HomeMy WebLinkAbout010-841-28-3107-LUP-1992-181 . Application for Land Use Permit � �
�ounty of Sawyer o
The undersigned fiereby makes application for a Land Use Permit and �
agrees that all work shall 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. 1
PRINT - USE BLACR INK OR PENCIL ��
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Owner Builder
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Mailing Address Mailing Adclress _
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�C�i�<r�-�t�CF�.io, �y�v 3 %m-�t��i �
"City, State, Zip City, State, Zip
Building Land Use Zone District �-� o 0
( ) New ( ) Filling r* d
(�/J Addition O Dredging Lot size j r U YC :� �D m n
( ) Alteration ( ) Grading
( ) Moving On ( ) Acres , ��y(}
( ) ( ) �
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New Construction �
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Size �,� ft wide ft wide �
2�3 ft long ft long �
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Floor area 3� sq ft sq ft �
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Total htg �� to peak to peak g�,� �
Stories / Stories ���
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No. of Bedrooms � rear lot line or waterline o
�° C
( eay r round) or (seasonal) G rt
Type of Bldg or Addition `'/a o
( ) Dwelling � rr
( ) Garage (1) (2) car �.
( ) Storage Building ��'� �'
( ) Boathouse ~
h
( ) Livingroom ��'�� � �° � � �
((�" Bedroom R�puac� �x�s�U� �--- ------F _.
( ) Kitchen-Dining �
( ) Porch - enclosed/roofed � ��,
( ) Deck - open � ' ���' ��� r�
( ) � ; �,�'�,o�
c �-, �8; ' �y t�
� I d� a �
Type of Construction i
(UJ Frame ( ) Block � c�,' p <v�
( ) Log ( ) Concrete Q�- � —� �
( ) Pole ( ) Steel ,— �
( ) Metal ( ) i - �.J �
3 ��
Construction Cost $ �„'r'"P�(9,c4-O > �
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Vol �37 Pg �y� of deed 1
CS Vol — Pg —" 7g' Li' ro �
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Cer. Soil Test g2_ -(1� I �
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-l�2 ----------CL Road --------------- I .
Sanitary Permit �2. o
PH�LL��.L �O� - Twn1 ' z
QD 7�
Issued 29 ��F �-�iqZ Denied �
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�^a t�c 1�- -dy�d;�)Cu £
Owner Zoning Administ ato
SEC. 28 TV#/P 41 R. 8
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PHELAN ROAD
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�DEPARTMENT OF £� APPLlCATION '� SAFETY&BUIL��ING5
irv�usTRv, FOR SANRARY oi��isiuh�
LAROR ANp PERMIT P.O.BOX 7969.�;'
HUMAN RELATIONS . (PLB 67) MADISON,WI 53'%07�
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Attach plans for the system on paper not less than 8%x 11 inches in size.Include a plot plan that is dimensioned or drawn to scale.Horizontal
and vertical elevation reference points must be shown.All appropriate separating distances and physical characteristics as specified in chapter
H-63,Wis.Adm.Code,must be shown.An index page or each page must be signed,sealed and dated by the designer.If designed by a Master
Plumber, the date, signature and license number must be shown.A legible reproduction of the soil.test report or the owner's copy must be
included. -
Property Owner. ` Mai" Address: q / � a
r` O G2 / U �— / u/a�.�d G<�l• �S�a�
Property Location: City, illage or To_�P: County:
�'/a uJ YaS o�-P�T N�R .E-Fer{-W �,� Q� 1,��
Lot Number: Blk No.: Subdivision Name: Ne st Roa ,Lake or Landmark: State Plan I.D.Number.
� Q �� �/ Uf assignedl
TYPE OF BUILDING
� � Number of
❑ Public' ❑ Variance" ❑ Other(specify�` eedrooms:
1 or 2 Family "State Approval Required. �/
TOTAL NUMBER PREFAB POURED-IN STEEL FIBERGLASS NEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTALLATION MENT ISpecify)
SEPTIC TANK CAPACITY �
HOLDING TANK CAPACITV � � �
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER:
EFFLUENT DISPOSAL SYSTEM �
PERCOLATION RATE ABSORPTION AREA
(Minutes per inchl: PROPOSED ISquare feetl: � New ❑ Replacement ❑ Experimental� ❑ Seepage Bed ❑ Seepage Pit
2 42� Alternative�specify) ❑ SeepageTrench
Wate Supply: Owner's Name as Listed on Soil Test Report Uf other than present owner�: �
�Private ❑Joint ❑ Public ��-f� ��-
�
I,the undersigned,hereby assume responsibility for insta tion o the private sewage system shown on the attached plans.
�Na e of Plumber. Sig e� -MP/MPRSW No.: Phone N�umber.
u� a� -CC�.a- /�7 �7rsr 6�Y-YZS'
Plu r Add E55: 1 Name of Designec -
CS� 6�
COUNTY/DEPARTMENT USE ONLY CST 82-175
� Sign f IssuingA ent� Fee: Date: �qppROVED SanitaryPermitNumbei:
$60.00 9-13-82 ❑DISAPPROVED 29514
fieason for Disapp vaL .
Alternate coursels)of Action Available: _ �
Change of ownership, building use or plumber requires a Sanitary Permit Transfer Form(67-T)to be submitted to the county prlor to im
stallation.Failure to comply will void the sanitary permit.
DISTRIBUTION:White-County,Canary-Bureau of Plumbing,Pink-Owner,Goldenrod-Plumber
DI LHR-SBDE398 IF1.07/81)
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUI�DINGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P-O. BOX 7969 BUREAU OF PLUMBING
MAOISON, �UI 53707
❑ CONVENTIONAL ❑ ALTERNATIVE StatePlanl.D. Number:
(lf assigned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOIDER: ADDRESS OF PERMIT HOLDER�. INSPECTION DATE:
� �dri � � �i
_.,
�� .� f�- t .. �� � i� t. ��. / `% _. /�� ,t <.. � � '� �-�i"
BENCH MARK IPermanent reference po�nt) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF.PT. ELEV.:
� J _ .
r � >-� l i i� �.c�/.','r r , � . , ;, .
Namr ol Plumber�. MP/MPRSW No.�. Covnry. Sannary Permil Numbec
�'.�� I/ , .- /' � ..� . . i � . . ' ! _ . . . .
SEPTIC TANK/HOLDIMG TANK:
MANUFACTURER�. LI�UID CAPACITY: TANK INLET ELEV.�. TANK OUTLET ELEV. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
�ri — 1�1 ;',,. .�. , . _ � - '?i' , YES ❑NO ❑YES ❑NO
BEDDING: VENTDIA.�. VENTMATL. HIGHWATER NUMBEROF �: ROAD: 7ROPERTV WEIL BUILDING�. iVENTTOFRESH
ALARM FEET FROM � LWE: �AIR INLET:
�XJYES ❑NO �� . ❑YES ❑ NO NEAREST I
DOSING CHAMBER:
MANUFACTURER BEUDING: LIQUID CAPACIiv PUMP MODEL PUMP/SIPHON MANUFACTUHER WARNING LABEL LOCKING COVER
PFOVIDED: PfiOVIDED:
❑ YES ❑ NO ❑YES ❑NO ❑YES ❑NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OF PROPEHTV WELI� B�1ILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FRQM ��"E AiR iN�Er:
PUMP ON AND OFF) ❑YES ❑ NO NEAREST
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing �.rrvcrr� oinnnEreN MATERIAL AND MARKWG
or excavation. (If soil can be rolled into a wire, construction shall cease until ' FORCE
the soil is dry enough to continue.)
' MAIN
CONVENTIONAL SYSTEM:
6VIDTH LENGTH NO. OF DISTR. PIPE $PACING COVEH INSIUE UTA #PITS. LI�UID
BED/TRENCH , rHervcNes , nnnreyioi. P�T DEPTH:
DIMENSIONS � ' ' -
GHAVGL DE PTH FILL DEPTH UISTH. PIPF DISTH. PIPE DISTR. PIPE MATERIAL�. NO. DISTH. NUMBER OF � � PROPERTV WELL�. BUILDING: VENT TO FRESH
BELOW PIPES ABOVE COVEH� ELEV. INLET ELEv. END�. PIPES. '� LINE: � � AIR INLET�
�, FEET FROM `_ �-� �
/ [/ �� �-O • ' " � : l NEAREST—� J 3 S ���J
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. TEXTU�7E PERMANENT MARKERS: O�SERVATION WELLS.
❑YES ❑NO ❑YES ❑NO
UEPTH OVER THENCH:BED pEPTH OVFHTNENCH;BED UEPTH OFTOPSOIL SODOED SEEDED- MULCHED:
CEN7ER EDGES�
❑YES ❑NO ❑ YES ❑NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
- ' WIDTH LENG7H N0. OF LA7ERAL SPACING. GRAVEL DEPTH BELOW PIPF�. FILL pEPTH ABOVE COVER:
BED/TRENCH raervcHes
DIMENSIONS
. MANIFOLD PUMP MAMFOLD DISTR PIPE MANIFOLD MATEHIAL�. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL& MARKING.
� ELEV.. ELEV. DIA. ELEV. PIPES DIA.:
EI.EVATiON AND
bISTRIBUTION '
INFORMATION � HOLE SIZE HO�E SPACING DRILLED COHRECTLY COVER MATERIAL�. VERTICAL LIFT CORRESPONDS TO APPROVED
PLANS.
❑YES ❑ NO ❑YES ❑NO
COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS�. NUMBE�R OF� ��� � PROPERTY WELL: BUILDING:
FEET FROM ��"E
❑ YES ❑ NO ❑YES ❑ NO NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
''IGNATURE TITLE
DiLHf? SBD 67�0 (R. 01/82) J ^ �.�(/�y,'-"� J�s... , .�1,,,,�
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� . � . ,. DOCUMENT NO. WARMNTY DEED �
�, 237 RD� 6 9 8 BTATE OF WIiCON81N—FORM 0 �
� THt� •rAC[ R[�[11V[D rOR R[CORDINO OATA I
140986 � � � �
i Harvey T Nor in an Register's OEEice � �
THI�S I�DEr�TiJR�� l�fad� b�.----••-•- •---•.........................................................••--•--••-• y y '
e� a or n i wi�e saw � co��c
I ...-•------ :.._..._.._...-----_......_-----•-••--••-•---•.................................................�-.....:.__.
' c eived for record ffie � day ot
••-----•--........_........_.................._.......-•---_........--•--•-••••-•-.....---...._...-------•---..... .. _ _ :'
S •- � OFri-1 A D 19 c (�',fip �
I gtantor...._. of....---__..... County �G�s�o'�i3�en o ctock
..._..__..._......-•--_.............................._....... , , � --
hereby conveys and warrants to..._ Dor is P . Moncel d and recorded 'n vob? 3 ?
I ......................._......................-•---......._...__... - � --
••-•-•--••-•-.......---••--• f orde on pape
..-•..............---_......._..__.......---__...--•--•--•--••-----......... .._...........-•-----•-• � � �
i ..».__......-••-_•-_•---------__.._.----•...•---...__....--•........................•---....-•-•---•-------•---...._....-•---•--- R i er
I ..�_._..__..._........_._..w.�...._.�.Y..._..__....._........_.......... .�..�.»^----8rantee........ of DeD�SC
._.._.._.._.---
Sa er ._......_.........._County� Wisconsin for the sum of
..._.._.. ...�'!'�'._....--------•--._.._.......
._.__,Q��__.�$1 ..00�_.Doll�a�C ..a�d__other_,.y,aluable F URN To
... :consideta�ion.._........_.................._.........:........_................._......_.._..---.• ��" �����
..__- --• -- --- - •- .. �~
. . _ .. ._......___._. ....._...._................•---•-...__. ...:-------....._...--- -
the following tract of land in.............Sav�er ..,....,...,......_............County
._.............• �
Wisconsin: ..__.------•---.._---•---._................••--•-•--............._..-•-•---..::......-•--•--........--•-------•--
East Half of the Southwest Quarter (E�i SW�) , and the Southwest Quarter
of the Southeast Quarter (SW,�, SE�) in Section Twenty-eight (28 ) o
Township Forty-one (41 ) North, Range Eight (8 ) West .
. • i
Subject to all easements , exceptions and reservations of record .
This Deed is given in fulfillment of a land contract between the
parties hereto bearing date of September 15 , 1966 .
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In Wimess Wher�,� e said ranto c.s . ha.Ve _. hereu�tp set..._the ir . �ands_.. and seal_S.. this
..._.._.._.._..l�fh day of..����?�......March....., A. D.� 19 _ _ �
. . ---- •
..�C . .. .. .C���-=' -- --'-...�------..�._�sEnL>
ra AND BmALED IN PR�8�N0� OF Ha vey -�N rdin
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.. ...... ....... .. ..__. ........_--•----• --......_..___.__..__ - Hel a `Nvrdin
enry es �
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. . . .... .. . ._.............................................
Ma Smith
...............................•-•-•---.....-•----•-•---------------•--•-•--...----•--------_(ssnL>
: Wyoming h
� Stau of VQl�Oolssta,
' ......._. ._.._...-------•-----.......County. � Personally came before me, this._...�.�t�_. day of..�.�s��+��---., A. D., 19.71.,
' a o din his wife
.
the above named ....Hr�l�v.�y.._T.,....�T.O�d�.i�_.��..��.�.3----..�...?_:..._.....o....................•---•---..................--•-•---........---.....
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......_.
to me known to be the petson..s. w�i5ri:exetuted fhe'(qregoing instrument and a knowledged the same.
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� � THI• IN6TRUMEHT WAf DRAFT[D sY �� }-- . �-' = • omin
� T . W. Duffy Attorne '' �OTAnT � dta Public ............ . �..c'�.�:�..1_(.� County, RNFs.
r Y -��;�. ��• '� � � + /"..............
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a , ay ard, W1.s . '��, " ..•' :: M Commission Expire�
' at 1 W H W , •...... ��� . My commission (expires) (i�)........Y... ....... ....••--•............_.�
y �, .., � El Nov. A;'t4T�' I
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(Stctloe 7l.fi (1) d tlu Wi�coarlo 5t�tnta pra�I�d th�! �ll In�tntmentf to be tecotded �h�il hne pltinl� printed ot typewritten tfieteon _ ,
1Le Ifimn a( the �t on� , wRaa�es �nd notu�. Satton 39.513 �imilul� requiw eh�t !he n�me of the penon �ho, or �mera•� r � �` 7 �'�T'y � 0 �J
meetd �iea� whlcb, dnR� I�wmad, th�ll be printed hpewr�tten, sum 8 ot wriNm l6ereon In a legible m�nnct.) '��. +�'�.-
wen�rwtt bE�b� BTAT� c3F WtsCONS�N Wleconefn LeR�t Hleek ComDen� ,
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