HomeMy WebLinkAbout012-740-04-4406-LUP-1992-100 Application for Land Use Permit ���S.�5�% �Z
County of Sawyer f �o �
The undersigned hereby makes application for a Land Use Permit and �
agrees that all work shall be done in compliance with the require- o �
ments ot the Sawyer County Zoning Ordinance and the laws and regu- M
lations of the State of Wisconsin.
PRINT - USE BLACK INK OR PENCIL
A• A.r-. � 1
�ar� � J�d ��r�<_r� < ,. _,� ,� .
Owner �Po��r Builder D
-R-�e� 9 �o x 930� t; ���,�� �
Mailing Address Mailing Ad�.ress
�G�1 u�a� �.'-_, , l� T
City, State, ip City, State, Zip
Building Land Use Zone District #-'� �.- o �
( ) New ( ) Fillir.g r'
(� Addition ( ) Dredging Lot size :`,;:�._;�� X ��."' � � �n n
( ) Alr.eration ( ) Grading II
( ) Moving On ( ) Acres ,_"j .L0� v �J
( ) ( ) 5
New Constructi�r `" '-" h��``��c N �
x F =_'"-.
o;�.- U,} ,g
Size �? ft wide '"� ft wide �
� ft long �U ft long �
Floor area �C{2, sq ft ;�� ' sq ft �
m
Total htg I�" �e--�eak �� to peak x F
o���RA� �
Stories �
� Stories ��
-- S�
No. of Bedrooms �"�_ rear lot line or waterline c�
0
(year round) or (seasonal) ,'8�'����- G rt
Type of Bldg or Addition
( ) Dwelling a o
O Garage (1) (2) car �^��`�� � rt
( ) Storage Building �l-5� N
( ) Boathouse � r•
0
( ) Livingroom �
( ) Bedroom '* -, . Q ��`���/�
( ) Kitchen-Dining ���'`�'� �:`: , � ' ' �� �
� Porch - enclosedf�rerrFe�d `>> o� �.'`�., � � ,
(yQ Deck - open � ." • ' - .� r�
{ ). ° �� 1, �
( ) j r' �JC � �
Type of Construction �,P �!C Z�Z o ���
,(�) Frame ( ) Block ,U ('''`�r." o
( ) Log ( ) Concrete --►' r�
( ) Pole ( ) Stee1 �pCl � — � � _ m
,o�
�
( ) Metal ( ) � _ _ � \ ~, �
Construction Cost $ � ' ��-=)
��. ^I�.__ �
Vol �,�4 Pg ISU of deed t
CS Vol �� Pg � � � } '� ro �
n� � w
Cer. Soil Test •`�' I ' �� 1`� H
� ...,;, ��, �
Sanitary Permit ��1 - OC;`1 --� -------CL Road --- ---- i
, � rr, ... ..,r� ' 4� �t�,�} °
z
n � � z
Issued z21hq����7Z � 'Denied
�
�A�� £ �
� � Owner � ' L�ing Administrator
!' �
;
1 L
S AW YE R C DUNTY CERT/F/.ED SUR V,E Y /�IAP NO.
PART OF THIs SOIITHEAST QUARTER OF THE SOUTI3GAST QUARTER OF SECTION 4, T 40
N, R 7 W, TOWN OF HUNTER, SAWYER COUN`lY, WISCON3IN.
B�ARING3 RP:FERENCED TO THE SOUTH LINE OF THE 30TTTHEAST QUARTER OF 9ECTION
4,T 40 N, R 7W, AS RECORDED IN C.3.M. VOL. 2, PG. 207 AS S 87°13� W.
� NOTE:
WHILB THE DETERMINATION OF THE LOCATION OF THE 1NEST LINE OF THE SOUTHEAST
t� QUARTER OF `PHE SOUTHHEAST QUARTER OF SECTION 4 BY THE SECTIOId BRENIiDOWN DID
�� NOT EXACTLY COINCIDE WITH THE EAST LINE OF C.3,M. VOL. 2, PG. 207� THE
DIFb'ERENCE IS SO SLIGHT THAT WE HAVE DETERMINED THAT THE EAST LINE OF 9AID
� C.S.M. A3 MONUI�NTED WILL BE SHOWN A3 THE WEST LINN: Ob� SAID QUARTER QUARTER
SECTION ON THIS MAP. NOTES ARE ON FILr.' IN TE� COUIdTY SURVliYUR9 OFFICE.
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� DOCUMCN7 NO. STATE f3AR OF NISCONSIN L`ORT[ 1-1D82 T��e e��cc 11[D6PVED roe ec<onoiHo o+r.
I i ' q�r�1 WARRANTY DEED
� _, _ --_ -_-- -_ _ . _ Neo+��.an�e �
_ . se»�rd�w�u,ty J ' / ,
SH i RR T FF Peoe�vcd lor rc�ord the `�' do7 d
This Deed, made between �"�ILLIAM.._�...........................„__,,.,.. d
i _-.-- � 9`�C'� A D 19l nl o'cloc9
--......... . . . ... .. .
- 7 l!
.__.' _.. ...... ............. ................. ......... . .... . and recorded In vd. �
..
. Grantor, ol P,ecord3 on poge �SO
................................................"'...................._""'...................-�
Iu�a.-.AANDY..A_...GUTSCH..and_J.UDY..A....P.QTTER,_..as........_.._ �- - � c:_. �_.-.��.
_jo.in.t..t.enan�s.-.....-- ..__............................. ......_......._.. - a.�.�tor
_._ ._ ....._..._...._..._._...._._......._. _._..___.._._.................
----..___ ------_..---'--"----------------'-----.__....__..----
-_., Grnntee, n'�'�
Witnesseth,That the eaid Grantor,for a vnluable cwisideration..._.
zece.ipt..o£..w.hich...is...hereby..acknow,e qe .__.._._.._
------ ----
, R[TUNN TO I i
conveys to Grantee the following described renl estate m ..SdWY2L......._...._....
Councy, State of Wisconain: � �ames M. Isaacson
� P.O. Box 97, Cadott, WI
G?ZT-----
Taz Parcel No:.......................�---------..
Lot Three (3) , Sawyer County Certified Survey Maps No. 2270
recorded in Volume 10 of Certified Survey Maps on page 395-396.
,I
� TR�NS��
$_��
PEL-1
;
This_.1S�--ROt�------�---- homestesd property.
(is) (is not)
Together with all and eingulur the hereditamente and appur[enxnces thereunto belonging;
And.......k1ILL.IAM.._G. SHLIIRIF.E.— —... ...__...._.... — ................ ._......._..._........................
warrants that the title is good,indefeasible in fee simple and free and clear of encumbrances except
those incurred by the grantees, if any
i and will wan�ant and defend the snme.
� Dated this /C�c.� Y of ....'_'.-CL1;``i
- .....---- -��--��-- da ....---�-- .............--...._..............19.8.5._.
" �/� _ �..
GRANTEE'S ADDRESSa (SEAi.) _�L�C�U.'/�'-r��_`./G�th�._.....(SEALI
Rt. 0, Hox 43E1 . William G. Shirriff ��
.... .......--......._..._.................__............._ --
Hayward, Wis.
. ._.(SEAL) ._........_......................................._......_._._(SEAL)
......_......_-------------_`--.___. ... ..... '__...................._.._..__.........._.._._.....-'----
AUTHENTICATION ACHNOWLEDGMENT
� Si ature of WILLIAM G. SHIRRIFF STATE OF WISCONSIN
Bn �� '----'----•'-----'--------�---------"'---�-'-'------• i
� 59.
"'_"_""___'__'"'_'_""'"'"""""' " " "'""""""'('"_"""""""""'""'""""'"'
� � / _County.
y . ..L...........,19...... personally came before me this................da�-of
authenticated thie�...da of...l.��l�� 85
__.. _;.. ..�i��i��'.. "'-"""-"-""""""-"'•-'-"-----'� 19--"". the nboce nnmed
, ._ /
(.l". �f'� . ���.� - ----
--�. .:........... .-- �-�--------�-�-....---�--.....--�--
.James M. I s acson ----------------�----...._..--�-�----�-�-------�---�---------.......---
�- ---- � -__.......----�--...---------........._--�-------- ------------------------�---�--�-----------------------------
TITLE:htE BE&S ATE BAR OF WISCONSIN
' ---------�------------'--------'------------------------------------.._.._.
'-
�?f---R-----'-----------...----"--'-------'----'--'- —'-----------------'--..................—�------�--'----------------
� %�' ��a�R���� to me known to be the person a-ho esecuted the
�' forevoing instrument and acknowledge the same.
I TNISINSTRUMENT WAS DRAFTED BY
� James M. Tsaacson, Attorne --......-�---......................-....--��----------�----....._._..
�------�--�---...._......_..............'--'-"--•--'--x---.....-
.._ NotnrY PuAlic..._.........._._____.._.._.....-Countc.R"is.
Box..97_,.__Cadott�_ Wisconsin 54727
-- - �-��-��----...--------�- -
(Siqnatures may be authenticated or acknowledged.Both TZF Commission is perm�nent.(if not, state e�piraHcn
� nrc not nccevsnry.) dntc: .__........_..� 19.. ..._.)
� ..._........._.___.'......_......
_ - �__ ___ _. . � __ ._—_ . __— .. _ . .__. ._.
_____—. __. ____�__._--._ . __ . ._ ._ � _ �
•Nsmee ot penons eienine�n.ny cenoaty ehould be typed or nrinted bclo..the'r aia�at��� �7 4 PG � /11 �
O DILHR sANITARY PERMIT APPLICATION �o�NTM
In accord with ILHR 83.05,Wis. Adm. Code SAWYER p
� � STATESANITARYPERMIT# �
' CST 89-005 114517 �
—Attach complete plans(to the county copy only)for the system, on paper not less than srn7E a�nN i.o.NUMeea �
8'h x 11 inches in size.
—See reverse side for instructions for completing this application. pETirioN
i. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. Foa vnaiqNce ❑v=s ❑ No
PROPERTY OWNER PROPERTY LOCATION
G - ' � �'E '/a F '/aS T O , N, R `y E (or) W
PROPERTY OWNER'S MAILING ADDRESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME
� � � 0
CITY,STATE - � ZIP CODE PHONE NUMBER GTV : NEAREST ROAD LAKE OR LANJMARK
� ❑ VILLAGE : � I �
II. TYPE OF BUILDING OR USE SERVED:
Number of Bedrooms if 1 or 2 Family � OR ❑ Public(Specify):
III. PURPOSE OF APPLICATION: (Check only one in#1. Check#2,3 or 4, if applicable)
1. a. � New b. � Replacement c. ❑ Replacement of d. ❑ Reconnection of e.❑ Repair of an
System System Septic Tank Only an Existing System Existing Sys�em
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. 0 Experimental
2. a. �System- b. ❑ Holding c.❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. 0 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 EIEVATION 6. WATER SUPPLY:
(Minutes per inch): REQUIR/ED(Square Feet): PROP/OSED(Square Feet):
S (!�. (S l0 O � Feet
Q Private ❑Joint ❑ Public
CAPACITY
VI. TANK Site
in alfons Total #of Prefab. Fiber- Exper.
INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel 9�ass PlasTc APP
Tanks Tanks structed
_.�
Se ticTankorHoldin Tank
Lif[Pum Tank/Si honChamber ❑ ❑ ❑ ❑
VII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans.
Plumber's Name(Print): Plumb r's Signalure:jNo St ps) MP/M�SW-No.: Business Phone Number
b �a � � '
P umber's Ad ress(Street,Cit ,State,Zip Code): Name oi Desig er:
�
1. .. '2 �Cl e �' . CIJ � .i�� S"(` '—a-rL_O.
VIII. SOIL TEST INFORMATION
Certilied Soil Tester(CS7)Name CST#
il (' i{ Y � J� —1 d
CST's ADDRESS( reet,City,State,Zip Code) Phone Number �}p
� ,. �l/ls `N 1 O i ` "t �" 7/�� � O � ��/J •�
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved SanitaryPermitFee Groundwater ate Issui A entSignature(NoStamps)
�Approved ❑ Owner Given Initial Surcharge Fee
AdverseDetermination �90 . �Q �25 . 0� 3-28-89
X. CI�MMENTS/REASONS FOR DISAPPROVAL:
SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original[o Coun�y,One Copy To:Bureau of Plumbing,Owner,Plumber
r
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING
LABOR & HUMAN RELATIONS DIVISION •
P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
MADISON, WI 53707
State Plan I.D. Number:
� CONVENTIONAL ❑ ALTERATIVE (Ifassigned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER� INSPECTION DATE:
� ��`. �� �� � � v Y s.�,� � � -- aa - ��i
BENCH MARK (Perm nent referenre point) DESCRIBE IF DIFFERENT FROM PLAN� L'��j/ REF. PT. ELEV.: CST REF. PT. ELEV.:
J
Name ot Plumber � MP/MPRSW No.: County�. Sanitary Permit Number:
di n- � o o`Z (c� C c��e.v F' � -dr� �
SEPTIC TANK/HOLDING TANK:
MANUFACTUREF: LIQUID CAPACITY: TANK INLET ELEV.� TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
�+ PROVIDED: PROVIDED:
/'—j'jJ/1 G�G� ��• c �� � YES ❑ NO ❑ YES ❑ NO
BEDDING: VENT DIA.: VENT MATL.� HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUI�DING: VENT TO FRESH
ALARM: LINE: 7 � AIR INLET�
FEET FROM � � 1�-, S- ,_�
❑ YES ❑ NO ❑ YES ❑ NO NEAREST� �.�
DOSING CHAMBER:
MANUFACTURER: BEDDING' LIQUID CAPACITY: PUMP MODEL: PUMPISIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED'. PROVIDED:
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTV WELL�. BUILDING: VENT TO FRESH
(DIFFERENCE BETWEEN FEET FROM LINE: AIR WLET
PUMP ON AND OFF ❑ YES ❑ NO NEAREST �
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER MATERIAL AND MARKING:
or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
BED/TRENCH WIDTH LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID
� TRENCHES: M�RIAL� P�T DEPTH:
DIMENSIONS �� 3� � � �tY
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: N . DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIPES: ABOVE COVER: EL(E'V. INLET: ELEV. END: �/� Q PIPES FEET FROM LINE: � � � AIR INLET:�
�� SI 4 7 � 7 �, Y�C� l � 3 NEAREST—� S �SD �2S )as'
MOUND SYSTEM:
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
❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. j
SOIL COVER TEXTURE: PERM�NENT MARKERS: OBSERVATION WELLS;
❑ YES ❑ NO ❑ YES ❑ NO
OEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED� SEEDED: MULCHED:
CENTER: EDGES:
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH NO OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE RLL DEPTH ABOVE COVER:
TRENCHES
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL& MARKING:
ELEVATION AND ELEV.: ELEV.: DIA _ ELEV.: PIPES: DIA.:
DISTRIBUTION HOLE SIZE: HOLE SPACING DRILLED CORRECTLY: COVER MATERIAL VERTICAL LIFT CORRESPONDS TO
INFORMATION APPROVED PLANS
❑ YES ❑ NO ❑ YES ❑ NO
PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL � BUILDING:
COMMENTS: FEET FROM LiNE:
❑ YES ❑ NO ❑ YES ❑ NO NEAREST�
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