HomeMy WebLinkAbout002-109-17-2900-LUP-2004-292 I r /'�
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Application for Land Use Permit (*Non-shoreland*) o o �
County of Sawyer � � �
PO Box 676 - Hayward WI 54843
715/634-8288
*Property that is not located within 300' of a creek, river or stream or within 1000' of a J' � �
flowage, lake or pond or does not have any of the above waterbodies located within � `�
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the property's boundaries. 'J� f
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMTTS HAVE BEEN ISSUED. 'J �
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����d� PRINT—USE BLACK INK OR PENCIL ,�
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wner Builder �:
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-7��:�3 � �,v�.�,i(, �.�,r�z � o.
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Mailing Address Mailing Address � �
�.,� � �.J.�_ 5 y�'°�3 � �
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City, St�Zip City, State, Zip S
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Daytime Phone Daytime Phone �n i
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Additional Information: Zone District: ��� r� '�
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Lot Dimensions: 1 �G� x ( �c� �
3 �
Date lot was created: Acres: G. �7 S n �,
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Is there wetland near the proposed structure? If yes, how far � � .
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Building Land Use Floadptain:( j �es (�No �; �
( )New ( ) Filling � x
(X�Addition O Dredging Driveway access off of a(Check one): �, �
( ) Alteration ( ) Grading ( ) Private Rd (�Town Rd. o �
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy i,, �
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Primary Structure Accessory Building Addition � �
( ) Dwelling ( ) Garage-attached/detached ( ) Deck W
( ) Year round ( ) # of car stalls ( ) Porch �
( ) Seasonal Qv Storage Building ( ) Enclosed �
( ) Frame built on site ( ) Screenhouse ( ) Living room �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen C,
( ) Mobile/manufactured (X) Other ( ) Bedroom �'i
( ) Other primary structure (x) �c,� ���.=� ( ) Relocate/enlarge � �
( ) ( ) ( ) # of new �
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Additional Information: �� „
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Type of Construction: �
(� Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete ^
( ) Other �
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Construction Cost: Primary Structure $ �
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Accessory Building: $���� Addition: $ � ,�
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Deed: Vol �7 30 Pg_�Q� Certified Soil Test# $z - ��� �"
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CSM: Vol Pg Lot# Sanitary Permit#_�?�_ ( R/ � �
Plat Envelope pr: N ,�
Condo Vol Pg � - Year Installed: �
Aff of ex septic Vol Pg Owner When Installed: � �
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Previous office approvals/actions:
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Variance: # LUP: # SP: # CUP: # �
Inspection Report: # Change of Zone District: ;'�' �I I���c,+
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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. Slie� #2. �r� --� #3. #4.
Size /;� ft. wide /��ft. wide ft. wide fr. wide -
�ft. long v"Zc9 � ft. long ft. long ft. long
Floor area_���sq. ft. � O sq. fr. sq. ft. sq. ft.
Hgt from grade �� �to peak 9� ft. hgt. ft. hgt. ft. hgt. i.
Stories�_ / stories stories stories
# of bedrooms�__
Rear Lot Line �
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� S�SL <[�1� "��� .
Fire Number and Name of Road 7� ��/�;� H���r� c1,� �� _
1. Enter lot dimensions and indicate north by arrow.
Signature of Ow or A NSorized Agent:
2. Indicate the location and size of the requested eonstruction � -�'
i aWre
activities. � v �
Pnnt Name: -t �c—✓,✓�J."`�. �'�^r•
3. Also, indicate the location and distance to the well, Tne eno�e oart�neg mec me iisced iorormz ion aoa mceocions a�e
true and cortect., ihat all work shall be performed in compliance
SeptiC t2S1�C and dl31nf1eld, wetland 3Leas, lot 11nes and to tlle with the requiremenLs ot ihe Sawyer Counry Zoning Ordinance
and the laws antl regulations ot the State of Wisconsin, and if
COriYCLllriO Of Y110 P02d. ading as owner(s)agent has the permission of the owner(s)to
perfortn ihe work requested on ihis application. The above
personsls hereby give permission for aceess to the property for
onsite inspedion.
Permit fee: $ 7S�'
June 22, 2004 - \
Issue Date Signature of I in ent
June 22, 2005 50%Rule: AverageRoadSetback:
Expiration Date
Office Comments: ASSessEd Ucr,Jue �9�Y7= � 98/l = SD, 963
Sm,vcr� �•5 = a5,S� 5,8°7o us ed
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