014-842-15-2105-LUP-2004-018 Application for Land Use Permit(*Non-shoreland*) o o/� •
County of Sawyer �, � �
PO Box 676 -Haywazd WI 54843
715/634-8288
*Property that is not located within 300'of a creek,river or stream or within 1000'of a � �
flowage,lake or pond or does not have any of the above waterbodies located within
the property's boundazies. s
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. � �
:
PRINT-USE BLACK INK OR PENCIL
1/D�/7r �- �
/ c�a�2� �c! �Gsan/ /�za-�t i�, �3�r•" �
Owner Builder a
1�s27 /V .Glf/r�l�a j�/1- Dh l3.sZ�iU.-Llhr�ulvl,�if' 1� � �,,�
s�
Mailing Address Mailing Address � O
�r76vci v.1 Gd/ s'��f�� �a�i�a�o(r Gr// �`f��/� � �
City,State,Zip City S at te,Zip �
7/s� G 3 5� �...� �- 7/� GTs� �a�� O
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Daytime Phone Daytime Phone '�
Additional Information: Zone District: C -/
�U
Lot Dimensions: o
T
Date lot was created: Acres: a���U �
Is there wetland near the proposed structure?If yes,how far /l/'4
Building Land Use Floodplain:O Yes (►fiNo o �
i}l�New ( )Filling
O Addition O Dredging Driveway access off of a(Check one): b
( )Alteration ( )Grading ( )Private Rd ( )Town Rd. �
( )Moving On ( ) ( )County Hwy (v�State Hwy (�j � �
O O �� �
Primazy Structure Accessory Building Addition �
( )Dwelling ( )Garage-attached/detached ( )Deck �
( )Year round ( )#of caz stalls ( )Porch �
O Seasonal O Storage Building O Enclosed i
O Frame built on site O Screenhouse O Living room � z,
O Modular/manufactured O Greenhouse O Kitchen � t�
( )Mobile/manufactured �Other ( )Bedroom J. �
( )Other primazy structure ( ) �'�-F�ce �3�dR, ( )Relocate/enlazge �
( ) ( ) ( )#of new � �
AdditionalInformation: � p
y� �
�
0
Type of Construction: 'ti
(v�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete � ~'�
( )Other �
H
Construction Cost:Primary Structure$_ �
Accessory Build' g:$ /�'d"D � Addition:$ , y
5.3� i ilp 5ag�ig� �' N
Deed:Voi �'y 3 Pg �''7 Certified Soil Test# pd -LY'� - z
CSM:Vol Pg Lot# Sanitary Permit# 7y
Plat Envelope Or: �C
Condo Vol Pg Yeaz Installed:
Aff of ex septic Vol Pg Owner When Installed: �
Previous office approvals/actions:
Vaziance:# LUP:# SP:# CUP:#�x��-,� �
0
Inspection Report:#_ Change of Zone District: �\� �
I��iB
Describe the construction using these columns. List the dimensions of each structure in a separate
column. List each story, each addition, each alteration in a separate column.
#1. Gf�7cG —/Ltr #2. r,��c� #3. #4.
Size��_ft. wide � G% . wide ;' ft. wide ft. wide
�ft. long �2 ft. long ft. long ft. long
Floor area�sq. ft. sq. ft. sq. ft. sq. ft.
Hgt fmm g�ade � to peak ft. hgt. ft. hgt. fr. hgt.
Stories / stories stories stories
# ofbedrooms N'ft � ��� ✓'CFC e c�Pect rcc �eC-� i ;�(oc- aeCr�
� 6'�°` �" !
Rear Lot Line !,-� '{� �c t F�� �� t c �_ � �(�
�� ��� �
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Fire Number and Name of Road ;'•r f J O_ -e C V`� � � �-� 2 U �'�(
1. Enter lot dimensions and indicate north by arrow. �� �;<r� , �,c' Signature of Owner or A�orized A ent:
2. Indicate the location and size of the requested construc�ion
SignaNre
activities. ����� � ��5�
Print Name:
3. Also, indicate the location and distance to the well, The above cer6fies that the listed information and intentions are
We and cortect.,that all work shall be peAortned in wmpliance
septic tank and drainfield, wetiand areas, lot lines and to the W�b �e 2quirements of the Sawyer County Zoning Ordinance
and the laws and regulations of the State of Wisconsin, and if
C0rit0illri0 Of Y.�1C T03d. aciing as owner(s)agenL has the permission of the avner(s)to
peAorm the work requested on ihis applicatioa The above
i
�f - ` t- �t ,� I� persons/s hereby give permission for access to the pmperty for
, fJ .��r onsite inspeclion.
Permit fee: .
� 7 s ��.
February 2 , 2004 ������,!/�✓���.���',�L
Issue Date �gnature of Issuing Agent
February 2 , 2005 3p% Rule: AverageRoadSetback:
Expiration Date
Office Comments: < �``�`/L� • � /� S �_
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'PEIERSON RD'
SHONN AS 66' NAD1H FOR �
MAPPING PURPOSES.
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` � THE EXACT LOCA710N OF
• I � iHE ROW FOR HWY. �83� � /
IS NOT CLEAR, A BEST flT
� � PROCEDURE HAS BEEN ' 12
APPUED.
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� 4 \ • �'T ` � 3214 � � � SHOWN AS 50' MAD7H FOR I
� \207 3� � MAPPING PURPOSES.
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RIVERVIEW � QPs c�`xou��vu a�vEv'smr �
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