HomeMy WebLinkAbout010-941-29-3301-LUP-1992-178 /
Application for Land Use Permit
County of Sawyer x o �
T he un dersigne d here by ma kes app lica tion for a Lan d Use Permi t an d �
agrees that a11 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 -
ma�ziL�r.� v. � V �►
�Ru� �. �o2N.�� ' �. �,� :- �
Owr.er Builder
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Mailing Address Mailing Address
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City, State, Zip City, State, Zip
Buildin Land Use Zone District � r �
g �-,.: A- 1 0
(y� New ( ) Filling ` rt
(X) Addition O Dredging Lot size �`�,7p�� (3., c_ N n
( ) Alteration ( ) Grading
( ) Moving On ( ) Acres ' D
( ) ( )
New Construc�iqn
�=.��. _ � ,� .
Size �,� ft wide ft wide
' ft long ft long
Floor area sq ft sq ft
� r
Total htg �� to peak to peak �
SC�
Stories � ' Stories
No. of Bedrooms rear lot line or waterline c�
h a.CL�cSS of-F 6o2tJ��( �oAP �
(year round) or (seasonal) �, rt
Type of Bldg or Addition � � � Q' r
( ) Dwelling �j� a o
(�) Garage �j (2) car <
( ) Storage Building m�
( ) Boathouse ~'
( ) Livingroom �yf,� �
( ) Bedroom Ktibk�
( ) Kitchen-Dining �
(X) Porch - enclosed/roofed -
( ) Deck - open
�
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� � � 794''" b �s� -��_�6� - I* __
Ty�e of Construction M 2 '��u��o, o
(4) Frame ( ) Block
( ) Log ( ) Concrete \ � `�
( ) Pole ( ) Steel 2�� i
( ) Metal ( ) � za� N �o
� �
Construction Cost $ �- �8 �' w
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Cer. Soi1 Test f7-- �'�`7 qpp'{ �
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Sanitary Permit -O2 ---------' _ o
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Issued Z_(_a �„� 194Z Denied
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Owner Zoning Admini tra or
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OD'02/ 77/H .11Nn0.�
DOCUMENT NO, WARRANTY DEIOD I
BTATE OF WIBCON8IN—FORM D
15931 '�
THI• irAC[ R[�[11V[D FOR R[CORDINO DATA �
A���/ v[IOO � �
� r�OWyOT �.OlYll}� '
THIS INDENI�.JRE, Made by..GEQRGE_.;GQRN.,F3Y.,_��a_..s�j,G�J�,$...GVk�IF� � R et�ed tae record ths ��ler ol
..------hi_s._ wi fe..---and._i??._.her...oW?�.__�i.9.��.........-•--••.............................. A D is ,� nt ; o�otook
i .••••-•••-----••••••--•••-••.................•••-••-•--••--......--•.._......_..._.............••••...._......._...._.....•••......-•-••-•... . end recotded In v 1. a��
i grantor...S of....................Sawyer.-•...-•--•---••---........._.._._......._..County, Wisconsin, o! R.co � on paqe
� hereby conveys and warrants to....PAU�,......GQ�`1.��C...sil��...1"�A�RI�X�`I�`.I..... � �u-r.u'_ ��d,,,._�
j ••••....�'a.Q�.�'t.Y.r..._kl�$...Wl.�S�..i.._�,�...J-Q�1�.j:.•••��Xla�1�Sr................................ Aeqlrtec
. .....................--••••-•---•-...-•-•-•..._..._......._................................._...............-•---....................._..... •
a�h
--...---..._.............._..._.....----.........._....--••---................_.....---•-•-•---...._._._..---•--graiitee...�.. of ,
Sawyer,...____ _ County, Wisconsin for the sum of _ �
......__ .._. ..................•-•----••-----....... ..._..
,__.__._Q.�e_._�Q],la�r.__and..,Qther.._gQod...�n�...v��,ua��e...cqnsi�,. RE �� �
S��_X�_�.].Qx1-- BOX 989
---- -----
�-•-•--- ..... .... ......... ......... ......... .•-•--..._....._.._.._ ._........._................
_ NAYIMARD, WISCQNSIN 54843 '
•...................................................•--••••._.............._.......----._...._.............................._................
� the following tract of land in.....................Sav�yer.._„_....._,_...,._._...,,,..___..County,
� Wisconsin : ...............................••••••••--...........--••-•....................._............__.._..._......_......._.. ��
The Southwest Quarter of the Southwest Quarter ( SW 1/4 SW 1/4 ) of
Section Twenty-nine ( 29 ) Township Forty-one ( 41 ) North , Range Nine
( 9 ) West , together with an easement two ( 2 ) rods in width on and
�rough the Northwest Quarter of the Southwest Quarter (NW 1/4 . SW 1/4 )
I of Section Twenty-nine ( 29 ) , Township Forty-one ( 41 ) North , Range
� Nine ( 9 ) West .
� Subject to reservations , easements exceptions of record .
TRAN�FER
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� I In Wimess Whereof, the said p,rantot..S. ha..Ve.. hereunto set......thei r..__.,, ❑d_.s, and seals.... this
.......4:ki1._...__._._. day oE.___._.._..1'1ay-----=�....................... A. D., 19...Z7 .
6I(3NED AND BBALED IN PFtEBENCE OF ..:.���. ...�.. ..... . ..... •• ••.-............•-• .... .. SEAL�
GEORGE��3��RNEY
...............................•----••---.............--•--..............---.......................... .....'-'�"•�... ............------� -- /....._....... .......... . ..............(SEAL)
AG S GORNEY
..._..••••••••••-••.......................•-••-••••••............_..•••••••....•••.. ••••••••••••••••••••...•••...••-•••••--•....•••••••-••••...•••-••-••-•••...........-•••-••••..(SEAL)
..................
..............................•••••..........................._................•••••••••......(SEAL)
State of V✓isconsin,
----••-•-•••--����3'-��---•-....-..._.County. � Personally came before me, tl�is.:.�.�.h_.... da of_ �� �_�.
y . ............�..._.__........, A. D. 19.7.Z..,
the above named ...�F,�Q.R�F:_..GQ�IFX__.t�Sl_S�_.���k'.,S...GQRNEY_�...hls wi_fe_,_._and__.in._her...own...__.
I �•-----••-.-..righ�-------------•--------•---......__..--•--...yr::��-E3-.f�...�y. -•---- --••----
to me known to be the person.s... who O 1[fad 'the f�14�;ping inst en no ged the same.
� � �NOTA ..
' -•, -=- -- •--. .
•...... .........•--......... ..._..-•-•---••---
� •---..._...........
THIS INSTRUMENT WA3 DRAFTED BY H �r . H SO17
•
�, Ni� SEA L \�ar .� ubl;c ......_...Sac'a�'er--•--......--••---••--••-----•County, �Vis. .
I Howard E . Hanson Atto � � '
t•i� "' . . •��Q�Yy commission Q€�4¢?f� (is)...�?e_S�1c�Xl.P.,,I1�....................
................
� (Section 39.31 (1) of tlu Wisconsin Statutes provi , jj�'a�� �nstruments to be tecorded shall have laiol
the names of the Qrantors, grantees, witneuos and notary, Settion 59.313 similady requires that the nama of�th►. � � �et on �j
niental a�oncy wh�ch, dra.ied such instrument shall be o, or o `^• � '
r
. printed, typewritten, stamped or written thereon in � legibla manner,)
nm A mr� nn �xri[vn/�LPtlsLt
� ��� _
P �� � � State and County State Permit # 1134
� ; Permit Application County Permit # —8"�Z9 ,
for Private Domestic Sewage Systems County SgWYer
CS? 7-327 .
"DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY paul Gorney Mailing Address: �putg 3
�� � � �v ' � � ��
B. LOCATION: ,_,;_�'2/ Y4�,:l• Y4, ection �, T� N, R� E (or) W Lot# iC.��
Sub isi n. .f�me, �, nearest r d, lake or landmark Blk# Village •
/ ��/'�-{ , �l� � / f.-i ft�U`'���_:' Township l
�.����_T�� � �� ! `� .11.1.
C. TYPE OF OCCUPANCY: C mer ia *Industrial *Other (specify) *Variance
Single family _� Duplex No. of Bedrooms � No. of Persons_�
. /
D. TYPE OF APPLIANCES: Dishwasher �li�'ES NO Food Waste Grinder � YES�'fPVO # of Bathroom�—_�
Automatic Washer _ �� (VO Other (specify)
�._�
E. SEPTIC TANK CAPACITY � Total gallons No. of tanks _
�'Holding tank capacity Total gallons No. of tanks
New Installation Addition_ Replacement_ Prefab Concrete
*Poured in Place Steel Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) � 2) � 3) �Total Absorb Area � ,� sq. ft.
New� Addition Replacement *Fill System
Seepage Trench: No. Lin✓Feet Width Depth Tile Depth No. of Trenches__
Seepage Bed: Length,=% t� �Width�Depth=�Tile Depth � y �� No. of Lines �
Seepage Pit: Inside diameter Liquid Depth Tile Size
Percent slope of land���/G� Distance from critical slope�/ `�_G�
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 the Certified Soil Tester,
NAME Lawrence Lam$hear C.S.T. # 55-469 and other information
obtained from - /J� �- � (owner/builder).
Plumber's Signature � _ ��p % ���/�i� Phone #�i 'J it/1/ �
Plumber's Address��! .,,�.� �` � � ► , ✓ '�l -
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well). �� ��
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Do Not Write in Space Below - FOR DEPARTMENT USE ONLY
Date of Application 5-19-78 Fees Paid: State 1,0 0 0� County l�j.BO Date 19 Msy 1978
Permit Issue� (date) 5—],9-�7$ _Issuing Agent Name LOY'1 Carryl
Inspection Yes No Valid# Date Rec'd
1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701
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Department of Zoning and Sanitation £ -
Sawyer County �
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Inspection Report
Owner Paul Gorney
Address Route 3 Hayward Wisconsin 54843 tp
Name of business
ro
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Builder C
r
Address
Plumber _ �aVern Dennis �
Address winter Wisconsin 54896
H
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Tnspection �
� Private ( ) Public Property Sanitary-instal °,
Dwelling Setback - lake
Violation Mobile Hm Setback - road
Garage Setback-lot line
( ) Sanitary ( ) Zoning Privy E
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ICouN Htu- Rd c°r H
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Discussed with owner yes no �
Discussed with builder yes no
Discussed with plumber _ yes no
�
Discussed with yes no
Dat e 5 —�9— �l�
Signature of Officer u^1��.