HomeMy WebLinkAbout002-145-06-0800-LUP-1992-225 � �
Application for Land Use Perndt
County of Sawyer o
ihe undersigned hereby makes application for a Land Use Permit and � �.t
agrees that all work sha11 be done in compliance with the require- o �
ments of the Sawyer County Zoning Ordinance and the laws and regu- '^
lations of the State of Wisconsin. ,
PRINT - USE BLACK INK OR PENCIL
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I.X:i��:n,e ,
C��' .� � G9��.�I� �rl /, ��y��
Owner �� Builder
���`�� fCou/S�/ L.a�e �j—��l�
Mailing Address Mailing Address �
l,�/�te�loo �s ����°�` sv�r�
City, State, Zip City, Star_e, Zip
Building Land Use Zone District �-Z r o
( ) N��a ( ) Filling rt a
(�-YAddition O Dredging Lot size �� X /0�-/(� m H
( ) Alteration ( ) Gradipg
( ) Moving On ( ) �v� Acres • Z°"7
( ) ( ) �' �
New Construction �
Size l� ft wide ^ _ ft wide �
� � ft long ` _ ft long
Floor area ?�,�, ; sq ft sq ft
� �
Total htg �3 "' to peak to peak �
Stories � Stories �
Nc. cf �edroor�s ---
� �_
! rear 1ot line oi waterline I c�
0
(year round) or (seasonal) �O<'� " �, rt
Type of Bldg or Addition � a o
( ) Dwelling , � r• rt
( ) Garage (1) (2) car ' � � �
( ) Storage Building � �'`> -`�_ � Y.
(�oathouse � ��� o
( Livingroom � \ � ��
( ) Bedroom
( ) Kitchen-Dining I �
( ) Porch - enclosed/roofed �
( ) Deck - open '�-9 '�6 '�
( ) � � � �c,'� � - �w
( ) `� � , � -
�� ` - �
Type -of Construction � E—� ��� _ �
(�Frame ( ) Block '
( ) Log ( ) Concrete \
( ) Pole ( ) Steel cn
(� ) Metal ( ) � ��� �' fD
� _ n
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g j $ S�� � <IS d f� I
Volstru�tioP Cost ., of deed � �
CS Vol Pg I �-��S � r, ro '�
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Cer. Soil Test D-( �� �
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Sanitary Permit -I� ----------�� r �
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Issued Z� �u�l� ��lL Denied L
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{ , Owner Zoning A ministrator
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— — MAPCE — — STREET — — —
— PINE — — STREET — —
�CALE: I INCH= ioo� F ET OR ASSESSMENT U E ONLY Na
DRAWN BY: C�( DATE: I983 INTENDED TO SHOW GONCLUSIV
COLON (�) INDICATES GOVT. LOT EVIDENCE OF OWNERSHIP OR
BOUNDARY LOCATIONS `
� �..�
PLB 67 3�12
j State and County State Permit # g 0-16 g -
i � Permit Application County Permit # _
� � ' for Private Domestic Sewage Systems Counry Sawyer
"DENOTES STATE APPROVAL REQUIRED CST 80-183
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailiny Address:
C �. �- L C 9_� e�rT R� ,��r l�3 �: r,�ar�r�a o , t��� , s 3 s�y
B. LOCATION: --- -Ya-- ---Y<, Section 3�, T 4� N, R 8 E (or) W Lot#��City
Subdivision Name, Ja.IleSVill�earest road, lake or landmark Blk# 6 Village
Beach Township B,�fS,f�
� .� t� � �- C u.
C. TYPE OF OCCUP NCY: ommercial "Industrial YOther (specify) 'Variance
Single family _�_ Duplex No. of Bedrooms � No. of Persons :�.
�• SEPTIC TANK CAPACITY �.�D Total gallons No. of tanks _�
HOLDING TANK CAPACITY Total gallons No. of tanks
Prefab concrete Poured-in-Place Steel,�_Fiberglass Other (specify)
New Installation '� Replacement
Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify)
E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate ,0—_—Total Absorb Area � sq. ft.
New ��Replacement Alternate (Specify)
Seepage Trench: No.of Lineal Ft. Width Depth Tile depth (top) No.of Trenches
Seepage Bed:�_Length_��� Width ��� Depth ����� Tile depth (top)�_No. of Lines �
Seepage Pit: Inside dia eter Liquid Depth No.of Seepage Pits
Percent slope of land_ ��� Distance from critical slope,/��-�*-ts�
WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑
Owners name as listed on EH 115 if other than present owner:
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 fiave sized the effluent disposal system from the EH-115 prepared
by the Certified Soil Tester,
NAME L`_t � � �r� c e � c� e-���-� C.S.T. # � ,S—�7� and other information
obtained from (owner/buiider).
Plumber's Signature ��4 � Mp����# l � �'� Phone # 7/.S 103�—.�3�
Plumber's Fddress (�� � m�� �4�� l�a 1-�-1��W (�R� � W'i 5 5�8y3
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20.Well loca-
tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors
property. If well has not been drilled please indicate.
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Do Not Write in Space Below - FOR COUNTY AND STATE DEPARTMENT USE ONLY
Date of Application 8=O 1-8 0 Fees Paid: State 14 . 0 0 County 36 . 0 0 Date O l AuguS t 19 8 0
Permit Issued�L� (date) 8-01-80 Issuing Agent Name Elaine Nehrling
Inspection Yes No State Valid# Date Rec'd
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)
o_..:..,.a r.___ -�i, i-+�
REPORT ON INSPECIION OF SANITARY PERMIT # So�/�R
(lj Name and Address of Permit Holder Person/Persons at Site 2 Date of Inspection
�(J!}kL �G6�12T (3u��e nn�TefrL/� � �u� c�'6
� �� ��' �u�"T ��j��� Time of Inspection
ame, r ss, icense o. o ns a tng plumber
9Y-cu,a� �` 3 0
3 INSTALLATION~CONSISTS OF: �Septic Tank �Seepage Trench �Dosing Chamber
❑Seepage Pit �ed ❑Holding Tank ❑Fill System
B N ermanen re erence oin escri e:
ToP oP Q,foc/c s oN s w CoR.�� o� �kzaYl.u�Y.
Elevation of vertical reference point: j Ba� Slope at site: � �j �
(5)MATERIAL AND DEPTH OF SEWER_ �/�S c�6
(6)SEPTIC TANK: Manufacture w T�L(� Liquid Capacity: 5'p
Tank Inlet Elevation: 9� Tank Outlet Elev: ��5'!6
# ft to lot or property line: �,�� # ft to well: 7,;�S
(7)DOSING TANK: Manufacturer: # of gallons:
# of gallon pump set for a cycle gallons; total capactiy of distribution
lines _ gallon; size of pump head; gallon per minute
horsepower brand name of pump and model number
Is the warning device installed? ❑YES ❑NO Wired? ❑YES ❑NO
8 HOLDING TANK: Manufacturer o ga ons
construction ; depth to the cover ft; If septic tank is
being used are baffles removed? YES ❑N0; ft from residence;
ft from well; ft from property line. Type of warning device
Is the warning device installed? ❑ YES ❑N0; Wired? ❑YES ❑N0;
Locking device on cover? ❑YES ❑ N0; Diameter of vent and material
Distance from building to vent
(9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth;
ft to residence; ft to well; ft to property line;
ft to ordinary high water mark of lake or stream; ft to edge of slopes
greater than seepage pit inlet pipe-elevation ft; bottom of
seepage pit elevation ft.
(10) SEEPA6E BED SIZE: ft width; ft length; tile depth;
li.neal feet tile; ft to residence; ft to well; ft to lot or
property line; ft to ordinary high water mark of lake or stream; ft to edge
of slopes greater than 20q falling away toward lakes, water courses or drainage ditches
Elevation of tank discharge line entering bed it.
11 SEEPAGE TREN H: Total length of seepage trench ft; width Y�5 ft;
tile depth � ft; '7S'O ft to well; ft to ordinary high water mark of
lake or stream; N� ft to edge of slopes reater than 20% falling away toward lakes,
water co ses or dr�inage ditches; elevation of tank discharge line entering seepage
trench ��� ft.
(12) Has system been installed in area indicated on EH 115? [�YES �NO
(13) Has system been installed in floodway? �YES '�NO Floodplain? �YES �NO
DILHR-SBD-6095 N.05/80
Si gnature of Inspector: ����� �,��y+p��
:
Department of Zoning and Sanitation
Sawyer County �
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Inspection Report K
Owner Bonnie $ Carl A. Eggert n
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Address Route 2 Box 163 Waterloo, WI 53594 r
a
Name of business
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Builder o°qv
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Address �*
Plumber Clarence Metcalf
Address Route 6 Box 157 Hayward, WI 54843
Inspection
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(X) Private ( ) Public Property )C Sanitary-instal � �
X Dwelling Setback - lake
Violation Mobile HM Setback - road � °
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Garage Setback lot line �
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Discussed with owner yes no � �f
Discussed with builder yes no �
Discussed with plumber yes no �
Discussed with yes no 00
Date � � t,� � g�
Signature of Officer _�� „1r,� '�'���n)
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DOCUMENT N0. STATE BAR OF WfSCONSiN-FURY 1
I r `' i" 'I 1- Grantee ' s Address : WARRANTY DEEO
I � � ��' l� 1 t� THIS SPACE RESERVEU FOR RECORDiNG OAT.>
I RL . 2 Waterloo , Wi
Roplde�. OfHc� �
I Hend�-icks and Naomi R , Sa.rTer CountT �
�� TIIIS n��l r� nad bet een William L . � �
'� liendrLcks , ' {ius�anc� and-wile,and eacli�l�s or�ier owii �'ON�°"� �o� record the dsT o�
I; , [c� A D 13�� a 1 �� o'doot
�, rl g 1t .� 1,� recorcled !n �ol.�?�_�
II __ Grantor of Rdcorde on poqa �x S �
I and Carl A. �ggert and Bonnie Eggert , husband and wife - -
il as joint tenants ---� � ' _ '� t�`"``, �`' "-` '``� ` ,
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II Grantee, ����
� W i 1 n e S 5 e t h , That the �riid Grnntor, (or a vnluoble considcrntion _ __ I
I ----- - --- ----- ----- RETURN -TU ------�—.. . . ._ _ _ . . . .__ _— �
convcyy lo Grc�nlec Ihe followin�; deticribec� rei�l estule in SawyeY' _ Neupert & Wakem�in, S . l: . ; j � �
�I County, State of Wisconsin: 122 L'ast Lake I
II Lake rfills , WI 53551 l�� •
Ij Lots 8 ; 9 and 10 , Blocic 6 oF Janesville Beach , Town of -- --- —
13ass Lake , Sawyer County , Wisconsin . Tax Key No. _ _ i
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I TRANSFER
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;i �'EE
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� is not
II 1'his__ __homestead property. �
(is) (is not)
I'' '!'o�ether wilh c�ll and singul,�r thc hereditamenis and appurtenances thereunto belonging;
�,� William L . Hendricks aud Naomi 12 . Heizdricks
And --- - - ---- -----
----- ------- -- — ----- ------------ �
�
ii w.irrcints lhnl lhe tillc is Food, indcfeasible in [ee simple and free tind clear of encumbrunces exce�t �
I zoning ordinances , building restrictions and highway and public utility easements
I
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I� and will warrant and defend the same.
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� Dated this -L���- day of v �I l'1 Q� _ 19 8�
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�� (SEAL) �/���C<<t-r-�k � /�-�'-ZLG�-,'�-�-c-f�t (SEAL)
;i * _ _ _ * William L . Iiendricks
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�� (SLAL) '��C,-�,- � �L� � �L' ` .��. �': _ � (SEAL)
'� * * Naomi R. Hendricks
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' AUTHENTICATION ACKNOWLEDGMENT
I
� Si�;natures authenticated this .—_.____day of STATE OI� �1l�$�6�1t�8Mk PIINNESOTA
II il
, - � 19 --- . I� ss.
' _�� ll"�L . '6��� County. � �
�! Per nall � came bejore me, this ��� day o[
il * /Cf�[�
�' ��-�_��the aUove named _ _
;� TITLE: ML.Mk3ER STATE BAR OF WISCONSIN t ' liam L. �Iendricks and Naomi R . Hendrick
� (If not, _
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'� ��uthorized by § 706.06, Wis. Stats.) �
,�
II � ----------- __ �
�I This instrument was dra(ted by - _
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!� Neupert & Wakeman, S . C . -- ---- --_--- �
�� - - —___ to me known to be the person _S__ who executed the fore- �
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i� going � t� ,:"c•qx;��a :�i@;arx.*r�^'h . �
.,,..ah���r,�v+�dY. " ,
; --- ��,j' �.�''��:�R�:,��
' � , 4�,w�:��T-� —
' (Signalures may Ue aulhenticated or acl<nowledged. Both �`--- ��•+$�� - �y'-'�j`�P�r� �`Q�
are not necessary.) - - -- - -
Notar} Pi � ._�iy Commiulon Erpin� Aup, �7, 11d1
- - -- ------ - - -- . . ount� , Si19[ Mi
A1y Co'�iififsZso . � ii . ie•nl . ( no , s t e expira�ion
dale:_ 1 [ c�• ;7 - -
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