HomeMy WebLinkAbout012-106-00-1402-LUP-1992-352 " Application for Land Use Permit �
County of Sawyer o
The undersigned hereby makes application for a Land Use Permit and x� �
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- M
lations of the State of Wisconsin. ,
PRINT - USE BLACR INR OR PENCIL
\
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✓��HRI L"Nt .JD,�-Jo�n�Wo�nicR ��Sl �,�� �NTE/��iPiSCs 1
Owner Builder R`
��nISO WcST/D�� ��i��vR�Vt D4��o���Qu/"1�1�f pGEf'�G7,
Mailing Address° Mailing Address
IV�tW DFRI�N W i5COn1.5'%NS:3)SI w/NTL� ��S S�Y�(p
City, State, Zip City, StaLe; Z�n
Buil�ing Land Use Zone District /�,�-I o �
(v?�New ( ) Filling �
( ) Addition ( ) Dredging Lot size l�Q�jQ7�,31��33Q m n
( ) Alteration ( ) Grading
( ) Moving On ( ) Acres -7S �
( ) ( )
m
New Construction
jJ,'s�l/'��sh
Size � ft ea-'r�e ft wide
__ _ ft long ft long �
Floor area sq ft sq ft � �
� S
Total htg �� to peak_{�o�� to peak x Z
Stories Stories
^Ic. o£ Bedroccr.s — rear iot iine or waterline I c�
(year round) or (seasonal) Ch�P/�EwA �lU�✓'�ytl�, rt
Type of Bldg or Addition a' t"
( ) Dwelling �j IP r°�: ,-°r
O Garage (1) (2) car y�� 1.-� �5' N• .
( ) Storage Building �� I
( ) Boathouse � o
( ) Livingroom � � � �
( ) Bedroom � �' ��c,� �
( ) Kitchen-Dining � �� ' �
( ) Porch - enclosed/roofed � � '
( ) Deck - open � /y 'D�
{I�D�S/� AN/ENNfI , r\,
( ) V
- p
i
Type of Construction �� '
( ) Frame ( ) Block � �
( ) Log (✓�Concrete �- a�5'— ` r\ �
( ) Pole ( ) Steel 3S' �� � y�i � .
Meta1 /E ""'""''`°"'
(�� �a ( �-- m�sH � r���;
, ', �I
Construction Cost $ ��U` T (r;
Vol �� Pg sa� of deed �
i
�s vo1 �/..9��i�g'�o e '7S �� Iy0 w � -
Cer. Soil Test -Z � � ��� �� � �
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Issued I LQ�-��}-�f_�}'�P12- ��qZ Denied �
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( �e��itil k—� -�C)��)Z4 £
Owner Zoning Adminis rat r
Ta w r � � �. �---� � � � � �-�
. FOR ASSESSRI'iEi�t USE G�viY
NOT iNTENQED TO SHOW CON-
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. , �. DUCUMENT NO. STATE T3AR OP WISCONSIN FOR11f 1 - 1988 , T���s e��ce ncsenvm roe nccunmHo c+*s
WARRANTY DEED i
1888 '72
'� -------- t ' �
-- ----- ,-----------__------_____. Aealdx'eOtNae y
-- ------ -----
....�4Q�..Zt7S�xdC1..H1.. . .. Sa�o7ar Ckxm7 j (
This Deed, made between .SEI._49N..T,._,RORR,..an.adult. man A�dved or rca ord the � dc� d
lls Road_,__Edinat MN 55435 p
- Q A D 19 Q� el o'dod�
� .__- ........... . . .-- ------
......_.. ___.._. ......._ ....'._' Id encl rerorded In �ol. 3SJ�
' _. ._._--------------------------------------------�------------------"-'--------..� Grantor� _ � - .
and._,�ohn..R_.-Woeckener...and_.Marlene_Jo _Woeckener °� �j'��':`�' <•`��Q � �
F� �
- � --�- --- - � . '
_.....16.150-.W-...Snp...'o.:..Hi1.1...Drive,...New. Perlin� WI 53151 __ �,���,
__......._..........--..._......--..... ..........__....... - - --- -- - ...._..... _.- '
� . _ . .......-'-------'------_---------------.___._...� Grnntea, Fiyrl '.
Witnesseth, That the said Grantor, for a valuable coneideration.. ONE I
dollar ( $1 . 00 ) or other good & valuable consideration . -.- _. —._ , ,-__ ____._
- - - .._... -... __.. _ _._._. ...... . . . . .... . . .
_ --— ,
Saw er ""°"" T°
�, convevs to Grantee the following described real estnte in .... . Y .. .. . ERA RONCLER REALTY
��� County, State of R�isconsin: I RADISSON � WI 5486!
�---_
' Taa Parcel No: ""'-'.""•'-"'_"--"""'-'-' ��
i �
I LOT SIXTGEN ( 16 ) RpGAGAMA SHORES, SECTION FOUR ( 04 ) , TOWNSHIP THIRTY-NINE ( 39 )
NORTH, RANGE SEVEN (7 ) WEST, TOWNSHIP OF HUNTER , SAWYER COUNTY.
FEE
I �E �
; i j
�
This warranty deed is in correction of warranty deed recorded Septembe�� 20, ' 983 �
in Volume 355 page 29 of the Sawyer County Registry , Document 11188527 �
� This ..............15_nOt . homestead property.
, (is) (is not) '
, Together with all and singulnr the hereditementa and appurtenances thereunto belonging; .
� pn� �rantor � �
....-'------------'................-----'--'-'-'---'------._.-------........._._........._......--'------_..
wnrrnnts that the title is good, indefeasible in fee simple nnd free end clear of encumbrances except �
ISubject to all easements , reservations and exceptions of record
�� and will warrant and defend the same. �',
, Dnted this . .___ . „_.. 01st OCtober % � S
, .. . .....V.. .. day of ----- ._/� _ ..... ..._ ".
3
� � �
� / /j� �{lf��r . .. r . i -_-- � ._ �._.(SEAL) �
� �: ......---- - � �L��//.�c'"=' � ----- �SEAL) ��./I . � �. -� - :
� r..,,,. ,n���.v,ivni�.;�nnnn,^.;:���v�MN�Mn• • �S21dOn T. RObb
� * .,;..... . .._....�::T.tiJ_-::id-Er�N!C.1kN..."'.. '...._....__..........._..._..._................___'__.....
,� I .+._y. r�x�.W�-'�Yoo��S�TE p�^Ny Z�509 6--�---...._ �SEAL) ----�--�-'--.._........._................_'---"----..._..---- (SEAL) I
2
. .p _ _ a...._...-- ---'-"--'..................'-..._..._._..._.._-----'--'-"--- �
� � AUTAENTICATION ACKNOWLEDGMENT I
�' � Signnture(s) -----------------------------___--.-"--..---'-'----"--- STATE OF WISCONSIN .
� 89.
......'"'"'..."""""'""""""""""""""""......."""..."""'....
"--'-"-'--""'---'---'-'-"--'-"'-Cou nty.
� authenticated this ._...._.day of........................... 19....__ Personally cnme before me this ................day of
' '-------•-""--'-"---."""""-------� 19._'`'_ the above named
_""""""""'-""""""'-----------'---."'-'---'--'-""-"'-_-"---
. •'-"--'--------"'_."'_."'-"'--"""" .--"'-"-""-" -'-"'-""'-"-"""--"--'--'----'-'------"-""-"-'-"'--"-------
�, TITLE: MEMBER STATE BAR OF WISCONSIN �,
'� - --"----'-----------------------------'------------------- '
�. (If not, ----------�.............-�---�------�-�---�-�-----�-- ---�---------�--...----------...-----�----------�---------------- �
authorized by § 706.06, Wis. Stats.) to me known to be the person .........._. n-ho esecuted the j
� , foregoing instrument and aeknowledge the same. '
I THISINSTRUMENT WAS DRAFTEO BY
Chester aoncler, - Realtor � --- - � - --- -- ---- - -
.........- - ... -- - ----.....--�- - - - ------ ....
.
- -- - - -- - --- ..-- - --- ��- -- - -- --
--�-------------------."'-"--------'----'-'-.-"'-'--------------'-'- NotarY Public --��-------------.._----...------County, Wis.
(Si�nitures may be authenticnted or ncl:nowledged. Both nZY Commission is permnnent. (Tf not, stnte expiratian
\\ nre not n�cevslry.) �
� . . . _ . . . . date: ._. ....._ . ._ __-- 19-- _..
. __ L -3 5 _ P� _� �>
_ _ _ ___ _ -
- - - -
•Namro of P rsans niening in eny cen�city ehould he fypeA or printed below thea aigneturc . O � � �
WAiI$�ANTv DEGD 9TAT: :A.^. OF P'ISCONS[u _��.,,..�,.. .�.. .i ni...�. r. �...
fl DILHR sANITARY PERMIT APPLICATION �a�NTY
_ In accord with ILHR 83.05, Wis. Adm. Code SA4TYER - �
� � STATESANITARYPERMIT�k . �
�� �� CST 83-260 98349 '�'
-Attach complete plans(to the county copy only)for the system, on paper not less than STATE PLAN I.D.NUMBER +�
8'F x 11 inches in size. �
-See reverse side for instructions for completing this application. pETirioN
I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. Foa vnainNce ❑YES ❑ No
PROPERTY OWNER PROPERTV LOCATION
�o l �� � '/a _ %a, S T 3 , N, R � E (or)�
PROPERTY OWNER'S MAILING ADORESS LOT NUMBER BLOCK NUMBER SUBDIVISION NAME
� c
CITY,STATE ZIP CODE PHONE NUMBER GTY NEA ST ROAD,LAKE OR LANDMARK
O VILLAGE :
�� � '� Q �
II. TY�E OF BUILDING OR USE SEHVED:
Number of Bedrooms if 1 or 2 Family � OR ❑ Public (Specify):
111. PURPOSE OF APPLICATION: (Check onty one in#1. Check#2,3 or 4, if applicable)
1. a. Q New b. � Replacement c. ❑ Replacement of d. ❑ Reconnection of e.0 Repair of an
System System Septic Tank Only an Existing System Existing Systerr
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.SVSTEM ELEVATION 6. WATER SUPPLY:
(Minutes per inch): RE�UIRED(Square Feet): PROPOSED(Square Feet):
'�.. � f0 L.f� Fee1 �IPrivate ❑Joint ❑ Public
CAPACITY
VI. TANK in allons Total #of Prefab. Site Fiber- Exper.
INEORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel 91ass Plastic APP
Tanks Tanks structed
Se tic Tank or Holdin ra�k �5C) � �O 1 ._�i S< -� � :�
LiftPum Tank/Si honChamber
VII. RFSPONSIBILITYSTATEMENT
I,the undersigned,assume responsibility for installation of the private sewage system shown on the aitached plans.
Plumber's Name(Print): Plumber's Signature:(No Stamps) MP/MPRSWICO�. Business Phone Number
� ._�
uv �rowr� �, — "r� 3s�
Plumber's Address(Street,City,State,Zip Code�: Name of Designer
I y$ l� �c�✓'� ,-Uc�n�
VIII. SOIL TEST INFORMATION
Certified Soil Tester(CST)Name CST#
��ctv� �� "'o e� 5
CST's ADDRESS(Street,City,State,Zip Code) Phone Number:
' �! � 7 �
IX. CQUNTY/DEPARTMENT USE ONLY
❑ Disapproved SanitaryPermitFee Groundwater ate I � gAgentSi na e(NoStamps)
�Approved ❑ Owner Given Initial Surcharge Fee
AdverseDetermination �� . �� 2.5 . �� — —
X. COMMENTS/REASONS FOR DISAPPROVAL:
SBD-6398(brmerly Pib-67)(R.03/86) DISTRIBUTION: Original to Counry,OneCopy To:Bureau ot Plumbing,Owner,Plumber
. ' � � � , � , i �
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUIL�INGS
LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
' �CONVENTIONAL ❑ ALTERNATIVE S�a�� P�a� I.D. Number.
- (I� dTsigned)
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OP PERMIT HOLDER�. AD�RESSOF PERMIT HOLDEH�. INSPECTION DATE�.
I 5 �' �I` � . l�1�eu:� '�rt�n � - �
BENCH MARK (Permanent relerence poinp DESCRBE IF DIFFEFENT FROM PLAN REf. PT. ELEV.: CST HEF. PT. EIEV
��o -�ovnc�.a.-��on D W • I�O �
Name ol PWm ec PRSW Nn. Couniy Sannary Permil Number:
v -� �3 3 3 S a- Saw er 8� -l3 � 7 8 3
SEPTIC TANK/HOLDIMG TANK:
MANUFACTURER: ' LIOUID CAPnCITV 1l�NK INLET ELEV. TANK OUTLET ELEV WARNING lABEL LOCKING COVER
q '-7 PROVIDED: PROVIDED�
s �l� ��� � • SS / / • � �~ �YES ❑ NO ❑YES ❑NO
BEDDING: VENT DIA.�. VENT r.�ail f+iGF� WaTFH NUMBER OF ROAD�. PROPERTv WELL� BUILOWG- VENT TO FRESM
ALAHM FEET FROM . �'"E / KO I AIR INLET�r
❑YES ❑ NO � 11 � ❑ YES ❑ NO NEAREST I S ��C. � O / �D
DOSING CHAMBER:
MANUFACIUHFR BEDUING� LI(1VIUCl�P/�CIfV PUM�' Mt)Utl �'U`.1PSIVH(INAL;NUfnClliHfH WARNWGLAl3[L LOCKINGCOVER
PROVIUfD PROVIDEO�
❑YES L�NO L_�YES L� NO ❑YES ❑NO
GALLONSPERCYCLE: vuMvnrvocoNr�ao�so�eaanorvn� NUMBEROF ''"�'PE"T` v�Fi-� eui�oirvc; IvervrroFaesH
(DIFFERENCE BETWEEN FEET FROM ��"F aia irv�er
PUMP ON AND OFF) ❑ YES ❑NO NEAREST—�
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing � � i f r�r�,u� n�nn�F rE�a r..�arF tiin� nn,n nnauKiNc
or excavation, (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continu�.) MAIN
CONVENTIONAL SYSTEM:
-< WIDTFi LENGTH NO OF �71SiH VIVf tiPl�CIN(I COVfH . �. IN511)t U111 =PIi> UOUID
BED/TRENCH ����� V � r�+ervcr+Fs � ninrEr�ini � p�T oevrN
DIMENSIONS S C �O�
GHAVELOFPTfI FILLDEPTH UISIi+ PIPI UISTN 1'IPE DISTR_ PIPF MATf.HIAL NU UI$iH NUMBER OF VHOPFRTV WELL BU�LDWG VENTTOFRESH
ee�ow aiPes �� asove co11 Fv ei ev irvi � r e�Ev E Nu � vu�t s FEET FROM urve � r�o � nia irv�er �
7 Gb 5.�----L � NEAREST—s � � W I I �1 � � 1
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM
and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA-
meets the criteria for medium sand. TIONS MEASURED.
❑ YES ❑ NO
SOILCOVER rExluNe — � _ — ��ii�ninNirvir,��v+K� E�s ��ustuvnnn,vwE� ��s
�._� YES ❑ NO LJYES ❑NO
DEPTH OVEF TRENCH BED DEPTH pVEF2 THENCH NEU I1CVT11 f)V iOP$fllL tinl�l)FI' �FFUf U MULCNED
CENTEH EDGES
❑ YES ❑ NO ❑YES ❑ NO ❑ YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM:
WIDTH LEN(illl NO. OF LATFf7AL SPnCWG ��H/1V! I Uf Vlll Nt t UW PIP! Fll L DFPTH /�BOVE COVEH
BED/TRENCH r�ENc�,Fs
DIMENSIONS
. MAMFOLD PUMP M�1M�q�U DISTP. PIPE MANIFOU) MnTEH1l1L NO UI51�� L'ISTH PIGE UISTHIBUiION PIPE 61ATENIAL & MAHKING
ELEV. ELEv pIA E�Ev. PIPE$ DIA
ELEVATSON AND
DISTRiBIJTION
INFORM.ATION rio�EsizE Ho�ESPnciNc; c�:i��t.uc�r�r�rc:iiv covE�aMnrEwin� vEHTicn� ��rTcoNHESPorvosronNvr�ovEo
P�A�i$
❑YES ❑ NO ❑ YES ❑NO
COMMENTS: PEfiMANENT MARKERS: OBSERVATION WELLS NUMBER.OF PR07ERTV WELL�. BUILDING
FEET FROM ��"E
❑ YES ❑ NO L� YES �_� NO _ NEAREST
Sketch System on Retain in county file for audit.
Reverse Side.
SIC�N T R TITLE .
DILHR SBD 6710 (R. 01 /82) � *
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