HomeMy WebLinkAbout002-940-23-5204-LUP-1992-185 � Application for Land Use Pe�mit `�`�
County of Sawyer o
_ The undersigned hereby makes application for a Land Use Permit and � �`�
agrees that all work shall be done in complia'nce with the require- o t
ments of the Sawyer County Zoning Ordinance and the laws and regu- �''
lations of the State of Wisconsin. �
PRINT - USE BLACR INK OR PENCIL
s�+��� m. � �i
Dor.��� k. �/o�T�� /
.s� o%o�/G'�sl �/�//� �h/!/S �v/C
Owner Builder
�2�-!� � �X�a3 A ,C�F�� �-�o��a.��i.
Mailing Address Mailing Address
�'���d�¢��/. s��3 S��76
City; State, ip City, State, Zip
Building Land Use Zone District ^ (�t - ? o �
( ) New ( ) Filling �
( ) Addition ( ) Dredging Lot size /Qa_CQ �G��� �n n
( ) Alteration ( ) Grading `� ,
( ) Moving On ( ) Acres I•S6' �
� ) ( ) O
New Construction
Size /8� 30� ft wide ft wide
?�5� ft long ft long S�
Floor area sq ft sq ft z
� � � �
Total htg �- 7 to peak ��T to peak x
Fkorv; �fl��.u- ��� �
Stories - Stories
No. of Bedrooms �"" ���h�5�<rP ��
rear ot ine or water ine o
i
(year round) or (seasonal) -c O •�� "1 cn �
Type of Bldg or Addition �' � Q��'`� � �(v x � r'
( ) Dwelling � ��;�, �� r� a o
�/`� C rt
1
( ) Garage (1) (2) car 35' �J �i� �, r•
( ) Storage Building ((� N q,
( ) Boathouse � \ (� J o `v
( ) Livingroom �' . � � a'v�,
( ) Bedroom , �� ��' T � , �
( ) Kitchen-Dining f�,
( ) Porch - enclosed/roofed �\ �
( ) Deck o en . �
(�.�-P����. �,t�lj��ia-/3�vi.q. �8� �� � �' r�
c > ' `� �
Type of Construction \1 � ��''I� \
( ) Frame ( ) Block ��
� � ��
( ) Log ( ) Concrete � �j� ��y /.Z$a
( ) Pole ( ) Ste 1 � l�I --_ _ !� �� �
( ) Metal (� �7pG�
�y� 00 __
Construction Cost $� �---"-`� �
Vo1 �g5 P� 3� �f deed � ` �
�
CS vol �_ Pg �I� `'"� g� �a �
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Cer. Soil Test� -337 ��� � �
�CS�>C��L �
C Road ----- ~
Sanitary Permit �j7- �05 --"----'- L -------�-- �
c/JO ,����T��-�D�C� ° z
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Issued 09��c,/ /q9Z- Denied N
3� �,�,�;3--T � �
r �� lo =x'�l�'� �7 ��Nur � lc`.�
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Occner Zoning Administ ator
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SA6lYEI2 COUP�TY C�RTIFIED SURVEY MAP NO
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4 � FP. I.P. SET gV � _—
R. PETERSor.� �__.____._.— Deputy
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SURVEYOR�S C�RTIFICAT�
I, LYLE ELLIOTT� registered land surveyor, hereby certify that by the direction of ILIA ANDREI�
I have surveyed and mapped the land parcel which is represented by thi, Certified Survey Map:
That the exterior boundary of the land parcel surveyed and mapped is described as follows:
A part of Government Lots 2 and k and part of the Southwest Quarter of the Northeast Quarter,
Section 23, Tozmship 40 North, Range 9 47est, Town of Bass Lake, County of Sawyer, State of
ldisconsin and more particularly described as £ollows:
Commencing at the Southvrest Corner of said Government Lot 2; thence along the l•lest Line of said
Government Lot 2 DT 0° 33' 35" � 37A•99 feet to an iron pipe; thence S 67° 00� 55" W 109.08
feet; thence Pd 0° 33� 35" E 632.56 feet; thence N 30° 26� 50�� 4! 201.70 feet to an iron pipe
being the point of Beginning;
thence continuing N 30° 26� 50�� W 100.85 feet to an iron pipe;
thence N 67° O1� 15" E bq1.55 feet to an iron pipe on the shore of Grindstone Lake;
thence along said shore on a meander line S 35� 55' 05�' E 102.60 feet to an iron pipe;
thence S 67° O1� 15" jd 681.L�2 feet to the point of Beginningq said parcel contains L 55
acres, more or less� including all lands between said meander line and the waters edge of
Grindstone Lalce, and subject to any easement of record.
That I have fully complied with the provisions of Chapter 236-31, of the Wisconsin revised
Statutes in surveying and mapping same. o
��nuun u
1�q+��sCOlVS jN�� �LLIOTT, la surveyor
� �': Vtis onsin Registration 5-1300
�r���. "sDate: June 30, 1980
ELIIOTT
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SCAI.,�: I INCH=4nn FEET FOR ASSESSMENT USF pNi v N�T
DOCUMENT Nop. WpRRANTY DEED T��s srnce eeseavco von necowoir�e cere
�+�`+ Z9 �S p � STATE BAR OF WISCONSIN FORM 2-1882 �
�xplw'�OINa� l
�� . ..,�.�;� . . . _. . . _.'_ '.. _"' ' _ _'�"_.� „��.� C.nud� f � /f(
Poc�n.ad lo� record t6s ( u �1
JAMES M GI.ARK and..sHtgl.�Y. ,7. _GI.ARK,..Hu4ban�..and _Wife,._. __ n D�s93 e��a a
� �
_ _ -- �a ���a.,�m .d.�_
__ . _
_.._
._. ..__._._.._._..._ .__ d Aer.vrdn ou pnpa u �
__.__. _....._" .... ._. •
�o„�eys A,,,{ we,.,_�„�y to DONALD _K,__VOIT and_ SHIRLEY M VOIT,____
Husband_and Wif� a� .Sl1R1lI1!QRSHIP..MARITAI...PRQF�RTIf,........._. .--- . ,
-- - ... - - - -_.... — - --- _ __..... --- -- _ - ��
_._ _ __ ._......._... -- -... ....... _.. .._ - - ._._....... -_ -- ... - - --
- _ -...__ _.....--.... - - -.__.. -_... -- — - -._... -- - . _.... -
............................ .. ... ____. . . . . .......... . ....._........... PETIIRN TO
- - - -- �� ��
-- _ -_ P
the following described reul estate ,� ._. Sawy.e.r ._ . ... - eo��cy, _
State of Wisconsin:
Tux Parcel No: 2�..4Q..9;.z,.4_....._. �
That part of Government Lot Two (2) and the Southwest Quarter of the Northeast
Quarter (SW}NE}) , ' Section Twenty-three (23) , Township Forty (40) North, Range Nine
(9) West, described as Lot Nine (9) , recorded in Volume Seven (7) of Certified Survey
Maps , page 412, as Survey No. 1543.
ALSO CONVEYING and subject to a perpetual non-exclusive easement for ingress and
egress over a roadway from the Town Road to the property described in Volume Six (6) '
� of Certified Survey Maps, pages 227-228.
Subject to the 66 foot road easement as shown on Certified Survey Map described
herein.
This description taken from Hayward Land Title Company Title Insurance Commitment No.
27400. '
TRANSFEFj '�
$ -�-�--- ,
FEE ;
This --------i s--_-_�:_-.. homestead property. �
(is) (is not)
I
Ex�e�,c�o� c� �v:,r�ancse5: easements, exceptions, restrictions and reservations of
record. i
� �
Daled this __-v.---f.���..��...._..._. day of __._.___...._._.Md,Y . __..._.._.. __._....--_---., 19-92_._. I
-- - -�PT��---�,__C/V�=-���.. �/-..-�_._(5EAL) ._✓Y� - ��`""�"2__._.._(SEAL) I.
. . ._ . .. .. .
��_. . .
J.ames.M, . Cldrk._.--._ - ----- _-- • Shir.le.Y J Clark .. __._... . II
_............ . .._._._..----��------
_ .----�---__....(SEAL) ._.._ .......__._......_..._...__.__-- �---......_---(SEAI.) �II
• __ W .._.._ ._ _.._..__ _._ ._......_ ._....... �
._.__._.__...._._ ..._..__ ...._"'...._._ .._ .. _._. .
�
AUTHENTICATION ACKNOW LED(}MENT
SUgnature(a)-'---.------------------""--'---"----'-"----'� .__.' STATE OF WISCONSIN County. � ss./S`�. �'�
a ent�cated th�s ____....day oY..__.._.._._...__.___, 19 .. Personally came before me th�s _______..__day of i
_..._.f`.'��........_..........._......, 19_9P.._ the abova nameJ
- -- - - - - - - - ---- -- - -- -- - -- --- - ---�- �emQs..M...C.lark...and_.S.hir.leJ'.-J-•-.Clark� i
.
- - - -- - - - - � ---- -� - � - - - � - - - - - - - - - - -- - - --- -- - '
T[TT.E: MEMBER STATE BAR OF WISCONSIN n�nh ����
------------------------ -------'----------�--------
eo`� AC� D `:
(If not� --------------'----"----_..------'--'--------' ----------------- -��-------- - --------------------- '
authorized by § 706.06, Wis. Stuts.) to me known t e t erson - - . who executed the i
foregoing inst � e ��� d�g same. i
Ward Wm. Wi6toHa wardrWIy54843aW ' Ck� -'� `- _. 1�� �-�---�-�---:_- �
--------- --- ------- -----y -`---- - --'--._. -'--------------- Notar Publ�c -- � - - =-------Count W�s. I
THISINSTRUMENT WAS DRAFTED 6Y
Sio atBrOes ma be authenticated or acknowled•ed. Both duteCommission � � /l� _ not, state' 19N�at�o) I
Y 6 �!
are not necessary.) 7
'—_ —� �L.f�4J 51; r'nE��,Ti.dbl�� �i
I •Namea of Deroons aignin¢ in any cepac y d t I�� V�'i lu he ni turcn.
°� DILHR SANITARY PERMIT APPLICATION �o�NTY
� s In accord with ILHR 83.05,Wis. Adm. Code
, �
v
� STATESANITARYPERMIT# �
�� �� CST 80-337 86183 � o
-Attach complete plans (to the county copy only)for the system, on paper not less than sTnre P�qN i.o.NUMeeR u'
8'h x 11 inches in size.
�ee reverse side for instructions for completing this application.
PETITION
I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. Fort vnainNce ❑YES ❑ No
PROPERTYOWNER PROPERTVLOCATION
Mr . & Mrs . James Clark �W '�a Ya, S Z T , N, R Eg(or) W
PROPERTYOWNER'SMAILINGADDRESS LOTNUMBER BLOCKNUMBER SUBDNISIONNAME
1508 East 84 th . Street L 2 -&--4- Par`�I Z,y�
CITY,STATE ZIP CODE PHONE NUMBER CITV : NEAREST ROAD,LAKE OR LANDM4RK
O VILLAGE :
II. TYPE OF BUILDING OR USE SERVED:
Number of Bedrooms if t or 2 Family 2 OR ❑ Public(Specify):
111. PURPOSE OF APPLICATION: (Check onty one in#1. Check#2,3 or 4, if applicable)
1. a. � New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e.� Repair of an
System System Septic Tank Only an Existing System Existing System
2. ❑ A Sanitary Permit was previously issued. Permit# Date Issued
3. � An Existing System has been inspected and soil conditions meet minimum requirements.
4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy.
IV. TYPE OF SYSTEM: (Check only one in#1 and only one in#2)
1. a. �Conventional b. ❑ Alternative c. ❑ Experimental
2. a. ❑System- b. ❑ Holding c.❑ Pit Privy d. � Vault Privy e. ❑ Mound f. 0 IGP
In-Fill Tank
V. ABSORPTION SYSTEM INFORMATION: (Check one)
1. a. � See a e Bed b. ❑See a e Trench c. ❑ See a e Pit
2. PEiiCOLATION RATE 3. ABSORPTION AREA 4.� ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet):
7 410 420
Feet �Private ❑Joint ❑ Public
CAPACITY
VI. TANK in allons Total #of Pretab. S1Se Fiber- � Exper.
INFQRMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel 91ass Plastic APP
Tanks Tanks structed
Se ticTankorHoldin Tank X 8�� 1 Rasmussen � S � ❑ ❑ ❑ ❑ ❑
LiftPum Tank/Si honChamber ❑ ❑ ❑ ❑ ❑ ❑ .
VII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation ot the private sewage system shown on the attached plans.
Plumber's Name(Print): Plumber's SignaNre:(No St s) MP/MPRSW No.: Business Phone Number:
Andr Rasmussen 715 798-3355
Plumber's Address(Street,City,State,Zip Code�: Name of Designer
P .O . Box 66 Cable WI . 54821 Dennis Rasmussen
Vlil. SOIL TEST INFORMATION
Certified Soil Tester(CST)Name CST#
L .J . uinn 475
CST's ADORESS(Sheet,Ciry,Slate,Zip Code) Phone Number:
Stone Lake WI .
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved SanitaryPermitPee Groundwater ate Iss ' gAgentSignature(NoS[amps)
0 Approved ❑ Owner Given Initial Smcharge Fee
AdverseDetermination �� . �� 25 . �� �-1�-8�
X. COMMENTS/REASONS FOR DISAPPROVAL:
SBD-6398(tormerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber
`, ,
e
' DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING '
-LABOR & HUMAN RELATIONS DIVISION .
P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
MADISON, WI 53707
State Plan I.D. Number:
❑ CONVENTIONAL ❑ ALTERATIVE (�fassigned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE�
�c�w�<S �ark ISO 8 � . F��l�� S-� ��oon��., 1�'�t.l S � 2I — 9 �
EENCH MARK (Permanent reference point) DESCRBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. E�EV.�
Name of Plumben MPl PRSW No.: County: Sanitary Permit Numben
cic c�s usse 3 i 3 c�l Sn-`t' -� 'r' a � - I as"
SEPTIC TANK/HOLDING TANK: " OU-�, S •t . Y� —
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.� TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
�'x�s,��K PROVIDED: PROVIDED:
� � . ^ CDv�C, 5 FjQO ❑ YES ❑ NO ❑ YES ❑ NO
BEDDING: VENT DIA.�. VENT MF+TI_�. HIGH WATER NUMBER OF ROAD: PROPERTY WELL� BUILDING' VENT TO FRESH
ALARM: FEET FROM � LINE: � � � AIR INLET: �
❑ YES ❑ NO ❑ YES ❑ NO NEAREST� 7 SO 7 �S ?S'� ?��'j 7 2,S'
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY� PUMP MODELL PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED'
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
GALLONS PER CYCLE: PunnP nN�coNTao�s oaEaATioNn� NUMBER OF PROPERTY WELL BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET:
PUMP ON AND OFF ❑ YES ❑ NO NEAREST �
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING:
or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO. OF DISTR. PIPF SPACING: COVER INSIDE DIA.: #PITS: LIQUID
TRENCHES� MATERIAL: P�T DEPTH:
DIMENSIONS
GRAVEL DEPTH FILL DEPTH DISTR. PIPE OISTR. PIPE DISTR. PIPE MATEAIAL: N0. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIPES: ABOVE COVER�. ELEV. INLET: ELEV. END� PIPES: pEET FROM LINE: AIR INLET:
NEAREST —�
MOUND SYSTEM:
Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW
❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED.
SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS;
❑ YES ❑ NO ❑ YES ❑ NO
DEPTH OVER TRENCHBEO DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL SODDED� SEEDED� MULCHED'
CENTER: EDGES:
❑ YES ❑ NO O YES ❑ NO ❑ YES ❑ NO
PRE$SURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING� GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER�
� TRENCHES�
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: N0. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL 8 MARKING:
ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.�
DISTRIBUTION HOLE SIZE HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL VERTICAL UFT CORRESPONDS TO
INFORMATION APPROVED PLANS
❑ YES ❑ NO ❑ YFS ❑ NO
COMMENTS: PERMANENT Mr1RKERS. OBSERVATION WELLS- NUMBER OF PROPERTY WELLL BUILDING:
FEET FROM uNE:
❑ YES C� NO L� YES C� NO NEAREST��
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CtLC c� � T � e�/t '� YU1,22� s / �� �4C� —
Sketch System on Retain in county file for audit.
Reverse Side. SicN uR nr�e
SBD-6710 (R. 06/88) �C G L,G��-Cc�[�-- —2 \ C�-�?�
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