HomeMy WebLinkAbout002-940-21-5105-LUP-1991-267 ' � Application for Land Use Permit 1
County of Sawyer 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 of the Sawyer County Zoning Ordinance and the laws and regu- �
lations of the State of Wisconsin. '
PRINT - USE BLACK INK OR PENCIL U'
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C, �E�r�'1- L, ��T L'{ O e� I��';.` G;,1 F d-`�r C,c 47 S�t�i-L<'1�/O h- �
Owner Builder
�r`�/.: �a i:'� -.,h n__- t,� ,,��' gox 512 I �
Mailing Address Mailing Address
' � i:�� /;j��t•;�•'.�' ���!�/,J; 'r.;' ,i/:': ; . . �
City, State, Zip � City,'State, Zip
Building Land Use Zone District o �
( ) New ( ) Filling rt
C�'Addition O Dredging Lot size cn K
(i�' Alteration ( ) Grading
( ) Moving On ( ) Acres ' = -
( ) ( ) �r
- - . � c� � k.
New Construction „
r
Size �, ft wide =/ /,-.,,., ft wide �/r�
` ,-� ft long � ft long
:loor area ! 1 sq ft �9: sq ft �,,�-
� ,
Total htg /'" to peak �� ' to peak � �
Stories j �_ Stories ''
No. of Bedrooms / rear 1ot line or waterline I o
(year round) os--Feee$erra�) �, �
Type of Bldg or Addition ,'� <,_ v' r
( ) Dwelling �� a o
( ) Garage (1) (2) car � � �,,
( ) Storage Building _ ' N �
( ) Boathouse `Y o
( ) Livingroom `� �i, _ ,;.� � �
(/f Bedroom -�N� -�- i�a �-o O
( ) itchen-Dining '�/�;.,�� �� - �� 0
( �orch - enclosed/roofed \J _
�
(�Deck - open s�� �9'�� ,''" i 'c"�a ���. � �'��ow
�r--- � D �= �,�� ��,�.• _ ,
( ) � ��,"�?"F 'h ,F� ' 3 �\` �
� - � ��GI-t+' - ,�": I
Type of Construction f�
(,�'Frame ( ) Block ?� r�.
( ) Log ( ) Concrete "
( ) Po1e ( ) Steel - - cn
( ) Metal ( ) `" �D
�
Construction Cost $ �� ;�,
Vol L C r' Pg 3(p of deed `
CS Vol � Pg �O� ro �
1` w
n
Cer. Soi1 Test �L -�;`�7 � `
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---------C Road --=------------ z
Sanitary Permit 1 -dCG - L
�C�E ���DA\1l"r o� r� S�TIG �-' �r',.'�' ' � z
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Issued 2(� 1�oV�x�nB�ER. Iq� � Denied
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Owner '^Zoning Administ tor
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SCALE: IINCH=400 FEET FOR ASSESSMENT USE ONLY NO
DRAWN BY: DATE: INTENDED TO SHOW GONCLUSIV
COLON (:) INDIGATES GOVT. LOT EVIDENCE OF OWNERSHIP OR
BOUNDARY LOCATIONS
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Pa�e 1 of 2 paves �a�t���� .
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I , �.cce��t : . tiv;anson , '.; i �consin i, e6ister�. �' La:ci .=, .;rvc;;�or ,
do :r�er�bJ �• �.�� � f;y- ur_der the provi ;:io��s oi Cr.�_p� er 230 , �4 oT zne
':� iscor.si� St�.tutes , and under the direction o� :azel , Gl�a , and
nobert 5�.:.or:son , o���ners of said land , I have � ,�rveyed , divided ,
ai�d mapped �:^:e land herein descri�ed , and tr.at �aici land lies ir.
i Gov ' t Lot o:.� ( 1 ) , Section t�A�enty-one ( 21 ) , Z �`.'�:r:s::ip forty ( �:0 )
i� orth , :4�_oe rii:le ( 9 ) ':� est , Tov✓n of isass La?-e , Sawyer County ,
V� iscor�sir. described as iollo�vs :
Com;;�ncing at the i;;eander Corner ���hich lies approxirnately
417 . �5 feeZ �:�est o� the southeast corner of � ectior: z1 -�o - 9 :
thence T�o�th 31 ° 53 � 1'•� est 196 . 22 feet to an iror: rou : thence ilorth
11 ° 13 � �•�' est 492 . 43 ieet to a spi]: � : �thence :; or��. 24°27 ' East
237 . 20 feet �o a sp�ke in tne F�.oad �•rhich is zr.e poi:�t -of-beginning
Z f.E1':� G :': ortn 21 °51 � =,4S�i, G �O:'1� �'I'.@ liOdQ � JJ • ��7 � P��, tC 3
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� r:er�-'.. � u��.� L11 7 ,5°34 ` �GCJ li � C..�� Ol) r y r: A
. 1 ee � to a_ iron rod on t'r�,.
Meander 1=r:e oi '.: indigo �a�e - said iron rod lies 22 feet from
the ��rater ' s edge _
i�ence SoUtn 49°37 ' `.' est 75 . 50 �eet alo::g the i;ear�der line
of said L�:��e to an iron rod lyir.� �5 feet frorr� the ���ater ' s edge
`�':er.ce tiou�h �7°08 ' �ast � 4?_ . 90 feet alo__o the m.�ar�der line
of saic L��:e to an ir,on rod lyino 9 reet irc::� �r.e ,A�ater ' s edge
i':�r.c ? Sn;;th 45°46 ' .: � �Z 1 j7 . 0 ° ;eet alor r the :r�ander ?ine
,
of sai d i,�:_e �o an iron �od lying 24 �eet T ro:�`t?ze ��;ater s ecge
�:^e:�� e :;ortn 42°2& � �.:est 2j; . 25 ieet to tre P . O . � .
a�.id lo� is to iriclu�.: e 411 the l�nd lyirg Let��;eer� zne r�:eander
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line a::d �:�ie ti�rater s ed �e ��t���een ti��e lot lir.�s ex�ended
a�ic ic� s are sub j ect to t:e i oi.t use o= the 50 �oot =:oad
as si?o�,:�?� o:: �Ze ?;�ap .
Said ic � s a.re su� ject to eatic;neY�ts and re�ervat�. ons of record .
`�::ere s:.all bn n_o fur�i7er aivisions of �r.ese lo;, s as rlo��� laid
out .
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Department of 7,oni.n�, and ;nniCrztion
S�wyer County
0
Inspection Report �
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�s
Owner Robert L. Sturges
--------- v�
Addreso 6813 Oaklawn Avenue Edina Minnesota 55�+35 y
Name of Uusiness N
Builder Peter Binder o
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Address Route 5 Hayward Wisconsin 54843 y
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Plumber r
Addreec
Inspection
(��rivnte ( � PuUlic Property Sanitary-instal o 0
wellin; Setback - lalce �+ �
Vlolc�tion i�9obile FI��1 Setback -•road o
Gnrn�e ;etb�cic lot lin: "'
( � Sanitnry ( � Zonin�3 Privy � s �_5� k �
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Discus�ed irith owner � ye> no �
Discusced wi.th Uui.lder ,Y yes no
7iccu�:;cci tiaith plumber � }� yes no
I'�'.scussed tiaith�j u� u„� k yea no �
DctE -�/��- �� (02 April 1a82) �
Si�,r:�itu�e of Officer - �
-���)-�����—------
David Heath - ZA
DOCUMENT.,NOMBEn AFPIDAVIT
2 e� C � �] ,1 EXISTING SEPTIC SYSTEM
lrJ !wY
ONE AND TWO FI�MILY H�' �'��' i
Scu-��: Co�•.ur, ( •
Rc�,�..•�. . �.c,•r.+ tlx� _ / / dcy tll
If the existing septic system does meet the minimum re- � � � .�a 9( rt �dwx�
quirements for groundwater and bedrock depths and if it M«,�,��,,��,�� :�� ,� �7.^
is functioning, an addition to or replacement of a hab- d p�,�e a, F,�,� �7J�L�
itable �tructure can be made in most instances without �_ �,-y,,.,�
updating the existing system. If the existing system BcqIM
is utili.zed for the addition, every attempt should be
made to locate and reserve an area which is suitable
for a code complying replacement system for when the
system fails. If the additiori will substantially in-
crease the wastewater discharqe , the existinq system RETURN TO
will be replacAd with a code complying private sewage Sawyer County Zoning Admin
system. P.O. Box 668
Hayward WI 54843
owner(s) Audrey L, and Robert L. Stur�es
rlailing address 6813 Oaklawn Avenue
Edina Minnesota 55435
Property description ✓Lot 4 in Govt Lot 1 S 21 , T 40N, R 9W. Parcel
: 1 . 5 . CS Vo1 8 PQ 105 . Vol 402 Records PQ 36 . 1 . 35 acres .
002-940-21-5105 . Town of Bass Lake .
1�1'y (we` Audrey L. Sturges and Robert L. Sturges plan to
(v, Add onto existing dwelling
; ; Add onto existing mobile home
; ) Replace existi.ng dwelling
( ) Replace existing mobile home
The present orivate sewage system has been working satisfactorily as iar as disposiiig
of waste�, If the present private sewage system does fail, it wi11 be replaced with
one that is code � mp ing.
�j b�l',�� ; %��� ') �(��S ��
obert Iv'r Sturges date
G��+ :�,��2�c:.�—_, /G/� y/
�Audrey L. Sturges date
Persenally came before me this
�//�' _day of �� �tttJ_, 19 ��
/ .....� '.
/ u�� � PAULh L. JOY
� ,
NGia.n s��ii�—MINNESOTA
� Notary Publ �E,.w�. HFNIJfPIV :OUNTY
. 1�1I1II2 O�'d�""�� My mmmission exp�res 417Ab{
...i.i..�.......�r
LLG .L �C� �,'011RtY� �.ffi4'L�Yl
My Commission ls expires "' ' %�
Existing se�tic system - Sanitary Permit 82-067
Date syste � instalied 30 August 1982
�.G v(l���A ZA or AZA
David Heath
� l bLTUF_�,a. ��i.�(l
date
This instrument was arafted by ��,� 3 � � � 2
Robert L. Sturges '
�DEPARTMENT OF � APPLICATION �
SAFETY& BUILDINGS
iN�usTRv, FOR SANITARY DIYISION �
LABOR AND PERMIT P.O. BOX 7969 `;'
HUMAN RELATIONS (PLB 67) MADISON,WI 53707 �
�
Attach plans for the system on paper not less than 6'/� x 11 inches in size. Include a plot plan that is dimensioned or drawn to scale. Horizontal
and vertical elevation reference points must be shown. All appropriate separating distances and physical characteristics as specified in chapter
H-63, Wis. Adm. Code, must be shown. An index page or each page must be signed,sealed and dated by the designer. If designed by a Master
Plumber,the date,signature and license number must be shown. The owners copy or a legible reproduction of the soil test report must be
included.
Audre L . Robert L s
Pro rt Owner: MailingAddress: �(�INA
�l�', a�; St u /� G ES 65�3 0 � wA k it�i ww ss 3
Property Location: Cisy.�fiLLayaor Township: County:
,�< ,�<S�, iT f�D NiR �� W ss w �
Lot Number. Blk No.: Subdivision Name: Nearest Road, Lake or Landmark: tate Plan I.D.Number:
C, w' ` Ilf assigned)
iIl C..
TVPE OF BUILDING
Number of
❑ Public' ❑ Variance' ❑ Other (specify)" aedrooms:
I� 1 or 2 Family "State Approval Required. �
TOTAL NUMBER PqEFAe POURED-IN STEEL FIBERGLASS iVEW REPLACE- OTHER
GALLONS OF TANKS CONCRETE PLACE INSTP.LLAT;ON MENT ISpecity)
SEPTIC TANK CAPACITY OOQ
HOLDING TANK CAPACITY
LIFT PUMP TANK/SIPHON CHAMBER
MANUFACTURER: (�
EFFLUENT DISPOSAL SYSTEM
PERCOLATION RATE ABSORPTION AREA
(Minutes per inch): PROPOSED (Square feetl: �NCW ❑ Replacement ❑ Experimental ❑ Seepage Bed ❑ Seepage Pit
�7� S / �� ❑ Alternative (specify) ❑ SeepageTrench
! fp
Water Supply: Owner's Name as Listed on Soil Test Report Ilf other than present ownerl:
� Private ❑ Joint ❑ Public
I, the undersigned, hereby assume responsibility ior installa:ion of the private sewage system shown on thz attached plans.
Name of Plumbe•�c Sign �u � � q"�� MP/A4PR6W-PN.: Ph�ofne�N(upm�be/r.
C �O�ti/ � � I�J I O b.7 ���
lumber's Address: , Name of Designer:
, • 33 - �u�s sy�� �
COUNTY/DEPARTMEfVT USE ONLY CST 82- 057
Sig of Issuing Ag Fee: Date: � qpPROVED Sanitary Permit Number.
�6� . �� 6- 1�— $Z ❑ DISAPPROVED � ��9�
� Reason for Disa roval:
Alternate courselsl of Action Available:
C;,ange of ownership, building use or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to in-
stella*.ion. Failure to comply will void the sanitary permit.
DISTRIBUTION: White-County, Canary-Bureau of Plumbing, Pink-Owner, Goldenrod-Plumber
D I LH R-SBD$398 (N.03/81)
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS
IABOR & HUMAN RELATIONS pRIVATE SEWAGE SYSTEMS CIVISION
P.O. BOX 7969 BUREAU OF PLUMBING
MADISON, WI 53707
� CONVENTIONAL ❑ ALTERNATIVE StarePlanl.D.Number.
(�r a::lgoedl
❑ Holding Tank ❑ In-Ground Pressure ❑ Mound
NAME OF PERMIT HOLDER�. ADDRESS OF PERMIT HOLDER: INSPECTIOA' DAiE�.
//� _ --1 � . ' . � . . +—� � ._ � �.'
�i/ I '�i - � � ' O i ! �!; 1/'i�.'. 'l, r `", .�
BENCH MARK IPermanen� re�erence Voin�) DESCRIBE IF DIFFERENT FROM PLAN�. / A ,� REF. PT. ELEV.: CST REF. PL E�EV.:
�����/l-� .
Namc of Piumben MP/MPRSW No.�. Counly: Saniiary Permt Numben
i �
v_ � � �
, , _�—� �� � 1 f� ���,, -� ; __ �j� �
SEPTIC TANK/H9�B+N6-��NK:
MANUFACTURER�. �IOUID CAPACITY: TANK INIET ELEV.: TANK OUTLET ELEv. WARNWG _ABEL LOCKING COVER
, PRO`.��DED�. PROVIDED:
� _ ' �r `� f�`^ . -' C�YES ❑NO ❑YES ❑NO
._ , .
_ , ,
BEDDWG: VENT DIA.�. VENTMATL�. HIGN WATER NUMBER OF �� ROAD: � PROPERTV WE�L� �3UILOWG: �VENT TO FRESH
"L"R"' FEET FROM LINE � AIR INLET.
❑YES ❑ NO ❑YES ❑NO NEAREST ` �2�
DOSING CHAMBER:
MANUFACTUREF BEDDING�. UOUID CAPACITV PUMP MODEL PUMP/SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑YES ❑ NO ❑YES ❑NO ❑ YES ❑NO
GALLONS PER CYCLE: Pumc arvo corvrRo�s oPeanriorvn� NUMBER OF �'NOPERTV WELL BUILDING I VENT TO PRESH
(DIFFERENCE BETWEEN FEET FROM `�"E "iR �"�ET:
PUMP ON AND OFF) ❑ YES ❑ NO NEAREST—j►
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing �FticrF, oin•nETEH nnAreRin� nrvo nnnaKwc
or excavation, (If soil can be rolled into a wire, construction shall cease until FORCE
the soil is dry enough to continue.) MAIN
CONVENTIONAL SYSTEM:
� WIDTH LENGTH NO. OF DISTF. PIPE SPACWG COVER INSIUE DiA rpITS LIQUID
BEDJTRENCH • THervcHEs , n,iarER�n�- p�T oEcrH.
DIMENSIONS % % - .
_< <<':
GHAVELDF�'-fH FILLDEP7H DISTH�PIPF pISTH PIPE DISTF. PIPF MATERIAL. NO. DISTH NUMBER OF �'anF'cRTV WELL BUILDING�. VENTTOFRESH
sF�ow aives AeovE eoveF� f:i ev irv�F r e�E�� ENo PivEs FEET FROM � � 1Ne� � niR irv�er�.
�. ' �% ' -7 cr -� �, ' � NEAREST—► '�
_; �� ' / <..
MOUND SYSTEM:
Mound site plowed perpendicular to slope Check the texture of the fill material for PROVI�E 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 NIEASURED.
❑ YES ❑ NO
SOIL COVER TEXTURE PERMANENT MARKERS. O(3SEFiVATION WELLS
❑YES ❑NO r�YES ❑NO
UEPiri pvEH iHENCH�BED DEPTH OVEH 7HENCH.�HED UEPTFI OF TOPSOI� SOUDEU SEEDED MU�CHED
CENTFH EDGES
❑ YES ❑ NO ❑ YES ❑ NO ❑YES ❑NO
PRESSURIZED DISTRIBUTION SYSTEM: �
WIDTH lFN(lill NO. OF IATERl�LSPFICIN(i GHl�VEI OEPTHBCLOWPIPF FILLDFPTHAHUVB ';UVrH
BED/TR ENCH rNerva+es
DIMENSIONS
MANIFOLD PUMP Ml�NIFOLD DISTR PIPE MANIFOLD MATEHIAL NO. DISTR. DISTH. PIPE UISTHIBULION PIPE MATEHIAL & MARKING
ELEV. ELEV. DIA EI.EV. PIPES DIA.:
ELEVATION ANO
DISTRIBUTION '
WFORMATION � F10LE SRE HOL'c SPACING DHILLED CORRECTLY COVER MAT[RIAL� VERTICAL LIFT CORRESPONDS TO APPROVED
PL�NS
❑YES ❑ NO ❑YES ❑NO
COMMENTS: PERMANENT MARKERS-. OBSEHVATION WELLS: NUMBER OF� P���PERTY WELL: BUILDING:
FEET FROM ��"E
❑YES ❑ NO ❑YES ❑ NO NEAREST
�__
, .
Sketch Syscem on Retain in county file for audit.
Reverse Side. --
SIGNATURE TITLE
D I L H R S B D 6710 (R. 01/82) �L�C•t�-G"� ,,�f�'L� �-c�+-7 Q�-L's+--
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