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Home My WebLink About010-941-20-1102-LUP-1992-470 Application for Land Use Permit County of Sawyer X o� The undersigned hereby makes application for a Land Use Permit and agrees that q all work shall be done in compliance with the requirements of the Sawyer County p Zoning Ordinance and the laws and regulations of the State of Wisconsin. � PRINT - USE BLACK INK OR PENCIL , ��rt/� /� ;J Gt�-✓G. �.' ` � ,f�i�X� � �C /�-yI?S G'G�e u 1 U<�G(. �i'�'✓C� za Owrner Bui der � ��L"��, ,�'��t_- �~��+ �f'�c-i—� /��' �.-.t'�.�8 � Mai ing Address Mailing Address � /�u ..,��.,�;-�� :�,� s�/�s1= �a�e ��i�L Gv, � s�sl'�`'�3 Cit , State, Zip Cit , State, Zip o � Building Land Use Zone District F} — rt ( ) Addition ( ) Dredlin Lot size ��L�� ' �� `�. � (�Cj g� g �� k �-•�:- ( ) Alteration ( ) Grading ',y � ( ) Moving On ( ) Acres �� \/ ti�� ( ) ( ) c��(�eT AoP ��i New Construction � �U� Zo A;�_'l 1�,A'r ��j , �� . �I Size � ft wide ��.3Z ' wide ' wide � t�', '\ /Lv ft long ��' long ' long Floor area "'� � sq ft � sq ft sq ft �;\,� � `. 1 i r ` � Total hgt / � to peak /� ' hgt ' hgt �' � � ; \ Stories / � No. of Bedrooms -- rear lot line or waterline o C (year round) or (seasonal) G rt Type of Bldg, Addition, Use a o ( ) Dwelling ~� rt c ( ) Garage (1) (2) car N' ( ) Storage Building o ( ) Boathouse p � Livingroom __ _ _ � Bedroom=r�•:+E - � . ( ) Kitchen-Dining � ?�`� � ( ) Porch (enclosed) (roofed) � ( ) Deck - o n ( � �: �. �� r <, ( ) Ty e of Construction �� % � , (� Frame ( ) Block i \�.� �.� ' ( ) Log ( ) Concrete �1 � `,rt C., rv' ( ) Pole ( ) Steel � C � ( ) � Pole/Metal �a � V\ . � PPo � { �� t� / �'. Construction Cost $S,JUv- 4-ltp 30'7 B�•�nc'�rw , � �J Vol �'_� Pg - t± of Deed CS Vol � Pg .d '� w �a n Cer. Soil Test 7- �J � � m I _ . ,` � � Sanitary Permit :' �- �-� `t L road -------------- z ---------- � LuP B'z—�S� ° L�_; • z zssued Qq QloomhF►P 1942-- Denied • � /�% � h � � �_t�'" �cL• ;=1/_/ : "%`!" i �(u � r�ck�-d�-C�UT"� E ,� Owner Zoning A ministrator Io �'► c, e� � � � � � � � ,�' d- �r �v e � \ �� ' � `� p � c �i � � \ �. � � v � � N _ �z f i +� � r ° o � �� F-- s<<, , -� i �I -�' a, > � i � s� � � � � �. I '�.- � � 3�x o� �`�� J c � �k _ _ � _' � - :� �' � _ �;, __�� ., � C� "S ( -�� P i /� _ / o}-ti�� %/ i �`" - _// � , �/' \ ��'�.� � �/ \ Q'� � � � I� � \/�\\� � d �� .�r.l ��/, � �. ��( 'C '�a C" k � E - - �"- - ` d�' �J� f, 1.C4I �CJ Or' j- I 3�' i�'�j��s�-� �� '' #�,.r��/ ��°�b�� i� � � 6 ,T1 i � �-�--- -� ---- � _ �G.� _ � �'//.v�, �� TOWN OF HAYWARD SEC. 20 T 41 N. R . 9 W. ,� -7 � .6.2 .5.2 �. .2.1 .I. I .6.1 .5.1 . 3 0 r 1 .7.2 .8.2 �sr .4.1 .4.2 ' .3.I F..ir .7:1 .8.1 .4.3 _ _._ � i �, I - �1 = DOCUMENT NO S 1�ATEi I;:�I{ OF \r I�7CONSIN FU11n1 3 - 1982 THIS 5PACE HESEftVED FOR RECORDIN(i DAU • N � � � � � QUIT CLAIM DEED � ;.�, �a.�„.�.�s��, _ ..: a.��.,,,�..�. _.., _, : . , _ . . . , _ ._._� • • 11eql�ef� Ousoe � ._____THOMAS__HAMS and ISLA HAMS :_ husband and_ wife 5°``'y8I C°"I'ty � - - ----- ---- - - --------- - "'-' " v�d oc rcx.�otd Ihe de) 01 ---------------------------- ----------------� - ----- ---------------------------------- �- <� A D 19 _ ct ;�$' oc1 �------•------------------------------ --------- --------------------- ----•----•------------- ------ t.i ar�d r�::ordad In vol. � quit-claims to ._DIXIE_,L.t__HAMS__and__ EUGENE _L ,._BAUCH,__both____.__ � � /� ' Q� [j()OUIi�J JA F�a�6 _]_j(L. �_��g.�e_ adul.�s__ as_ join�__t_�nants ._______ _________ _________ ------ - - --------- -- -�---------._---------- ----�- --- ------------- --- --- ----------------------------------- R !slet �- - -- - ----------- -------- ------ -------- ------ ----------------- ----------------------------• . ---- , � ----------- ------- - ---------...- •----------- - - -------- --- --- •-- ---------- - -- - the following descriLed real estate in __.__.S�Wy_er____.__.___________._..___ County, State Of WISCOTiSIII : RETURN TO � �.�a,,�� Ill-�Lt� � Tax Parcel No: -------•-__-----•----------- , / The Northeast Quarter of the Northeast 4•!arter (NE�NE} ) , Section Twenty (20) , Township Forty-one (41 ) North, Range Nine (9) West . � F=E�� ,� if `- - EXEMPT This _._.�S..I�ot__.______ homestead property. (is) (is not) I)ated this . - -- - -- --- ---------- ----- -- da�' °f - - -- - -- --- ---------------- ---- ----- - ._, 19- - -• , ,,,,,,, /� � -- � _ _ -- -- --- - ---- --- --- - -- - (SEAL) � -- - --•- �-a""'�--� - - - (SEAL) � * - .Tb_ m�.s_H_ams - -- �-------- --- - - --- -- ----- - (SEAI.) --- -- - •- - - • ----•--•------ - - - -- (SEAI.) * - * - -Isla__Hams.. -�---� - - � -.._._..-- ._..-�- - - -_ --... --------- ----�- -- - - AUTHENTICATION ACKNOWLEDGMENT Signature(s) __..__ STATE OF WISCONSIN ------ ----- ---...--------------------------- ss. -------------------------------------------------------------------------------- �il W�IE �C' -----------------------•--•-----------County. • authenticated this ____.__day of__________________________ 19_.__._ Pe�,sonally came Uefore me this ._�9_____.._day of , �• -...,.. -.:.;t , -----•---�l��v¢m�JP-�--------------� 19__�.'/_.. tl�e above named � � . • f � ' Thomas & Isla Hams ----------• -----------------------------------•-----------:•�------•-=-- ,- -------- : .; ' ' ;' ,:-------•----•---------------•-----••------------------•----------•- ��, �`___"""__""_"""'__""__"""'__"""__""__' """"""""" ' � _""'__""""'__""""'_"__""'___""'_"""""""'_"'___'_" -'." '"' "' T[TI.E : MEMBER STATE BAR OF WISCONSIN ' ,-----;;------------------------------------------------•------------------ (If not- ------- ---------- ------------------�-••----------------•- -----•=---•----------------------------------------------------- ----------.. authorized Uy § 706.06, Wis. Staty,) to me known to be the person �___._____ who executed the , fo e�oi g instrumen �nowledge the sanie. THIS INSTRUMENT WAS DRAFTED BY �` � �� ``�;L�J " � L, . � �j� � � - �/—�-------'---'---------------�— . - ---'-�----"--'-'----'-----'---- li - ---D.uf_f.y__I.a�_0£f_i.ce-----------------------=•----:--�-- - . - -��.x.�'-�-----�-=---�=�%'!'�---------------- ,. ;: , . . ---- ------- _ - Hay�aard, - �� - -54-$4�- ------- --- - ------------ -'•_-. . Notary PuLlic -----�r�Ek'�Qr- --------------County, Wis. (Siguatures may be .�uthenticated or acl.nowled�ed. Both �1Y Comn�ission is permanent. lTf not, state expiration �re not necessarY•) dute: --- -�u-� �l 6-�----/`-�-------------- � 19�`S_.) --__- -_:---_-__-_-=__---_______-_-- ---_.-.-_______�;-�--___-____---- - — - 11�L �1 `� 6 �G 3 � `7 �DILHR SANITARY PERMIT APPLICATION COUNTY •- In accord with ILHR 83.05,Wis.Adm.Code SAWYER a � � . STATESANITARYPERMIT# „ � � CST 87-145 98359 ~ —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBeR � 8%x 11 inches in size. �ee reverse side for instructions for completing this application. PETITION i. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. Foa vnRinNee ❑ves ❑No PROP TYOWNER pROPERTYLOCATION �,/� Q S �Yn 'Ya�S T'Y��N,R E(or9.Yy' P(i RTYOWNER'SMAILINGADDRESS �OTNUMBER BLOCKNUMBER SUBDIVISIONNAME U C�— —� CI ,STATE , ZIP CODE PHONE NUMBER CI7Y : N�AJ�S AD,LAKEQHi)4 ND RK �! ��n ❑ VILLAGE: Qr. /// l�F�/ � C' ui� II. T E OF BUILDING OR USE SERVED: Number of Bedrooms if 1 or 2 Family /�l OR ❑ Public(Specify): ill. PURPOSE OF APPLICATION:(Check only one in#7. Check#2,3 or 4,if applicable) 1. a. �New b.❑Replacement c. ❑Replacement oE d.❑Reconnection of e.❑Repair of an � System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit# Date Issued � 3. ❑An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM:(Check only one in#1 and only one in#2) 1. a. �Conventional b.❑Alternative c. ❑Experimental , 2. a. �System- b.❑ Holding c.❑ Pit Privy d.�Vault Privy e.❑ Mound f.❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. �See a e Bed b.❑See a e Trench c. ❑See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6.WATER SUPPLY: Minutes per inch): RE�UIRED(Square Feet): PROPOSED(Square Feet): O D ��c � ,° Feet Private ❑Joint ❑Public CA ACITY VI. TANK in allons Total #of Prefab. Site Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel 91ass P�astic APP � Tankns Tanks structed Se ticTankorHoldin Tank v ..z �� LiftPum Tank/Si honChamber VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for insta atio of the private s ge system shown on the attached plans. PI mber's Name(Print): / Plum er' i ature:(No Stam MP/�.-. Business Phone Number: '��ic.��im" �1r2 �.� i� -� /�7 �S ��yzs PI ber's Adtlress(Sireet,City,St te,Zip Co ): , Name o Designer. ?,-eq �e eF'.�� Gv , -� c�� VIII. SOIL T T INFORMATIO ' C ifietl Soil Tester(CST)Na e CST# wr. � �V,� ��Er,� yd 9 C 's ADDRESS(St�eet,City,State,Zi Code) , y� Phone Numbec ,c1 Q—� . -'�I wa � G� �� 7�5� ��Y—YLS-3— IX. COUNTY/D PART ENT USE NLY ❑Disapprovetl Sanitary ermi[Fee Groundwater ate Issul eniSignaWre(NoStamps) �Approvetl ❑Owner Given Initial Surcharge Fee AdverseDetermination y90.00 $25.00 8-26-87 X. COMMENTS/REASONS FOR DISAPPROVAL: SBD-6398(formerly Plb-67)(R.03/86) DiSTRIBUTION:Original Io CuuNy,One Copy To:Bureau of Plumbing,Owner,Plumber DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUIL�INGS �ABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVI$ION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 �CONVENTIONAL ❑ ALTERNATIVE $IatePlanl.D. Number: � li� as:�q„eel ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER: AODRESS OF PERMIT HOLDER: INSPECTION DATE: �o -� - � '�oX 3 I k�1 � �ua�c� 8 -a 7 -8 BENCH MARK IPermanen� refere�ce voint) DESCFIBE IF DIFfERENT FROM P�AN�. REF. PT. ELEV.: CST REF. PT. ELEV.� �o v �r � v�-v`-� o n s e i c `�v�.k o� � Name ol Plumber. MryfNPqSW Nn. Cnuniv Saniiary Perm�i Numben �w reh�e �-rn �ec�r l O 7 `-f S aw e, r' �7 - l �`-� 9 8 3 s 9 SEPTIC TANK/HOLDIMG TANK: MANUFACTURER: LIOUID CAPACITV. TANK INLET ELEV. TANK OUTLET ELEV WARNING LABEI LOCKINGCOVER �ROVIDEU PROVIDED�. T�`'�� 06� � 7 • 63 � 7 , ❑YES ❑NO ❑YES ❑NO BEDDING: VENT DIA.�. VENT M11nT t HIGH WATEH NUMBER OF ROAD�. PROPERTV VJELL BUILDING� VENT TO FRESH � L �� A`nqM FEET FROM ( � LINE I n��' AIR INLET�. ❑YES ❑NO -C C� ❑YES ❑ NO NEAREST � I �b � �� wc-t '_ DOSING CHAMBER: MANUFACTURER BEDUING�. LIOUID Cnf'nCliv 7UMP M(IUEL PUMP.iIPH(7N MnNU4 nCiUHE�t WARNING LABEL LOCKING COVER PROviDED PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PunnanNocorvrRo�soPeanriorvn� NUMBER OF �'HOPENTV NELL BUILDIN(. VENTTOFRESH IDIFFERENCE BETWEEN �� FEET FROM " ��"F 4iR i"�Er PUMP ON AND OFF) ❑YES L_� NO NEAREST—� SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing � f N�,i�� u�nn,F re�+ n,ni� H�n� nN�> aanNKwa or excavation. (1f soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: � WIDTH LENGTH NO nF �)ISiVV VIPC tiVACINt, COVFN INSIUE 11IA =PIiS LIOUID BED/TRENCH � l,,.� ! tteerva�Fs ( a�nr�E�y�i�� I PIT oePTH DIMENSIONS ' � S i d ^�—� �LO�T" GRAVEL OEVTH FILL DEPTH UISll1 PIPh U�STH PIPE DISTR. P�PF MATERIAL NO UISiH NUMBER..OF -� . PHOPEHTv � wFLL [3UILDING�. VENT TO FFESH BFLOW PIPES �� ABOVE COVEH EI Ev INI I f ELFV LNU viPf ti � : ��- UNE �a AIR INLET� •�� 16 . 3 FEET FROM ? �� p W e� _ PV C NEAREST—► 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 SOILCOVER TExTuaE �t �rn�n�v� n,tn�n��Kti+s uitsei+varir�rvwF��s ❑YES ❑NO ❑YES ❑NO DEPTH pVER TRENCH BED �EPTM pVFH THENCII HF U U(PfH UV 1f1P5��IL 1nUUl U �F6Uf I) MULCNED CENTER EDGES I__� YES C�NO C-� YES �_ � NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH�,�,; wrorH �ervar�� 7Re�cr+es �arEran� sPncirva ��NnvE� ��Fvn� taEi_��w Nivt Fi�� oevn� neave coveH DIMENSIONS � ......... MAMFOLD PUMP MANIFOLU DISTR. PIPE MANIF OLU Ml�TEHIr1L NC) UISTH UISTH PIPF UISTHIf4U IION PIPE MATEHIAL & M1IAHKING � � E�EV. ELEV OIn ELEV. N�PES UTA �. ELEVATtON AND DISTRIBUTION`` INFORMATION�;- �OLESIZE NOLESP�IC�NL L'RIUEDCf)HHECItV COVEHM1".ATtHIAL VENTICnI �IfTCORRESPONDSTOAPPFpVED PLFlNS ❑YES ❑NO ❑ YES ❑NO COMMENTS: PERMANENTMARKERS: pBSEFlVATIONWELLS NUMBEROF PHOPEHTV WELL�. BUILDING: FEET FROM ��"E ❑YES ❑ NO ❑YES ❑ NO NEAREST Sketcn Syscem on Retain in county file for audit. Reverse Side. siervnTur�e — nT�t DILHR SBD 6710 (R. 01/821 , �� kuar h � � X c�1 �h � 1 i � Y �na 5� / O� � ♦ y� a� � � �� ' � �,,�`r� � ° � � ' - �_ � r � � � � � � � % �Y ,a�-�'d d ,�'� G� � �� o� o��r T�o'�` �-�� - � � � � o�� , . � b'ifi '� ��'�a�' su��.�. S-��wo� . � , E �