HomeMy WebLinkAbout008-937-08-5317-LUP-1992-220 /
' 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 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 BLACR INK OR PENCIL ��
51�e i lcL. �. d- b
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(,�lrar�cc-5 S.�cuciznvTz-- =�c�� �
Owner Builder
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�sos �e�� d�o r
Mailing Address Mailing Address
t,��n �Fk�rGC �� l �¢76/ �
City, State, Zip City, State, Zip
Building Land Use Zone District (C2-( o �
( ) New ( ) Filling rt
(,>;) Addition O Dredging Lot size �4�� 54.�t_ N n
( ) Alteration ( ) Grading
( ) Moving On ( ) Acres 1 •a'1 ��
( ) ( )
D
New Construction �F`�
�-;;;t:�.'� �
_ �
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Size �_ ft wide �o �p ft wide i�
��
ft long � � ft long
r--
Floor area ��� sq ft 17g sq ft c�
R
Total htg �� to peak "� �C-�e� �eak, � � ''
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Stories � '�"" Stories �/ � �
No. of Bedrooms — ____ ,_� ,_ �
___ ___ ____��erline c�
0
(year round) or (seasonal) L,4rct �30' CttETac � rt
Type of Bl�g ar Addition � o' r
O Dwelling �3�� I a; r°.r
( ) Garage (1) (2) car (,q' � Y
O Storage Building I �r m I�,u
( ) Boathouse ' `r' ~'
( ) Livingroom - F--n�K "� �
( ) Bedroom ��_�„_
( ) Kitchen-Dining �S
(�) Porch - enclosed/roofed �� ,: 3z�� � I
(� Deck - open �' :Y)
� �' -_�E�fl Z2 ' . F�"
� ) , SCt{�� `W � �
. -�- ,�. Po¢Lµ . .�
Type of Construction �{ � � .� �
(�) Frame ( ) Block I _ � i
( ) Log ( ) Concrete ' �
( ) Pole ( ) Steel ' ih �
(� ) Metal ( ) �'� ,�, �
Construc ion Cost $ 1���. � ��;'
aFi4� � � � ., � �'
Vol ��Z Pg q-Ug of deed I
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CS Vol 1l Pg t13 ro �
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Cer. Soil Test �(�-o'L9 �' �
, ". 'r°, I�a
Sanitary Permit ��,-p31 ------ --CL Road --------------- .�
� �/12oc�NE.4p LhtiC o
`��i->v>frn-,�� - - - �'�"S'� T".�n� ' Z
Issued ZZ ..�{,�IU �qQZ Denied �
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Owner � Zoning Administ ator
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SEC. 8 TWP37 N. -.jF
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� Sawyer County Zoning �d;ninistration .
:
Inspection Report �'
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Owner Sheila r1. and Charles S . Lc�veren�tz
Address 1515 Golf Rc�ad Eau Claire , S�;isconsin 54701 �
Name of business
Builder r1��
Address
Plumber t'�/A
Address
lnspection
(X ) Private O Public ( 1 Pre��et�ty O Setback - lake
V1UlSt10T� l ) ���;�' Iling ( ) Se �thack - road o
{; ) �ti4obile Hm ( 1 Se;:'�ack - lot line �
( ) Sanitary ( ) Zoning ( ) Garage (X ` Average Lake Setback:
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I� . Vol 3 B 2 P�; . 4 08 C�I�I Vol . 11 P�T 113
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�iscussed with owner (�; ) � �
bi � cussed ���ith builder ( ) �
Discuss �d with plumber ( ) �
Discussed with ;:;
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I�ate 19 �`-aY 1986 �' �
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5ibnature of Officer ��c�-t.u� �,�c'«� •`
Ik�vid Fi. fieath , Administr�ator
._l_1�:��:IL'�1� i`I�i j�r;��rL L'.1It ��j�� 1'V�..��,ONSIN I�U1Cl1I :S-1fl82 11115 �F'ALE HtSERVtU FOR REIlOHDING DA7A
QUIT CLAIM DEED
I 21 s 2 c 9 nbylater� 0111c�
se»•yr,� Couu�y � '
I hbcelvcxl loc rvc�rd Ihe /'1t. deY u�
; .....�C A R E N__K,.._.S C H M I T Z_,_..i n d i y i d u a l_l y__.a n d__a s__w i f e__.o f I � c
, Jerry -L._ -Schmitz, - - - -- - -- --- --- ---- - --- - -- - ----- - � -"� ----- A n i�/° e� :�. o�d� �
I .- - ---- -------•------- ----- --- ----- ---- - --- --- ------- - -- -- - - - -- - +-----T.9 ut�d r.x�oi.�.xl f vol.�9
�---- --. .
- -- - ol H�x:�, or, {�aya �.3c)
y�,�t-��.���„5 to .___CHARLES S . LEVERENTZ and SHEII.A M:_ -
- -- --�------ -- - --- - - �����:� ..-� .
;�' .___ I.EVERENTZ, husband and wife as survivorship R�ta
_ - - - ... -�- - - -- ._ --- - - -- ----- - -- - - - -- - -- -
----marital--prop.erty� . ---� - -- - -- -- -- - ---- ---- -- '� '
�--------- ------------------- -- -- ----- ----- - ---------------------- ---- - . z... — - - PUT I
.- -- ---- - - ----- ----------- � po �,
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- �----- --- - - ---- -------------------------------------------------------------- - --------. ,
�� the follo�eing described real estntc in ----_-...��AI}1�X---------•-------_---- County, �
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State OF WISCOIISIII: I RETUfiN To DOri Losby, Lawyer
306 S . Barstow St , II
, ��
Eau Claire , WI 54701 ',;
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Tax Parcel No: ----------------------------- III
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That part of Government Lot Three (3) , Section Eight (8) , Township
Ttiirty-seven (37 ) �torth, Range Nine (9) West , described as Lot One ( 1) ,
recorded in Volume Eleven ( 11) of Certified Survey Maps , Page 113 , ;;
'' Survey No. 2361 . li
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� This deed is given in fulfillment of a Land Contract between the
parties dated November 22 , 1985 , and recorded in the Sawyer County office
of the Register of Deeds on December 16 , 1985 , in Volume 382 of Records ,
Pages 408-409 , as Document No. 198336 . !,
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This _....�.5..T1QG---.--.._ homestead property.
!� (is) (is not)
iI D�ted this ..... ---- --29t�1- - -- - day �e - --- December .... ___ ._. .. -- --- - , is_$9_. j�
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' _ --- -�- - -- -(SEAI,� _ _.S�GNATURE BELOW-.. - - ---_(sEAL)
__ _-- •
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i ' - �----�----------� ------- - -- ------ ---�- -------------- - * . Karen. K.-...Schmitz - --- - - - -------- �
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,. - - ----� �-•- - -- -- �- - -
- ------- - - _(SEAI.) ____._ . .. - -- - - - �-- �- - -----(SEAL) ��
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� ._ _� -� -........- _ _ -- - - -- -- ... - _. ...... . . ... . . _....._ _ __
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II AUTHENTICATION ACKNOWL�DdMENT
,
i� Signature(s) -------------------------------------------------------- STATE OF X�S1�Xl?�SXdC OHIO II
�' ` ss.
�' -------------------------------------------------------�------------------------ UNION `
---- ----------- - --------------__coU►,cy. 2 9 th
authenticated this .__..._day of._____________________.., 19_____ Personally came Uefore me tLis ____.____.__.day of
'� __necember_________________., 19�9___ the above named �
-- -------------------------------------- --------------------------------- Karen K. Schmitz �
----- •------- -------- ->�------�-----= --- -----.---------------------- --
* . i .i J. -r+
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---- --------------------------- -------------------------- -------------- -�-�rc:._...-�-�----•---..-r-'�'-•:-------`-�•_-`---�------------- --•------
, TITI,E: BfEbTBER STATE BAR OF WISCONSiN �
-- ----- ------------------------------ --�--•--•---------------•-----•---
��� (If not- ---------------- --- ---------------.._...------------
- - -- - - ---- --- --- - �--.� -- - - ----- ----------
tiuthorized by § 70ti.Ofi, �'Vis. Stats.)
to me knowi�.t ��f �e�rt'-.,____... ._ wl�o executed the
foregoing inb�}�i��i� ��f'ev�Qfu�edge tlie sanie.
�\ 6.
THIS INSTRUMENT WAS DR4FTED BY `�.' F_\r '��5���� �
Don Losby, Lawyer ------ :-,;- -�.,,-;� � --- --- � - -- ----
- ----- - - ---- - --- ----- -- � �" .
- ------------ -------- � - -- �
--.. :�; '. . � - �
* -, J-r-�--- ---� - -- --• � � ------- ---------------
_---Eau..C_1_aire ,---WI_547_01------------------- -- � � � ..cou»t ��. ON
- NofAr.y ubll� ---_----�il�lll�_� � -,------ Y,
(Si�natui•es rot�y be autLenticated or acl�no�vled�;ed. I3oth 1��.1' Comuiiss�on is permanf��.l f not, state expiration
are not necessary.) � r ' - � �''3 /
clate: - --- -- - r'• - -=--- ------- ---- -- � 19�Q_...)
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'� 4UI'f CI,AIM DtiGD ti'fA9'I; It:Ut UI' 1�'ISI'ONtiIN ��'�::������,i„ I.���::�1 Itlnn6 C,� li��•
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APPLICATION FOR SANffARY �ERMIT °�
� DILHR SAWYER
_C�UNTY W
(PLB 67) UNIFORM SANITARV PER 'IT�'
'� CST 86-029 77033
—Attach complete plans in accord with s.H 63.05,Wis.Adm.Code for the system,on paper not less than 8'/x 11 inches in size.
—See reverse side for instructions for completing this application. PLEASE PRINT
PROPERTY OWNER MAILING ADDRESS
CHUCK LEVERENTZ 1515 GO�F RD. EAU CLAIRE, WI 54701
PROPERTV LOCATION CITY:
NW SW 8 37 9 vi��°cE: EDGEWATER
1/4 1/4,S ,T ,N,R E(or VIF rowN oF
LOT N MBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, E R LANDMAFiK STATE PLAN I.D.NUMBER
ar� Gov NA NA LAKE CHETAC NA
TYPE OF BUILDING OR USE SERVED �
i� 1 or 2 Family Number of Bedrooms: 3 CJ Public(Specify): NA
THIS PERMIT IS FOR A: '°
� New System . ❑ Tank Replacement ❑ Repair
❑ Replacement Soil Absorption System ❑ Revision ❑ Privy
❑ Altemate System L� Reconnection ❑ Petition for Modification
IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK.
� Seepaye Bed ❑ Seepage Trench � Seepa�e Pit ❑ Holdiny Tank
❑ System-ImFill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy
❑ Existing,For Which A Previous Permit Is On File,Permit# issued
❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions.
To2al #of Prefab. Site S[eel Fiberglass Plastic
Gallons Tanks Concrete Consvucted
Septic Tank Capaciry 1��� 1 X
Lift Pump Tank/Siphon Chamber
Holding Tank capacity
Manufacmrec � H FF N
IF THIS IS AN ALTERNATIVE SYSTEfJI COMPLETE THIS BLOCK: ❑ Mound ❑ In-Ground Pressure
Total #of Prefab. S'ite Steel Fiberglass Plastic
Gallons Tanks Concrete Construcred
Septic Tank Capacity
Lift Pump/Siphon Chamher
Manufacturer:
PERCOLATION RATE ABSORPTION AREA ABSORPTION AflEA WqTER SUPPLY:
(Minutes per inch): REQUIRED(Square Feetl: PROPOSED(Square Feet):
2 615 620 � Private �' Joint ❑ Public
I,the undersigned,hereby assume responsibility for installation the priva�sewa e syst shown on the attached plans.
Name of Plumber 1Primb Signature: � MP MPRSW o.: Phone Number:
LEROY SANDRIDGE Z� / 3120 �71513543882
Plumber's Address: ' Name of Designec
ROUTE 1 BOX 265 SARONA, WI 5 70 SAME
COUNTY/DEPARTMENT USE ONLY
Sign u of Issuing Agent: Fee: Da2e: ._:Disapproved
$95.00 5-23-56 ��q ❑ow�e����e���iva�
pproved qdverse Determination
Reason for Dfsa rov I:
Alternate course(s)of Action Available:
DILHR-SBD-6398(R.SB2) DISTRIBUTION: Original to County, One Copy To; Bureau Of Plum6ing,Owner,Plumber
.
�EPAR71V1ENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY �
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS
P.O. BOX 7969 BUREAU OF P�
MADISON, WI 53707
� CONVENTIONAL ❑ ALTERNATIVE S�atePlanl.U. Number
�II asslgned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME O 7EFM1T MOLDER: ADDRESS OF CERMIT HOLDER'. INSPECTION DATE:
G tcLC� ver �z �` � � � �' . � w �c. G �atY� c.c� i S-, - slo
BENCH MARK IPermanent reference po�nt) DESCRBE IF DIFFEFENT FROM PLAN ,J--y �o� qEf. PT. ELEV.'. CST REF PT. ELEV
Ndmeol Plumber. MP/MPRSW Nn. Cnuniy $amlary Permrt Nomber�.
L o Y o �G - O3 (
SEPTIC TANK/HOLDING TANK:
MANUFACTUFEF� �IOUIDCAPACITV TANK WLF? ELEV TANKOUTLETELEv WARNINGLABEL LOCKINGCOVER
/� qo ,/ PROVIDED. PROVIDED'
u G N l. IvC 2� UU O �� / O• 7 ��YES L�NO ❑YES ❑NO
BEDDING�. VENTpIA. VENiM�I1 HIGIIWnTF.H NUMBEROF ROAD�. PNpP[RTV WELL dUILUWG IV[N� TOFRESH
nt.nr�ni FEET FROM LINE AIR INLET
❑YES ❑NO L_� YES ❑ NO NEAREST �'S � 7ZSr 7S � �'
DOSING CHAMBER:
MANUFACTUREH BEDUING. LIp�11f1 C,�PnCI Iv PUMP Mt)UEL PUM7 SIPHON Ml�NU� nC1UHEH WARNING LABEL LOCKING COVER
PROVIDED� PROVIDED:
❑YES ❑NO ❑YES ❑ NO ❑ YES ❑ NO
GALLONS PER CYCLE: aunnP nrvo corvrHo�soPEHnriow��_ NUMBER OF �'"r�rewry wFu eui�oin�c; I vErvT ro FResr+
(DIFFERENCE BETWEEN FEET FROM ` ��"E ''ia iN�ET
PUMP ON AND OFF) ❑ YES ❑NO NEAREST—�►
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of piowing � � f �r�,u� ninn,F rE r+ �.iart H�ni nrvo MaHK�Nc;
or excavation. (lf soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM: �
�VIU1H �EN(iIll N(7 UI �)ItiIH I'IVk '.�'��.INt, CUVf il IN:lll)L Ull� iVIIS LIQUID
BED/TRENCH /J � y z � ti�trvc��ts � ainrtrain� pIT
DIMENSIONS oevrH
�- lv AV
GRAVEL DEPTH FILI DEPTN U151�� PIPf UISTH PIPE DISTR. PIPF MATERIAL NO ICiH NUMBE�R OF � PHOPEary WELL BUIL�ING VE1JT TO FRESH
BELOW PIPF� I ABOVE COVE(a EI Ev INl f t ELEV ENU ' / PR'E 5 �FEET FROM�� "�.�'' . .. LINE / � f AIR INLETy
I / �� / G•.3 / P• � �v'e JO3 _1_ NEAREST—� � s �'JU 7Z, 7ZJ�
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
❑YES ❑NO
SOIL COVER TExTURE a�iininrvtNi �ani�Kti+s oissEr+van��rvwe��s
❑ YES ❑NO ❑YES ❑ NO
DEPTHOVERTRENCNtlED DEv7110Vf�+ THENCIIHFU I)fPiHt)F7(1�'Stn� tif�Ul)F11 SFEUfU �ViULCF1ED
CEMER EDGES
L_IYES C�NO ❑ YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
� WIDTH LEN(i711 NO. OF IATEHAL $PACING <��Hl�VEI. UEP7N H( LUW VIPf FILL DEPTH ABOVE CJVEH
BED/TRENCH raehc�Es
DIMENSIONS
. . . . . �: MANIFOLD PUMP MAMG(7LD DISTR. PIPE MAMFOLD MATEHIAL NO UISTH UISTH PIPE UISTHBU IION PIPE MATEHIAL & M1IARKING
� ELEV. ELEV UI� ELEV PIPES DIA
ELEVATION AND
DISTRIBUTION
INFORMATION , �OLESIZE HOLESPl�CWG U��I�LEUCf1HHEC1Lv COVEHA9A7EHIAL pL� $CI�LUF7CORFESPONDSTOAPPROVED
❑YES ❑ NO ❑ YES ❑ NO
COMMENTS: PERMANENTMARKERS. OBSEFVATIONWELLS NUMBEROF PHpVERTV WELIL BUILDING�.
FEET FROM ��"E
L� YES ❑ NO UYES ��NO _ NEAREST _
� �I
Sketch System on Retain in county file for audit.
Reverse Slde.
SIGNAT TITIE
DILHR SBD 6710 (R. 01 /82) �� ` `"`-w`-L�
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