HomeMy WebLinkAbout002-103-04-0100-LUP-1992-281 . � ;' -
� - Application for Land Use Permit y�
County of Sawyer o
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The undersigned hereby makes application for a Land Use Permit and �
agrees that all work shall be done in compliance with the require- X o �
ments of the Sawyer County Zoning Ordinance and the laws and regu- "'
lations of the State of Wisconsin. '
�i�, � PRINT - USE BLACR INK OR PENCIL �
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o� � � / C�1" l�.`��l-�(�'� — ` � `I �
Owner Builder '�+
2 oh ?.2 i 7 �� `f� V J�-�`�,��� R
Ma' ing Address M1a1 iling Address
4� dv la4��iV " �"\�1W�\v� ""_ �� �
City State, Zi City, tate, Zip
Building Land Use Zone District �'Z o �
( ) New ( ) Filling rt
( ) Addition ( ) Dredging Lot size �� �a J�'f N n
��lteration ( ) Grading
' ( ) Moving On ( ) Acres .�_;
( ) ( ) � 4
�
New Construction � ,�
v
Size ft wide 2o ft wide �
ft long � ft long �
Floor area sq ft 9 2 o sq ft
te
Total htg to peak � to peak �
Stories l Stories
No. of Bedrooms rear 1ot line or waterline c�
0
(year round) or (seasonal) �, rt
Type of Bldg or Addition � r�
( ' Dwelling °; °
( ) Garage (1) (2) car C
( ) Storage Building � m�
( ) Boathouse �+ �'
( ) Livingroom Q` �
( ) Bedroom i
( ) Kitchen-Dining I I
( ) Porch - enclosed/roofed ` ���'
( ) Deck - open n
(�S� 12�1Gcs��C[�F $l� r�'�� °V"
( ) �
i�.0 � � 'fk o
T pe of Construction '� `'� �
(�¢' Frame ( ) Block I�C f� �` r
( ) Log ( ) Concrete � /, d �
( ) Pole ( ) Steel i� �/�
( ) Meta1 ( ) � / ` n n
Construction Cost $ ���OU,�a C �L �1 �
Vol 7 Pg �3 of deed n' `�� � C
CS Vol Pg S y
�, �. _ ro
Cer. Soil Test �-ZI� �� H �
N ; � -�
Sanitary Permit - ZL� C Road ~ I�
---- ----- L --------------- o
z
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Issued � x'
� ��5�-- ��9Z. Denied N
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wner Zoning Administ ato "
DOCUMENT N0. STATE BAR OF WISCONSIN—FORM 2
WARRANTY DEED
THIS SPACE RESERVED FOR RECORDING DATA
1��6'1� �
Hn�l.irr'n r'Hlco ���
ROB�RTA STAFF, a/k/a ROBERTA D. STAFF, a widow �„"�"`�"'"ty ' '`�3
not remarrie H�<��:a.+i,����,�;{ inV9y=_<�-r oi
� (i�.__ �\D 1�30..L_el��?/'/cJ..�Y
��r t..,n:l n��.rn9iai tn vcL_.j p V__
conveys and warrants to NORMAN W. KUHL and LIllA J, °� �"�`�' ' ""9��
KUHL, his wife as loint tenants, f�-�-�"`�—�'-�
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RETUHN TO
1��� �,�
!he(ollowing described real estate in awyer County,
State of Wisconsin:
Lots One (1) to �leven (11), inclusive, Block TaxKeyNo.
rour (4) , Abendpost Beach, Sawyer County, Wisconsin
����1�`�Lo�
GRANTEE'S ADDRESS: ���
North 67 w 22208 r24 ���YS,�
Willow Lane
Sussex, Wi. 53089
This homestead property.
(� (is not)
Exceptiontowarranties: Municipal Zoning Regulations, Easements and
, Restrictions of Record.
Dated this �7 day of /'r�`-`�C c�.t/�� ,19 84 ,
�I G���-VI.iCX> �Yi � S,�.Y�Aa( (SEAL) (SEAL)
� Roberta Staff .
(SEAL) (SEAL)
AUTHENTICATION �G ACKNOWLEDGMENT
�Signa ures authenticated this t� day of STATE OF WISCONSIN 1
cLv� �19� I
ss.
� County. �
Personally came before me,ihis day of
'�ef___ T _oe�12 _ _, 19_ihe above named
TITLE:ME ATE B R OF WISCONSIN
(Hrie�--------------------------
�,M,ory�d-ny�aesos-w+s-s�ts� —
THIS INSTRIIMENT WAS DRAFTED BV -
to me known to be the person who executed
Attorney Jeffrey T. Roethe the foregoing insirument and acknowledge the same.
Roethe, Buhrow, Roethe, & Pope
Edgerton, Wisconsin 53534 � —
Notary Public County,Wis.
(Signatures may be authenticated or acknowledged. My Commission is permanent. (If not, state expiration
Both are not necessary.) date: �y �
The use o(witnesses is oplional.
'�ii,�"�'�,`roti�
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Furn�shed ny: PREFERRED TITLE SERVICE,INC. ���, �+�,�'
���
25 WESTMAIN STREET �;l _- _'� �_`_[""��
MADISON,WISCONSIN 53703 � r} -]�;,
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�S� A119TRACTc . TITI.6 INSI�RANCR . 65Cqftw'9
•Nimes nl persons si9nin9 In any capacily shoula be lypotl or prinled below Iheir slgnelures.
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WO LF STR EET
SH � ET I OF 5 SCALE � 1 � � = 100'
fl DfLHR SANITARY PERMIT APPLICAYION _
In accord with ILHR 83.05,Wis.Adm.Code couNn
� ' SAWYER o0
CST 89-214 STATESANITARYPERMIT# �
-Attach complete plans(to the county copy only)for the system,on paper not less than 124112 N
8�h x 11 inches in size. ❑C�eck if revision to previous epplication �
�$B8 f8V8fSB SIdB}Of If1StfUCtIOfIS fOf COfilpl0tlfi9 ihlS flPPIIC3tlOf1. STATE PLAN I.D.NUMBER
I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION.
PR PERTYOWNEH PROPERNLOCATION
r< v4,s3c� T d,N,R ���w
PROPERNOWNER'S MAILING ADDRESS LOT# BIOCK# �
� J� ��
CIN.STATE ZIP COaDE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
7 F
II. TYPE OF UILDING: (Check one CI NEAREST ROAD
� ❑State Owned ❑VILLAGE
�7 c
❑Public 1or2Fam.Dwelling-#ofbedrooms� ARCELTAXNUMBER(S)
III. BUILDINGUSE: (Ifbuildingtypeispublic,checkallthatapply) 002-103-04-0100
1 ❑ApVCondo
2 ❑Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑Outdoor Recreational Facility
3 ❑Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ RestauranUBar/Dining
4 ❑Church/School 8 ❑ Mobile Home Park 12 ❑Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1.❑New 2.�Replacement 3. ❑Replacement of 4.IJ Reconnection of 5.❑Repair of an
System System Tank Only Existing System Existing System
B) ❑A Sanitary Permit was previously issued. Permit# — Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11�Seepage Bed 21 ❑Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 Seepage Trench 22 ❑In-Ground 42 ❑ Pit Privy
13 ❑Seepage Pit Pressure 43 � Vault Privy
14 ❑System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1.GALLONS PER DAY 2.ABSORP.AREA 3.ABSORP.AREA 4.LOADINC�RATE 5.PERC.RATE 6.SYSTEM ELEV. 7.FINAL GRADE
REQUIRED(sq.tt.) PROPOSED(sq.tt.) (Gals/day/sq.R.) (Min./inch) ELEVATION
O Q Feet Feet
VII. TANK PACITY Site
in allons Total #of Prefab. Fiber- Ex er.
INFORMATION New istin Gallons Tanks Manufacturer's Name oncrete Con- Steel 91ass Plastic APP
Tanks Tanks structed
Se ticTankorHoldin Tank QV G �
LlltPum TanWSi honChamber
VIII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Nama(Print): Plumber's Signature:(No Stamps) MP/MPRSW No.: Business Phone Number:
�
lum r's dress(Street, iry,Sta , ip ode�:
� - 8� 3
I . COUN /DEPARTMENT USE ONLY
❑Disapproved SanitaryPermitFee pnclueesGrountlweter ae ssue Issu� AgentSignature(NoStamps)
�Approvetl ❑OwnarGivenlnitial S�rcnergeFae)
AdvarseDetermination $115.0� 12-5-89
X. COMDITIONS OF APPROVALlREASONS FOR DISAPPROYAL:
SBD-6398(formerly PIb67)(R.11/88) DISTRIBUTION:Original to Counry,One Copy To:Safery&Buildings Division,Owner,Plumber
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r,e�,�aTMeNTOF iNousTRr, INSPECTION REPORT FOR SAFETY&BUILDING
LABOR 8 HUMAN RELATIONS DIVISION
P.O.BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION
MADISON,WI 53707 S�am aia�i D.Namoe.:
�CONVENTIONAL ❑ ALTERATIVE (�tass�9�ee� �
❑ HoldingTank ❑ In-GroundPressure ❑ Mound
NAME OF PERMIT HOLDER� AD�RESS OF PERMIT HOL�ER: INSPECTION DATE.
i�lo2H � t - a x a-� � w�rd �ST a -s - 8
BENCH MARK(Permanen re�erence polnt)DESCRIBE IF DIFFERENT PROM PLAN'. REF.PL ELEV.' CST REF.PL ELEV.:
NemeolPlumber: MWMPRSWNo.: Counry: SanitaryPermitYumber:
�.o�•a SPr�Ec 33so Sawr� 8�' -aa�
SEPTIC TANK/HOLDING TANK:
MANUFACTURER� LI�UIOGAPACRV'. TANKWLETELEV.: TANKOUTLETELEV.: WARNINGLABEL LOGKINGCOVFR
' I �1 p PROVIDE�: PROVIOEO:
ttU�FCUTT OO '�I�i . T IS • Z� ES ❑NO OYES ❑NO
BEDDING: VENTDIA.: �� VENTMATL.: HIGHWATER NUMBEflOF ROAD'. PROPERTY WELL: BUI�OING: VENTTOFRESH
ALARM� FEETFROM LME: 1 / I AIRWLET�.
❑YES ❑NO �-� ❑YES ❑NO NEAREST�� O 56 ai 3
DOSING CHAMBER:
MANUFAGTURER: BEODING: �IOUIDCAPAGITV: PUMPMODEL PUMP/SIPMONMANUFACTURER: WARNINGLABEL LOCKINGGOVER
PROVIDED: PROVIDE�:
❑YES ❑NO ❑YES ❑NO ❑YES C NO
GALLONSPERCYCLE: PUMPANDCONTROLSOPERATIONAL'. NUMBEflOF PROPERTV WELL BWL�ING: VENTTOF9ESH
(DIFFERENCEBETWEEN FEE7FROM �iNE: AiRw�ET.
PUMP ON AND OFF ❑YES ❑NO NEAREST�
SOIL ABSORPTION SYSTEM. Check lhe soil moisture at ihe depth of piowing FOflCE LENGTH: OIAMETER'. MATERIAL AN�MARKING'.
or excavation. (N soil can be rolled into a wire,consiruction shall cease until MAIN
the soil is dry enough to continue.)
CONVENTIONALSYSTEM:
BED/TRENCH WIDTH: 1 LENGTH: 1 NO.OF DISTR.PIGESPACING' COVER WSIOEOIA.'. $PITS: LIOUI'J
TRENGHES: � MATERIAL: P�T pEPTH'
DIMENSIONS I a 3rj -- �j �-�R�
GRAVEL DEPTH FlLL�EPTH DISTR.PIPE DISTR.PIPE DISTF.PIPE MATERIAL NO.DISTR. NUMBER OF PROPERTV WELIL � Bl11LDING' VENT TO FRESH
BELOWPIPES ABOVECOVER ELEV.INLEL ELEV.END' (� PIPES' LME' / / d � AIRWLET: 1
tl ,.93 . FJ Y'VC NEARESOT�� 3 b r �Z �
MOUNDSYSTEM:
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
❑VES ❑NO meets the criteria tor medium sand. ELEVATIONS MEASURED.
SOILCOVER TEXTURE PERMANENTMARKERS: OBSEPVATIONWELLS;
❑YES ❑NO ❑YES ❑NO
DEPTMOVERTRENCH/BE� DEPTHOVERTRENGH/BED DEPTHSOFTOPSOIC SODDEO� SEEOEO: MULCHED�.
CENTEP'. E�GES: �
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TflENCH W�OTH'. LENGTH: NO.OF �qTERrILSP�GWC. GRAVEIpEPTNOELOWPIPE �II.I DEPfhIA90VECOVER�.
TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIA�' NO DISTR. DISTR.PIFE DISTFIBUTION PIPE MATERIAL&MARNING'.
ELEVATIONAND E�EV.'. ELEV.: DIA.�. ELEV.: PIPES �IA.:
DISTNIBUTION HOLESIZE: HOLESPAGING. �RILLEDCORRECTLV: COVERMATERIAL: VERTICALLIFTCORRESPONDSTO
INFORMATION APPqOVED PLANS
❑YES ❑NO � ❑YES ❑NO
COMMENTS: PEFMANENTMARKERS: OBSERVATIONWELLS�. NUMBEROF PROPERTY WELL BUILOIVG'.
FEE7FROM �iNE:
❑YES ❑NO ❑YES ❑NO NEAREST�
�� fl � vmb�rS � �o-� � �ah
�v�-���e� O.s c� c�� h
Sketch System on Retain in county file for audit.
Reverse Sitle. i 7uaE� T �`
SBD-6710(R.O6/88) � \��M�
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