HomeMy WebLinkAbout014-842-20-4103-LUP-1992-405 � ' / k�
Application fo� i,and Use Permit � �
County of Sawyer i
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The undersigned h=_reby makes application for a i.and Use Permit and agrees ' �
that al� work shall be done in accordance with the requirements of the Sawyer r,
County Zoning Ordinance and the Iaws and regulati_ons of the State of Wisconsin. �
PRINT - USE ONLY BLACK I.7K/PENCIL
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Owner � Builder �{-�
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mailing address maili.ng address I
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city, � ate, zip city, state, zic , �
Building Land Use Zcne Di�tri_ct /'y�/
� New ( ) Filling � � Gs 7
( } Add_e.tion ( } Dredgina L,o: s;s.e ���(�. �[ �C-�`7c.'����.C.� I s �
( ) Alteration ( } Grading N n �
( } Moving on O _ Aczes /�Q�'N[,_�� 1'+-��47� V i�
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New Construction
Size �� ft wide _ ft saide ��
_��_ ft long £t long �
filoor area ���_ sq ft _ sq ft ,�
iotal hgt _�__ to peak to peak � /•
Stories _�_ �
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No. of bedroom�: rear 1ot line or waY,erline
-- — �
(year round) or (seasonal-} �-- ----i J
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Type of bldg or addition � i N �
( ) DwelI.ing � i �f*
(� Garage (1) (2) car � � �s
O Storage building � i c rr
( ) Boatnouse � —� N � Y,
( ) Liviagroom � i ��
( ) Sedroom � i �
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( ) Kitchen-dining � �
( ) Porch - enclosed/roofed i� i
( ) Deck - open � � �
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� iT N.
Type of construction � i 1
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(�/(�� Frame O Hlnck � I �Li'� i �jVy��
Q ) Log � ? Concrete � ��,5���1i��`�� i "�
{ ) Pole [ ) �tee7. � y�> i �v
( ) Metal 1 } � �' �
__..________. i ,i DE.� k'� y' �E i
LI,�,�,, � •r 1 V%
Construction cost :;�7-(�O� i� �X �Y�1 g� �� �(JA�
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Vol ��� �a_��_ of deed � � �Fc� � � i �
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CSM Vol Pg i i ro
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Cer. Soil Test �s^ �`� i � � i m
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Sanitary Permit �5-�Tl___ � `T��� � l�'
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Issue3 ����b_���L q,� Denied----- W�
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owner Zoning Adm'nis rator
r„ ,� SIMONS RC
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Plb 67 State and County State Permit # 18367 �
� Permit Application County Permit # 5 -Q�A
for Private Domestic Sewage Systems County Sa�Pr -
C �� S-08�
"'DENOTES STAT APPROVAL REQUIRED
Date Approval Rec ived from State if Required State Plan I.D. #
A. OWNER OF P OP�RTY Mailing Address:
,
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B. OCATION: _�_T_ l� �F Y4, Sect on ��, T�,Z, N, R�_�or) W Lot# City _
Subdivision Na nearest road, lake or landmark Blk# Village
� Township �,�igQQ�
C. TYPE OF OCCUPANCY:�Commercial 'Industrial *Other (specify) *Variance
Single family _�___ Duplex No. of Bedrooms 7�,e,c,� No. of Persons�_
D. TYPE OF APPLIANCES: Dishwasher � YES NO Food Waste Grinder � YES_NO # of Bathrooms�..
Automatic Washer _�_YES fV0 Other (specify)
E. SEPTIC TANK CAPACITY ��} �} (� Total gallons No. of tanks /
"Holding tank capacity Total gallons No. of tanks
New Installation __ Addition Replacement _ Prefab Concrete ,I� _
"Poured in Place Steel Other (specify) _
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1 ) � 2) 3) , Total Absorb Area ,'?, �� sq. ft.
New Addition Replacement "Fill System
Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches __
Seepage Bed: Length �Width �_ Depth �C_� Tile Depth �_ No. of Lines _ '�
Seepage Pit: inside diameter��� �� Liquid Depth Tile Size __
Percent slope of land SC,�n /,�( -�j Distance from critical slope 7 �Q
I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
by the Certified Soil Tester,
NAME �,��iQ�s�+-!</ s'F.v C.S.T. # ,�-� //, ;� and other information
obtained from -'o � wner u der►.
Plumber 's Signature � � MP/MPRSW# ��g'S'� Phone #�9f� -3�s�''
PLAN VIEW: Provide sketch below of system (include direction of s►ope and all distances in accord with
H62.20, including well).
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Do Not Write in Space Below - FOR DEPARTMEN � �
Date of Application 6-19-75 Fees Paid: State 1 , 00 County 10 , 00 Date June 19 1975
Permit Issued/8� (date) 6 -19-]5 Issuing Agent Name ,�,.
Inspection Yes�No Valid# ate Rec'd
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1. county (white copy) 3. owner (green copy) DIVIS�ON OF HEALTH, P.O. BOX 309, MADISON, WI 53701
2. state (pink copy) 4. plumber (canary copy)
� � .. . ,. ,- •--
DOCUMENT NO, STATE f:AR OF YlISCON9IN—FORM 1
' 'j �VAltlt:l�"1'Y lli�:l�;l) �
I ��;� TH19 SPACE IiCSCRVED FOR RCCORDING DATA '
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� ---- - ------ ,— --- : �Reqi9ter's Office �.
Th• Marie Larsen, an aC�Ult _ Sawyer County
is Leed, made between.............�-�--� -�--..... ......... .-------- �---•----
•••••••••- ���,
xnK�Ma�l.................................•••...._.................•••••••-.........-•••••••.....••••••••••..__...................... I�Received for record the ,-✓L-7� doY of
.._...•••• •••••:.:.::........................•••••-•••••••••--...............••••••..........._............--•-•......•••••••••••..............
�v" _A D l9�at�d�clock
........................ Granrot ,�r'f ond recorded ln vol.�N/ ,
•••-•• ••••...-•••-......•••••••••••••••••••._...•••••-•••••••••-••-••...........................••••---...,
JaC}C G.._.,s 'ostrom. and_._Susan__.S �OStrOITI_�................... oE Records on poge1� _
and ••--......-•............... �... ..... �.
._.husband...and._wif�._..as.--7-o.i.nt...tenants........................................ � . �. %` ��
...-••••••••••••••-••••••••..........................•••••••••••••••••••...•••••••••-••...-••••-•......_._....•••••••••-•, Grantee, , /� gister
tS✓itnesseth, That the said Grantor for a valuable consideration............................
'; ••-•••••••.....................•--•-•._........••-•••.......••••••---•--••......•-•••-•••.........._......................•••--•••-•••••-••...••-•••--
i Deputy
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conveys to Grantee the following described rea! estate �a_.._.Saza.�rer................ councy, jl
I� State of Wisconsin: I� RETURN TO
The Northwest Quarter ot t!� Southwest Quarter ��
(NW 4SW 4) of Section Twenty (20) , Township Forty--,I__ . _ __ _
� two (42) North, Range Eight (8) West, and the
TaxKey #..•••••....................•••••••••••••-•••••
Nor�heast Quarter of the Southwest Quarter
Tl�is is .................. homestead propezty.
(NE4Sw4) of Section Twenty (20) , Township Forty--two (42) , North, Range
Eight (8) West, except a parcel located in 20 acres of land in the
� South Half of the Northeast Quarter Southwest Quarter (SzNE4SW4)
Section 20, Township 42 North, Range 8 West, Sawyer County, Wisconsin,
subject to easement of record excepting a tract in Southeast corner
of this property better described as follows : Beginning at the
' Southeast corner of said twenty acres, more or less, in S'z NE�SW% of
Section 20, Township 42 North, Range 8 West, thence Noxth 88�33 ¢West
� 265 feet; thence North 42°15 'East 390 .00 feet; thence South 300 feet to
i
point of beginning, containing 1.00 acres more or less.
; Subject to all easements, exceptions and reservations of record.
� Together with all nnd sin�;ular the hereditamcnts and appurtenances thereunto belonging or in any wise aPpertaining:
'�', And _...._�aX�:.e....�aTS_eIl.....................•-....._.......................................--�-�---•-••-..............••-••...---._......_....................•••••••••••••........-•••
; watrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except........................................................
'' -•---•••••--••-•-•••••...........•-•._..........•••-•••••••...•••..................••-...-••••-•••••••-••..........•-•..._............-••••••••-.................---•.........•••••-•-•••-•----........•-•••••...••••••-•••_•-•
�. ..........:..........••••••••-.._--...._...............-••._............-•••-...-••-••-••••--•••.......-••_.._........_........._..._............................•--••..._...•-•---••-••.----..........._......._.....••-......
and will warrant and defend the same.
;'. Executed ac.��YWard.,._..Wisconsin 29th,.._..__.._ day or........June : 72
•••..................••.......... this................. .........., 19........._.
�� ��_.—� ' �.
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� �SI(3NED Ap7D H�AI, ll�i-ne:sL;� oF �/���- GLn��vrv.-•••-•-•-----.......(SLAL)
�— � l ...-�-•-•---.•-.•--•.•--••-�......................••--•......_
�, � � � _ Marie Larsen
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` ................./...._....... ...---....._..._......_...��/......-•-----------.........
;' - ..............•--•------....--•••-••-•••-•--•.........................•---•........._......--�SL•AL)
T.W. Duffy
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I' ....................(SEAL)
�.............�-------` ..---.. .........-- -�.r ..c��'��...---...._.... .......---.._�---��------------------�----�----�---------�----........__.
,; �. ..�.- . .
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�I J.J. Seddon
�, ...................................••••-...........-••••--••••---•-•-••-•........._...._.._...(SEAL)
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I� Signatutes of ................. .............._........-••••-...........
•-••..._._..•••...............................................•-......_.......-•-...••-..._.._.........................•••••••......
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;� authrnticated this.••-•••-•......••••••.................•-••..._.. day of-•-•--...........---�--...-----...._........._.._.....•••••----••-, 19.....••••..
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�� ••-••-•••--....-•-••-•••-••-••••-•••-••••••..............:.................•-•--••••-••---..............._
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`� "fitle: l�dember State Bar of Wisconsin or Other Party
;� Authorized under Sec. 706.06 viz. ...........••...................................•-•...
'� STATL OP WISCO2`'SIN
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� ...........................y �..........._.................County.
' Personall came heforr me, this..... ..............29th ... .. . _ day �f............►�ne
.. ._.........................................•-•-•.., 19.,�2,
the above nameJ....Mar'12 Larsen, an 1C�U1.'t woman
........--�----�----��-----�----�----��.....................
.... � -..... ......................��-----............................._.
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................................... �---. .................._........ ....-- --.....---.........._.
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to me known to he the -1 ---
I i prrsr�n........ who executed tl�e fo����ipp�u�ytj����rnt an1 ack awlr,l�;c,l t6�aamr. �'_� -••
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• THIS INSTRUMENT WA9 DRAFTED BY ,�� �1 � � � - � .�,��i � �.�..� \ ��
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i J .".' .�. .vr. �
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� ���r ,. - - ,� _
; T.W. Duffy - Attorney ���Y�= �' �' �r' Thomas W. Duffy �
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, . ._.._................. .... .. - --- ---
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.. ..a�_.Z;aw......._........... ..,_......
! The use of wirnesses is optiunal. ..i;'� ; Nbtary Puhlic, Sawyer
......... .... ... __._..... . ... ................. Count��, \�'is.
! � � ary �„��;��,�,5��>� �as�F (��) _I'ermanent
---__. ________ - .
Nan�es of ptrsun> >i,qning in any capacity shuul� bt type�l ur priiitc'�� bcl�nv tl�cit si�;n:iturre.
• V'�t:,, 2 41 P�- 161
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