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012-640-05-2205-LUP-2004-176 Application for Land Use Permit(*Non-shoreland*) o o _�, County of Sawyer � PO Box 676 -Hayward WI 54843 715/634-8288 Z � *Prooerty that is not located within 300'of a creek,river or stream or within 1000'of a _ S flowage,lake or pond or does not have any of the above waterbodies located within �� the property's boundaries. 7 CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. , � PRINT-USE BLACK INK OR PENCIL �1�4��, c.h� I�arl�1 (�I �chefs� � � ��'l � � �► � Owner Builder p- � E S� .`�y L 0.Nn v�e S+. P o i?�:�x _�c y- � Mailing Address Mailing Address � O E�ihekl�,� LL �;os.�c -� � � City,State,Zip City,State,Zip �' �' t- 7SIS - .=ZJC; "'.;`/S o, Daytime Phone Daytime Phone � r' � Additional Information: Zone District: �( �C��, S � �- Lot Dimensions: � - . F Date lot was created: ��8'6� Acres: I• �0 6 y F Is there wetland near tbe proposed structure?If yes,how faz ��- Building Land Use Floodplain:O Yes (X)No �` (%)New ( )Filling o T O Addition O Dredging Driveway access off of a(Check one): � ( )Alteration ( )Grading (N)Private Rd ( )Town Rd. � ( )Moving On ( ) ( )County Hwy ( )State Hwy � � � ) � ) � � � � r" Primary Struchzre Accessory Building Addition N o (y.)Dwelling (X)Garage £tache etached O Deck � (X)Yeaz round (t)#of caz stalls QC)Porch r �SP�s�n2t ! 1 Storage Building ( 1 Fnr,]osed OFrame built on site O Screenhouse O Living room � � ( )Modulaz/manufactured ( )Greenhouse ( )Kitchen p ( )Mobile/manufactured ( )Other ( )Bedroom v} _ ( )Other primazy structure ( ) ( )Relocate/enlazge ' \ ( � ( ) ( )#of new �' O � AdditionalInformation: � p � � 0 Type of Construction: � (K)Frame ( )Log ( )Pole/metal ( )Block ( )Concrete � V7 ( )Other � � Construction Cost:Primary Structure$ C-s; o c., , c o � Accessory Building:$ �''��°� w•�'�' �7� ""���Addition:$ , � � � Deed:Vol -7�$__Pg��f�_ Certified Soil Test#_Q�/-O�$_ ' y CSM:Vol�7}Pg 20 S Lot#� Sanitazy Permit# O�/-D 7� � 7y Plat Envelope 1� ln39B Or: 6� Condo Vol Pg Yeaz Installed: Aff of ex septic Vol Pg Owner When Installed: � Previous office approvals/actions: Variance:# LUP:# SP:# CUP:# Inspection Report:# Change of Zone District: s���o� � 13�o"1S Describe the construcHon using these columns. List the dimensious of each structure in a separate column. List e�ach story, each addition, each alterallon in a separate column. � #1. 15 + -�-lua � #2. ,i( �id �/oQi #3. Ga�ru � #4. �'c�i c�� � Size � � fr. wide i S fr. wide I S ft. wide �S ft. wide 3 v ft. long �ft. long �� ft. long �° ft. long Floor azea �6� sq. ft. �{c;� sq. ft. �-/8 ro sq. ft. a yo sq. fr. Hgt from gade to peak ft. hgt. ft. hgt. ft. hgt. Stories stories stories stories # of bedrooms a- S Rear Lot Line ,c ' �' _._�.----�—* i _-_ ..,.._,___.— + :;+�a S ` h �°' ,-�� � 7' � � " � � � � � t �� ��.n ; .� � _ _ t� SPI_ _ � { - . I '` _ , W ,; — ,, _� �- -- � � . , . . � � � , �� � � � � � � — � x�/ '� _ ; � o;, i � � � x3 '� � � I i � � ' — — � i �- - -- — N � — io cy - i< 1-....- -• - -_..".____..._L"�r -_ _--�-� v � "t �I�H>�t+ � � , � - _ - — — — — — — — o�— —� � r Fire Number and Name of Road �}p,�)ie LL �o r • T� w�����c k ��a i� a 1. Enter lot dimensions and indicate north by arrow. Si n ur of Ow er or uthorized Agent: 2. Indicate the location and size of the requested construction - c��/Z�,C�� CSn4'�. �12e�,�`� &CtIV1YlES. ,� - SgnaNre /� PdnWartre: �lc�ln L'+hGl ��G (�p l�'1 ���1P�S 3. Also, indicate the location and distance to the well, The above certifies mat ihe listed intormation and intentions are true and correct.,that all work shall be pedormed in compliance septic tank and drainfield, wetiand areas, lot lines and to the wIN Me requiremenLs of ihe Sawyer County Zoning ONinance and Ne laws and regulations of the State of Wisconsin, antl if CCritCillriC Of tI1C T02d. acting as ownef(s)agent has the permission of the avneqs)to peAortn the work requested on this application. The above personsls hereby give permission for access to the property for onsHe inspectian. 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