ke
Garage Setback-road
( ) Sanitary ( ) Zoning Setback-lot line
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Discussed with owner yes no
Discussed with builder yes no
Discussed with plumber yes no
Date
Sionature of Officer hu--
I DOCUMENY NO. STATE BAR OF WISCONSIN— FORM 2 I
NARRANTY DP�ED �
I THI9 9PACE RESERVED FOR RECORDING DATA �
� 15 2 6 4 � ��a o�� t
s�r ca�,r�
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I I� F3ecefved for record the �•�do oi �
By This Decd. .A�]Cu�.1..�...RaY...�'ickson___and_._G�mthia__Anne__.._ p
. . ���_ A D 19 7� at � o'clock
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.F'.�x:IC�S.QXI.t-.kl�.S...Yi1.,l_�.E'r...........••••••••••••---•..................................••-•.............................__..... _�M and recorded!n vol. .Z�3 �
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.......•••..........................•••....._..... o( R�curde on pago�f'�Q �
•------�--��--••---•--•-•..........................................•••.........................._..._..............._........................_....... �. '
� Grantor conveys and warrants to....Pr�txa.G�S...�....a���S.Q�..�_.Patsy..L.*_.__... i —�C�L�'"�-s"' ����'�-*^- I
� .Bat�son}..hi.s..w.i.�e.�....��...Joint_.tenants................................. . . .......... F�q;�cAr ;
...................................................................................................................................................... r- Dep��ir
, ......................................................................................................................................................
,
� ..............................................................................•--............./.............. , Grantee...s.., �
� for a valuablc consideration.......Of_ Orle.__ClOu3Y' �1.� and .other OOC� ��
.._...-•---�•---..1..............�_............ ....•••....�......
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� _.a�d..valuable....�o.n..s�.deration.-�.........................�-�--......---�--�--........:.................... RE URN TO
� . Patrick H. Bateson
the following described real estate in........S�w,Y.�r................................................ CoUnty,
I� Statc of Wisconsin: � Rt• 2� BOX 121
� ` -H 2�� -W1gCOri81.���1�__!
,�� The Northeast Quarter of the Northwest Quarter (NEti NW�) 1•aX Key #..............................................
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� and the South Half of the Northwest Quarter (S2 NW4)� all
�� located in Section NinOteen (19)� Township Forty (40) North�h;s is ....n4t...... homestead property.
�� Range Nine (9) West.
� TRR.NSFE�.
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Exception to watranties:
S�zbject to all easements� exceptions and reservations of Recortl. ,
Executed at..✓.........�_1r.,M.�,.��_ '�lE: CC:�^-�-:4.er�.... this...✓......� � �� .i ��4� -��:�- .... 75
,.•••••••••......_.... ..0.............. day of................... . ...... .., 19......._...
I -� .� �`, � .
61aNED AND SEALED IN PRESENCE OF =.-��;.�:-r!1;�!y.i ��(' __��.,-. '
..... ...�._.. �-`- ( ..ti.:�....�:�::-1r:.�-...(SEAL)
I � p��j,g��Erickson
, � —
-�•..........................................................................•••-••-•-••••••-..........._. 1 , }-
I ....�,.� ��"�5��`�C�....... ..l».:��`r.-.-----tj:.:�.j.i�..4w.1a.l�.....(SEAL)
� � thia Anne Erickson
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,I ••••••••-•...........••••••••••......................................................•--...---(SEAL).
, ..-••-•.....-�..................•--------•._........................---•-•-•••-••--•-•-..._._............
....---�--...--•----------------------------------•-•�-----•••----•--•........................(SEAL) I
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Signaturesof ••..................................................•••••••........................
authenticatedthis................................................ day of.-�--�--•...........--•--�----......---..........................., ]9----....... I
Title: n[ember State Bar of Wisconsin or Other Party I
- Authorized under Sec. 70C.06 viz. ................•-•....._._...........................
V.G.L�C.�-,ti.�._.�,•
STATT OP Wt3�ONSTN
� ss. �
......-r//��:�`.-.---�f�..<<.:f,:...�....................County. � c�: � _
� Personally came before mc, this......-�--......�cf.--..-........................ day of.........��:::'_":f...--� �-� -...,...... ----......................, 19........., I
� ' ' d thia Anne Erickson his/r�nfe 7 I
the abo��e named...Der�riis..Ra�r...Er�.ck�so.n....an......CYn.....----�-�............. .....................:.... .......- i
i ...........................................�---..........-�---.............. ...--.................................-- �� -........-�----......... ........_................_....._..............---�----................. �
Ito me known to he the person..3--. who e�ecuted the foregoing in$trument and acknowledged the same. � �
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� THIS INSTRUMENT WAS DRAFTED BY �.�• ���1�-••-�`��-• '� �-���-�•���-����
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i The use of witnesses is optional. • V �f' . � ��, �� �
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�i Names of persons si�;nin� in any� capacity should be typed ot printed below their signatures. , q � � � i
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