HomeMy WebLinkAbout014-942-21-3207-LUP-1992-366 - Application for Land Use Permit
County of Sawyer �'
The undersigned hereby makrs 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. �
PRINT - USE BLACK INK OR PENCIL �
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Owner �uilder
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Mailing Address �— Mailing Address
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��rtl, ,����at;' 1,, 1 `ti �`'r� �fF7v«lrii'C'� �'S �
City,'State, Zip Ci�� State, Zip
Building Land Use Zone District � �, � o �
( ) New ( ) Filling �
(�} Addition O Dredging Lot size /(X„ {3 X �/Z� � � N �
��_s ,
( ) Alteration ( ) Grading `� \ �
O Moving On O _ Acres e 9 `j R
( ) ( ) ; \
� U
New Construction ���/c��-' - �� �
.�� r
Size �y�; ft wide ft wide ?:
�
/�, ft long ft long ' �
�
Floor area ='/? sq ft sq ft �'1
. td a�
Total htg ,/n to peak to peak �
Stories / Stories
No. of Bedrooms `� rear lot line or waterline c�
0
(year round) or (seasonal) � rt
Type of Bldg or Addition � ' � � r
( ) Dwelling �� a; rt
( ) Garage (1) (2) car ^ -�'�, C
( ) Storage Building •�'°a;' N•
( ) Boathouse �s' �'
( ) Livingroom � �+qe y� �G q
( ) Bedroom
¢� Kitchen-Dining C-��{��NS �
O Porch - enclosed/roofed 51 Pu1• Zy � C
( ) Deck - open �
� ). �aG�_..,_-_—�f � r\
� ) D � n� �I
<1 ir��,�d��r� J 3
Ty e of Construction - � r�
(�j. Frame ( ) Block � Z Y� � � �
( ) Log ( ) Concrete �,yy
( ) Pole ( ) Steel � � � ��� �
( ) Meta1 ( ) �,, r�
�
Construction Cost $ B,00p n� 3��� C �
� I
Vol y5/ Pg ��/ of deed �
CS Vol Pg y
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Cer. Soil Test � NE���N q� � M
Sanitary Permit _/Z C oad�- ~ �
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Issued �5 Sqp}e�1Pr ��Z Denied �
' � / � / ~ �
_- '�' t� � � � %,,:f rC �t.� ���� -��,9`1.�Tx, E
�' Zoning Administ to
� ''v��Y 1 FISHERMqN
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��'� NELSON �s.�
LAKE 15,�
REF.: SAWYER GO. DEED RECORDS �
U.S.G.S. — HAYWARD + STANBERRY
EAST SGALE: I INCH= 400 FEET FAR ASSESSMENT USE ONLY NC
AERIAL PHOTO C3 DRAWN BY: KM DATE: 7-3-78 INTENDED TO SHOW CONCLUSI�,
COLON (:� INDIGATES GOVT. LOT EVIDENCE OF OWNERSHIP OR
DOCUMENT NO. STA^tE BAR OF WISCONSIN FORM 1-1982 T�i�s arwcc HESEqVEO Fow RECOqOINO uere
WARRANTY DEED
2 �. 9255
This Dee .... _---- .._ _ _ - - -_� _::�:_ n.ome.owo. � �i
:_--..
_._. .. ,.
d RALPH J RUDE and STELI A A. Se�.ye� Cow�ry � �
mede Letween . .._... ._ ...._
RUDE� hls wife ' ' �"" e�� for �eoord Ihe da� �I
-- - - - - - - - - - - -- ..._..-- -- - - - - - -- --
- A D 19�� al �oclool
_._._...._.__.___...___..__..._...._._..._____.....__........__...____."......_.__. _� �rxordud In vol. .S
' _' """"_"'__'____""'_"""_"""'....""""""'_"___"'___"___"'_'� GianCOi� ol {ieco� a on paqe �v
nnd ._.NELSON_LAKE_ LAND PARTNERSHIPt a Wisconsin . �
_ .partnership � c uzu -.
_ _.... ......... _
___... - - _.--_._...... --_.......... ----- - - - -......_.. -__..........
,.
----�---------................------'-------._ Grantee, ��
-��---�------------�-��----�--�
W1tIIBSSBtf1, That the said Grantor, for e v�.luebla coneideretion_.__
______of_one_dollar_and_ other__valuable_consideration _. ___
Sa er RETIIPN TO —
.
conveys to Grantee the following described renl estate in . __ Y?Y ........_.
County, State of Wisconsin: � �v
Tax Parcel No: --'--"'_"'--'-"""-'-""""'
The North One l3undred (100) feet of the South 'Phree Hundred (300) feet
of the Northwest Quarter of the Southwest Quarter �(NW}SW}) of Section
Twenty-one (21) ,Township Forty-two (42) North, Range Nine (9) West.
TRANSFER
$ 3�-�y
FEE
This is not homestead property.
..-�-(is) (is not) �
Together with all and aingular the hereditamente and appurtenancea thereunto 6elonging;
And....._grantors--.-.--..:
- � - ---. . . - � - ---- - --.._ ....._--...._.._--._....---�--.-.....------........
warrants that the title is good, indefeasible in fee simple and free anJ clear ot encumbrances except
all easements, exceptions and reservations of record.
and will warrant and defend the same.
Dated this ...�-th------'--------- day of ------------- JulY---'---._.._..--------......._--� 1990._..
-------........---��-----------...---�----�---�----....(SEAL) --�[±�c�.h.�.-:U�-_^"�-�.�-�--_.....__.....----(SEAL)
* ..... -- - - � -.. �-�--� --- - . RALPH J. RUDE
._...- - --- --- _...../.- �- - -..._ - - -
���J/) ' / ,�
...----�------------...._-�----�---------------------..._(SEAL) -�ilK.L'.k.-GS!_G.L...,1�1.1.-L�. :.. — (SEAL)
---..._...---
� -- - - -� --- ---- - - � . STELLA A. RUDE
-- -..... --...--._..._._..._ - - - - -- -
AUTfIENTICATION ACKNOWLED6MENT
Signature(s) .T�'V'�' . STATE OF WISCONSIN
---'-------...'----lv' - - -'- --'-'--
=`tP�Y pU9 r�
--."--"-'--'....'---'-'-"---"'----s Q- '------ �1� -' ' County as.
- - -
.......SAy1YER -�---- —�--. .
authenticated this ..._....day�f.__ ..�NOMAS-W:- 19�--- Personally cume before me this _...Zth_.._.day of
.�
% 90
DUFFY ---J!�lx.----.------_--------. 19.-'--'- the ebove named
�--------------------��------------4---- #ireamm:bPairoiwt -- --
� __...RAI.P_p J__._RUnE_&_STEI,LA_A,__ RUDE
. �. .. ... .. ..... . �/ J' _ ---- - - �
.qt„ �--- --�- -�--
TITLE: MEMBER STATE B .o �� """� -"-- ----
F
.. -- ----. ....
Uf not� . .. ��hl f Wr,.t.+a�' -- -' ..
-� -
._. _ _ .
authm�ized b -- - - ----- -----------------'------- -------------
y § 706.06, Wis. S a . to me known to be the person .._.....__. who executed the
foregoing '�strument and acknowledge the s
THISINSTRUMENT WAS DftAFTED BY
—_ ---"—
Thomas W. Duff ------- ---1-_------------R—
� �----- - --......... - -Y -----�- - �-�- - ------�- - - - - -�--- -- - -�-- - �- --- - �
-
Ha ward WI 54843 � - - -- - - --------
---� --- - - ----
- - - -- ---� -- ---- -� - -� - - - -- -
- - - c
' - - ' - - --- -- Notary PuLlic ...____
(Signatures may be nnthenticated or neknowledged. Both h�)' Commission is pe� fl� flFfFFX-- ount , Wis.
ar� not ntcessary.) . ��'���h�����(;state expirution
,. SkN:YfB (OUfd fY
VOL4 � Y RG��. 61 __ - �9
- _ _ _ - -
. .
� My Commissmn Is I's�C•!aneof
•Nemes o( n�rsune xie��iny iu e r 'unacitY nl ould Le lrV!�1 or V�'inlud LJnw ILeir sib���luru.
4�' DILHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05,Wis.Adm. Code couNn
— � SAWYER
. �� ��_ CST 9O-1�F�+ STATESANITARYPERMIT#
-Attach complete plans(to the county copy only)for the system, on paper not less than 138051 ' I
8'feXll inCheSiflSize. N. S00 FT. �f S.3� Checkitrevisiontopreviousapplica�ion
�ee reverse side for instructions for completing this application. sTnTE P�nN i.o.NUMaER
I. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION.
PROPERN OWNER`��a PROPERN LOCATION
Fel�on I.ake P @rshi N.WYaS.W. Ya, S 21 T 42N, R �(or) W
PROPERN OWNER'S MAILING ADDRESS LOT# BLOCK�
1 0 South Fronta e RD.
� CIN�STATE �• z5o33 e PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER
�.
II. TYPE OF BUILDING: (Check one) CI7Y NEAREsr r�OAD
❑ State Owned VILLAGE: �nroOt 27 b
❑ PUbIIC x❑1 Of 2 Feff1. Dw@I Ilfl9--#Of bBdfOOfT1S�— PARCEL TAX NUMBER( ) •
111. BUILDING USE: (If building type is public,check all that apply) 014-9 42-21-3210
1 ❑ ApUCondo
2 ❑ Assembly Hall 6 ❑ Medical Faciliry/Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ RestauranUBar/Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash
5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPE OF PERMIT: (Check only one in line A. Check line B it applicable)
A) 1. � New 2. � Replacement 3. ❑ Replacement of 4. 0 Reconnection of 5.❑ Repair of an
System System TankOnly ExistingSystem ExistingSystem
B) ❑ A Sanitary Permit was previously issued. Permit# — Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 � Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ SeepageTrench 22 ❑ In-Ground 42 ❑ PitPrivy
13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1.GALLONS PER DAY Q,ABSORP.AREA 3.ABSORP.AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAI_GRADE
REQUIRED(sq.R.) PROPOSED(sq.ft.) (Gals/day/sq.ft.) (Min./inch) ELEVATION
��� 410 410 Feet Feet
VII. TANK CAPACiTY Site
in allons Total #ot Manufacturer'sName Prefab. Con- Steel Fiber- plastic Exper.
INFORMATION New xistin Gallons Tanks Concrete structed 91ass App.
Tanks Tanks
Se ticTankorHoldin Tank X � Weise
LittPum TanWSi honChamber
VIII. RESPONSIBILITY STATEMENT
I,the undersigned,assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name(Print): Plumber's Signature:(No Stamp MP/MPRSW No.: Business Phone Number:
c n
. 1�+98 915-634-4595
Plumber's Address(Street,Ciry,Sta[e,Zip Code):
IX. COUNTY/DEPARTMENT USE ONLY
� Disapproved Sanitary Permit Fee (incluaes Grounawarer a e ssue is g Agent Signature(No Stamps)
�Approved ❑ Owner Given Initial Surcherge Fee�
Adverse Determination �115 . �� �-18-9�
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398(formerly PIb�7)(R.11/88) DISTRIBUTION: Originel to Counry,One Copy To:Safery&Buildings Division,Owner,Plumber
DEPARTMENTOF INDUSTRY, WSPECTION REPORT FOR SAFETV 6 BUILDING
LABOR 8 HUMAN RELATIONS DIVI9ION
P.O.BOX7969 ON-SITESEWAGESYSTEMS OFFICEOFDIVISIONCODES&APPLICATION
MADISON,WI 53707
Slaie Plan LD.Number
�CONVENTIONAL ❑ ALTERATIVE otass�9�ea�
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAMEOFGERMITHOLOER� ADORESSOFPERMITHOLDEP'. INSPECTIONDATE:
ElSoN L� lo�� a -! e�P 8-10 -9 p
BENCH MARK(Permanen�relerence po'm�)DESCRIBE IF�IFFERENT FROM PLAN' REF.PL EIEV�'. CST REF.PL ELEV.:
�'Cr�om Slc�.lh � 0p
NameolPlumber M%MFR61MNo.: County SanitaryPermitNum c
C o� ehce �l co_ 5ctw e Q6-la I380S
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: . LIOUIDCAPAQTY: TANKINLETELEV.�. TANKOI/TLETELEV.� WARNINGLABEL LOGKINGCOVEP
Gp PROVIDED'. PROVIDEO:
�—`S�—C� SO ICJ • '63 • 3 ES ❑NO ❑YES ❑NO
BEDDING VENTDIA.: VENTMATL'. HIGHWATER NUMBEROP ROAP. PROPERTV ELL BWLDING: VENTTOFRESH
CI ALARM: FEET FROM LWE'. ' � � I AIR INLET:
❑YES ❑NO C� ❑YES ❑NO NeARESr--� ��
DOSING CHAMBER:
MANUFAGTURER' BEODING'. LIQUIDGAPACITV: PUMPMODEL'. PUMP/SIPHONMANUFAGTIIRER: WARNINGLABEL LOGHINGGOVER
PROVIDED'. PROVIDEO:
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
GALLONSPERCYCLE: vunnPANOGONrROLSocERATIONAL� NUMBEROF �ROPERTY wELc BUiLDir�G: VENTTOFRESH
(DIFFERENCE BETWEEN FEETFROM uNE AiR WLEr.
PUMP ON AND OFF ❑VES ❑NO NEAHESi—►
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depih of plowing FORCE �ENG1N� oinnnEiea: nnqieain�nNo MnaKiNc:
or excava�ion. (It soil can be rolled into a wire,construction shall cease until MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
BED(TflENCH WIDTH�. ' �ENGTH'. NO.OF 01STR.PIPE$PAGING' COVER INSIDEDIA.'. �PITS: LIQUID
� TRENCHES'. I MATE IAL' P�T - DEPTH'.
DIMENSIONS ' S �1
GRAVEL DEPTH FILL OEPTH DISTR.PIPE DISTR.PIPE �ISTR.PIPE MATERIAL'. N0.�ISTR. NUM6ER OF 7ROPERTV WELL�. BUILDING: VENT TO FRESH
BELOWPIP�€S: ABOVECOVER' ELEV.MLET: ELEV.END: PIPES'. FEETFROM LINE: � � � AIRWLET'. (
7. , � Q � NEAREST� Q � � � �
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. I
SOILCOVER TEXTURE PERMANENTMARKERS'. OBSERVATIONWELLS; �
❑YES ❑NO ❑YES ❑NO
DEPTHOVEFTRENCHIBED DEPTHOVERTPENCH/BED DEPTMSOFTOPSOIL'. SO��EP. SEEDED' MULCHEO:
CENTER'. EDGES:
❑YES ❑NO ❑YES ❑NO ❑YES ❑NO
PRESSUflIZED DISTRIBUTION SYSTEM:
BED/TRENCH N'IDTM: LENGTH: NOAF LATERALSPAGNG. GRAVELDEPTHBELOWGIPE FILLDEPTHABOVECOVER'
TRENCHES:
DIMENSIONS �
MAMfOLO PUMP MAMFOLD OISTR.PIPE MAMFOLD MATERIAL N0.DISTR. �ISTR.PIPE �ISTRIBUTION PIPE MATERtAL&MARKING:
ELEV.: ELEV.' DIA.: ELEV.: � PIPES: �IA.:
ELEVATION AND �
OISTRIBUTION HOLESIZE HOLESPACING: DRILLEDCORREGTLY'. COVERMATERIAL: VERTICALLIFTCORRESPONDSTO
INFORMA710N � APPRoveoP�nNs
❑YES ❑NO ❑YES ❑NO
PERMANENTMARKERS: OBSEFVATIONWELLS NUMBEROF PROPERTV WELL BUILDING:
COMMENTS: FEETFROM LINE:
❑YES ❑NO ❑YES ❑NO NEaAesi�
Retain in counry file for audi�.
Ske�ch System on
ReverseSide. GN uae. ' •
SBD-6710(R.O6/88)
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