HomeMy WebLinkAbout020-638-10-2301-LUP-2008-137 Application for Land Use Permit: (*Non-shoreland*) o o ,
County of Saw��er � � ��
PO Box 676 - Hayward �%VI 54843
715/634-8288 G
*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 witY►in
the property's bounda.ries. � �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REi�UIRED PERMITS HAVE BEEN ISSUED.
PRINT-USE BLACK INK OR PENCIL �
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Owner Build��r ��
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Mailing Address Mailing Ad ress O
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City, State, Zip City, State, Zip � �
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Daytime Phone Dayti�ne Phone
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Additional Information: Zone District: ���- �- �
Lot Dimensions: (�`-�� x�v y�' .
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Date lot was created: Acres: l�� n
0
Is there wetland near the proposed structure? If yes, how far � ��
Building Land Use Floodplain: O Yes (�o (j, �
( )New ( ) Filling � �
(�ddition O Dredging Driveway access off of (Check onf,):
O Alteration O Grading O Pi•ivate Rd ( Town Rd. N �
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( ) Moving On ( ) ( ) County Hwy ( ) State Hwy � `''
N �
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Primary Structure Accessory Building Addition � � °
( ) Dwelling ( ) Garage-attached/cietached (• ) Deck � � Cr
( ) Year round ( ) # of car stalls ( ) Porch i � �
O Seasonal O Storage Building O Enclosed o � ��
( ) Frame built on site ( ) Screenhouse (�iving room � � �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen N 3 ��.
( ) Mobile/manufactured ( ) Other ( ) Bedroom � �' �
( ) Other primary structure ( ) ( ) Relocate/enr.arge � A
� ) ( ) ( ) # ofnew o � �`
Additional Information: � � �
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Type of Construction: g � Q
(�rame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete �. �
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( ) Other
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Construction Cost: Primary Structure $ 3�; ,SL� � �
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Accessory Building: $ Addition: $ �
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Deed: Vo1,�38672 Pg Certified Soil Test# �}� '0•3� °Q z
CSM: Vol Pg Lot# Sanitary Permit# �����%�� o� �
Plat Envelope Or: N
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Condo Vol Pg Year Installed: �
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Aff of ex septic Vol Pg Ovvner When Installed: "
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Previous office approvals/actions: �(� -�Q Z,
Variance: # LUP: # � � " e ' SP: � CUP: #
Inspection Report: # Change of Zone llistrict: �I �l0�
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Describe the construction using these columns. List:the dimensions of each struc:ture in a separate ;
column. List each story, each addition, each alteration in a separate column.
#1.,At�c�j�-i L���� #2. C, #3. #4.
Size ,Z�2 y ft. wide 8 ft. wide ft. wide ft. wide
8 /D ft. long �Y ft. long ft. long ft. long
Floor area 3l0`�` sq. ft. Il L, sq. ft. sq. ft. sq. ft.
Hgt.from grade�t�to peak ft. hgt. ft. hgt. ft. hgt.
Stories�_ stories stories stories
# of bedrooms N :
Rear Lot Line
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Fire Number and Name of Road (V `{ ?J `� Z, �'�I� �ai>t% �- fj�c'c=i` 1`I
l. Enter lot dimensions and indicate north by arrow. ign )w ori �tt:
2. Indicate the location and size of the requested construction �t � �4—��
Sign ture
activities.
PrintName: �.�I,.�1� i4::►�� ���
3. Also, indicate the location and distance to the well, The above certifies that the listed information and intentions are
true and correct.,that all work shall be perfortned in compliance
septic tank and drainfield, wetland areas, lot lines and to the with the requirements oi the Sawyer County Zoning Ordinance
and the laws and reculations of the State of Wisconsin, and if
centerline of the road. a�c��s as ow�er�s>a�,e�t, has the permission of the owner(s)to
perform the work requested on this application. The above
personsls hereby give permission for access to the property for
onsite inspection.
Permit fee: $ 7s�
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Issue Date Signature of Issui gent
Z o09 50% Rule: Average Road Setback:
Expiration D te
Office Comments:
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