HomeMy WebLinkAbout012-740-33-2410-LUP-1992-376 Application for Land Use Permit y �
County of Sawyer �
The undersigned hereby makes application for a Land Usa 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. �
PRINT - USE BLACR INK OR PENCIL
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Owner � Builder �
'��3ox �K r �R \ �T� �3ox �3 9.�
Mailing Address Mailing Address �
���2r�� , VJ t ��b'Z� �/4%CJ�e ! .S�(> T�
City, State, ip City State, ip
Building Land Use Zone District /�� � r �
( ) New ( ) Filling �
rt
( ) Addition ( ) Dredging Lot size /Ob� x /�DO� N n
� Alteration ( ) Grading �,,
( ) Movin On ( ) Acres �l 5' +:� /. _;^� �
�Q 200� ( ) � ''" (U
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NeW Construction �PEµ�CC,� �
( �
Size � Z ft wide �O� ft wide �
�_ ft long l`-1� ft long �
Floor area �-}�Z sq ft sq ft n
m �
Total htg � z-� to peak to peak x y
Stories ` Stories �
No. of Bedrooms Z- rear lot line or waterline c�
0
(year round) or (seasonal) �j1iz �o-F ,L,',�,� �, �
Type of Bldg or Addition o' r-�
( ) DweLling / � °: ,°rt
( ) Garage (1) (2) car ,/ ��-� - �
( ) Storage Building {� °� � m� I
( ) Boathouse �/ l,, i ' o r•
( ) Livingroom �� WQ � ��'� �
( ) Bedroom �t�
( ) Kitchen-Dining � �' � Im
( ) Porch - enclosed/roofed � 86�
hg Deck \ ope ��
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( ) -- - `- - - -- - � i
Type of Construction G�F.. �`-� '� IG
-�( Frame ( ) Block 1�=" -- �M������ --� - �
( ) Log ( ) Concrete � `�
( ) Pole ( ) Steel W
( ) Meta1 ( ) �b� �1s���q � � �
Construction Cost $ �p � � �Cr���'�- 4 -� �
Vol �0 Pg �_ of deed '�'d �J I�JJ
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ro �
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Cer. Soil Test O\c� Z,�at�,� N�
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Sanitary Permit �_3a��0- c Road �~ �
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Issued � /���L,,,o 1=IQ� Denied �
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�d� Owner �Zoning Admini tra or
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�VARRANTY DEED. STATE OF WISCONSIN—FORM No. 1 17CJ
This Indenture� Made this �5th day of Jt11y A. D., 19 69 ,
netween Mabel M. Kowaleky, a widow, of Wisconsin Rapida, Wood County, Wisconcin----
. part;i of the first part,and
:dor��ell �er�utn and Alarjorie L. Bermar., huebe.nd and wife, both of the City of Appleton, Qutgamie County,
Wi sconsi n, parti es of the second part as
�oint tenante aad not as tenants in common
«'iTNESSETFt,That the said part y of the flrst part,for and 1n conaideratfon of the sum of
Sia Thousand FYve Hundred and no�100 ($6,500.00)--Dollara---
to her 1n hand pald by the sald part �8B ot the second part,the receipt whereof ls Uereby confessed and acknowledged,ha 8
glven,granted,bargalned,sold,remised,releesed,aliened,conveyed end c nflr e nd by theso�presents do QS gtve,grant,barg¢In,sell,remise,release,
�n �'o�t�� ten8ri c�/� i
i
alten,conve��and conflrm unto the said part �08 of the second part, thei r t�e"s and asslgns forever,the following described real estate,
situated in the County of Sawyer ,and State of Wisconsln,to-wit: �
The West 100 feet of the Fast 1020 feet of the Southeast Q�arter of the Northwest Quarter (SF� NW'�) of Section
Thirty-three (33), Township Forty (40) North, Range 5even (7) West, lying south of the Chippe�oaFlo�dnge at high�
water mark. I
Note: The above stated purchase nrice is intended by the partie� hereto to conetitute ful.l p�3ment for the
real estate described above; one (1) 1964 Richardson Mobile Home, 10� x 50�, Title No. G28J1291, Identificatio�
� No. 15311, which is situated on sa1 d roal ectate; and all of the contents of sald mobile home on the dat�e of �
' the closing of this transaction. ;
This instrument was drafted by Marvin L, �gina, Attorney, of Fountain City, Wisconsin
TOGETFIER with all and singular the hereditaments and appurtenances thereunto belonging or in eny wise sppertalning;and all the estate,right,
title,lnterest,clalm or demend whatsoever,of the safd psrt y of the flrst part,either in law or equtty,either ln possesston or expoctancy of,Su and to tlio
� aboce bargalned premises,and their heredltaments and appurtenances. �
TO HA�E A I)TO FIOLD the sald emi$es s above described with the heredltamonts and appurtenances,unto the said part i gg of the second I
n �oint te�,n�y a� �gti �n C�01i��EVER.
part,and to t thei r ie r an ass gn
:1ND TfiE SAID MSb01 M, Kowal�ky, a widow, party of the firet part,
{or herself and her heirs,executors and administratoz5,do ea covenant,grant,bargain and agree to and witti the said i
p¢rt 128 of the second part, thei r helrs and assigns,that at the time oP the enseallng and delivery of these Presents
� 8h9 16 well seized of the premises above descrlbed,as of a good,sure,perfect,absolute and
lndefeasible estate of inheritance in the law,in fee simple,and that the same are free and clear from all incumbrances whatever, i
as ,join�heitrnants and
and tl�at the aboce burgnined premises in the quiet and peaceable possession of the sald part i es of the second pnrt, heirs and
assigns,ngainst all and ecery person or persons lawfully clalming the whole or any part thereof, �e will forever�VARRANT AND DEFEND. i
IN�41TNESS �VfIEI2EOF,the said part S' of the flrst part ha 8 hereunto set h8T hand and seal this 15th �
da��of 'July ,A.D.,19 69 .
Signed and Sealed ln Presence of Mabel td. KOWal81�y Mabel M. KowalSYy (SEAL)�
Alarvin I,. Gugina. Marvin L. �ina (sEe�.) �
David J. �na David J. FU.gina
(SEAL)
(SEAL)
STA'PE OF �VISCONSIN,
ss.
Buffalo County.
Personally came before me,this 15 th day of July A.D.,19 69 ,
the above named �bel M. Kowalaky, a widow, party of the fi rst part,
to me known to be the pexson who eaecuted the foregoing instrument and acknowledged the same.
Received for Itecord this 6th day of David J. F1igi na David J. Fligina
notary
Au�ll�t A.D., 1�J 69 .at 10��o'cLocicA• M.
public aeal �otary Public, Buffalo Coimty,wis.
Laura �. McLaggan geqister o:nesds. uffixed
n2y commtsston�sia perma.nent A•n.,1�
Deputy.
Q FPPLICATION FOR SASIYE.B COUNT.P
SAP7I1^ARY P.'Hl�?IT
i
� Application j��Z1(nQ Dat _���1 L
�� � Fee of $ZOa o0 received ��i,/j_,_�� �' ��-� �
Date � County Clerk
� Application is hereb� made for�a Sawyer County Sanitary
Permit for mork to be done on tiae premises described Fcerein.
g�Rv,rfl f�r�l
�� (/ �`�.U, . `-c�r�,4'.�-�
Owner A�s TeZephone
� T7ee � o f the ,�/,//, Sec. �� Tmn. lG� R. �` ,Ll/-
• or
Lot Block _ Sub-division ��- �,�j� _�NT��
. /�.L-ce��('ti�E"t-t� �.,ld(/�-l;'=.�-� � ,�CG� �. �l:l-�;c..�- ,
GJ •rk contem ated To Ue perf�mad by
1Jumber of Bedrooms _� Plumber of Bathrooms �-
Dis'�masher /�i-- Garbage. Grinder �z��--
Automatie tlasher �� �
l
_ Soil Description � �',��rP � �'" _�
Septic Tar�k Size ,��" gaZ'✓. �
Seepage Pit � Height .�`�_ Diameter � � �
S2epage Trench __ Length _ fJidth Depth
� Septic Tank Permit � =�L/�a
Percolation Test Form PLB 43 attached �_�
Yes No
ContempZated completion date
Applieqtion Appro ed Per�it # 3,2 /��
a
Sarcitarian G � `�-. / -�
Owi2e�� Agent �70�2 ze Da=-e7-
Remarks
FinaZ Inspectio�i � -
Sanitarian /'�f-�,�� �`%�'ir��' %'� /���
! ,'��� Owrae2�/Agent P]oti fi2d i Dc;::i
�-Y
Remarks
*** Se�d or�i;inat a.nc� three copies with.*** .
fee r.;� $Z0.00 to County C"�ark
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: Indicate Lot size and shape ,t� location of d�aelling ( D) , s �ptic �ank
(ST) � septzc fieZd (SF) or seepage pit (SP ) an� distance of anr��
� portion of septic sz�stem from dwellings z�eZZ and propertz� Zine .
�:S�p.�6perty Zies �ithin SO feet of a Zake , river o2� a stream so
indieate and show distance there from.',,.
If anr� po �'ti'on `�of the conternpZated 'coiistruct�ori 2J'LZZ Zie iJ2tI22Yl
25 fe� t of dzuelling, �eZZ, sept.ic tank;,� septic fieZd or seepayre
� pit of abbutting o�ner so indicate .
Tlie undersigned agrees that all work performed anr� equipment
instaZZed s ,haZZ be in accordance. with t�ae Sanitar� Co<,�� o f Sa�z�er
Ceunt� and aZZ appZicable Zav�s and reg?�Zatiozas of the �;i�ate c�f
�iseonsin and recommenu'ations of the Sa�� er Countz� San �: ;-;; � ; ;��� .
,-t" ' %I ���'-
Owzzer, Agent ignatur,
'Plb. #43 �� SEPTIC TANK PERN'ST N0. �.��`y D
Ly'�/s� RE PORT ON S OI L PE RC OLAT I ON TfiST
y/� A N D S 0 I L B 0 R I N G S
��,�
TO
�� DIYISION OF HEALTH - PUJMBING SECTION
� P.O.Box 309, Madison, Wis. 53701
� Pursua,nt to H 62.20, Wis. Adminiat�tive Code
NAME IL/F Yf.1C {'`R (�t V'\ PROPER'I'1' ADDRESS �(�l.l lJ ''I Lc �/ '�L/ �, S
L]
LOCATION (Cheok One) City _ Village Toxn _(G'� LC- {� �-� ✓ County �
C#,�y--er ToKnship !i/
WATER SUPPLY FRMii Publia Ut311ty Cooperative Private Well
SEWAGE DISPOSAL INSTALLED BYs L i'(.t Y eY1 P e ��f c�i��dress �'�Q y/,�� /� Y rl�aJ /_S' ^ Da.te
SEPTIC TANK SIZE � �� Q Ma.terlal ��� / G, �_ Pem olation & Soil Borings Teat Data
EFFLUENT DISP.s Tile Size No. Lin. Ft. Trenoh Width Depth of Tile
Seepage Bedt Length Width Depth of Tile
Seepa.ga Pit: Outside Die.meter � '� / ' Liquid Depth _ �'�
TYPE OF OCCUPANCYs , ��
RESIDENCEs Number oP Bedrocros _� OTHER: (speoify) Tl''(,� �1 � Y Number of Persons p�
FOOD NA57E GRFNDERs Yes No �sknaasher: Yea No "''"��Automatio Clothes Washert Yes No �^"""
P E R C 0 L A T I 0 N T E S T
Test Dapth Che.raoter of Soil Hours Water Test Time Dro in Water Lavel Inohea Minutes
Number Inahes Thiokness in Inches Since Hole in Hole Interval Seaond to Next to Last To Fall
lst Wetted Overni ht in Minutes I,ast Period Iast Period Period Qne Znah
Example
P- 0 36" To Soil 10" Cla 26� 25 es or no 30 1 2 1 2 1 2 6d
/� 1 ��« � _. .. , i, '' �
b 0� � i' /
�� � �� ,� 10 � � r � �� /� � � ��G
�' i
I,/i � , l� /- i. ii �
� 7 G �:r: � �:i.• �v � ;��c�--
RECCRD DATP. FROM MINIMUM OF 3 TEST HOLES
Compute size of absorption area in aoaord xith H 62.20 Wis. Administrative Code.
S 0 I L B 0. R I N G S - Minimum 36��� Belox Pro osad Absor tion S stem
Test Total Depth De th to Ground Water
Number Inahes Observed Estimated CYsar�oter of Sail xith Thiclrness in Inohes �
Example
B- 0 72" 72" $laak To Soil 12" Cla 18��• Sand 18" Gravel 24'�
I � D ' ' ' I � C G� U �
� i , i
� a • � � �
1 - � � ., 7 /
RD DATA FROM MINIMIJM OF 3 TEST HOLES
I, the undersigned, hereby aertify that the peraolation tests reported on this form xere made by me or under �y super-
vision in aocord with the procedures and method specified in CkiaPter H 62.20 (13)� Wisconsin Administrative Code, and
that the da.ta reoorded and location of test holes are norreot to the best of �y knowledge and belief.
NAME �_ � C-� � �� �� � `�-�.� C i.l TITLE ��� tl (� ��� �
(Type or Printj
Y.SGIS3RATION N0, or hLiSiER PLUMBER LICENSE N0. �/I�I? � J rI X
ADDRESS �L I� C� 7�S
DATE: � SIGNATUi� �� � �'
/
`7,�� ,-� :--n.�r. ��T..
. �llf;T� OF INSPECTION�� MADE DY ��ap`/}',�Z� _C �_..�
,INSPECTION CALLED FOR BY , �%2' DATE � /�-��I �
'OUINER AD SS ���ti�ierc/�,
,� r
�_,i-, of �_4 Sec. 3 i TF c � � N R_�W
��s f�;�� �. .,,y��'� �r.._.rE�L,.,.�av�'z.•,r/flm,�..�-
LOT BLOCK _SUBDNISIO�T TO(+1I�T �c�v
PLUNIDE��� LIC.�I p ADDRESS ���._c��—u-r�+�� �
WORK PREFORMED , c�� e�yC� `�%�
' Mfd.
SEPTIC TANK - Siz (�Z� Material �j,�_by�s �c:c.�u�
lank
PIPE TITE: From House to Tank_�Outlet C�
� Surface Depth
Manhole Ext.: Yes_�No�to Cover
Other Extensions:_ �'���—
Vent `�� Taate.r Fi11ed Tank: Yes No�_
SEEPAGE PIT - No, of Pits��. Dia. 5�� Depth below Inlet �
Total Secon�t:
� Seepage Area ,CG� Dia. Depth belova Inlet
V Gravel around Pit; Yes No k
�
� Manhole extension belo��r surface ��� inches.
� Lining material used C�»,>.�1� ,(��`Vent: Yes�_No_
SEEPAGE FIELD-Length of tile lines ft. Number of lines
• � Distance between lines ft. Length each line ft.
� Width of trench inches. Filter materials used _
� Tile below
Depth of filter materials inches. grade in:
Area of trench bottom Vents
� '�'C? /< �.-�,.-t�--t��1 - �f.1: �
no a�i ca � �, .� Conunents � �
Distance from: � � a ' � o a a�i
a� •� .a.x a� m
3 � +� en�++� + �a
� a x s �I � °�
Septic � �+�,�y� � � �
Tank 6 /.?�
Seepage ,
Pit "0 L) �C'�<< '7! x.ti_
Seepa�e
I'ield
Priv
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