HomeMy WebLinkAbout006-440-20-4301-LUP-2004-376� �
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 L
flowage, lake or pond or does not have any of the above waterbodies located within
the property's boundaries. � �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMTTS HAVE BEEN ISSUED. �
PRINT-USE BLACK INK OR PENCIL
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Mailing Address Mailing Address �
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City, State, Zip City, State, Zip ( �.,�
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Daytime Phone Daytime Phone �- �,
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Additional Information: Zone District: �` � A
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Lot Dimensions:
Date lot was created:
Acres: 'yfi' 3�b o �
Is there wetland near the proposed structure?If yes, how far �
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Building Land Use Floadptai�:-� �j I�`es (`�No �°
�New ( ) Filling - �
O Addition O Dredging Driveway access off of a(Check one): �
( ) Alteration ( ) Grading ( ) Private Rd � Town Rd. o
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy �, �
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Primary Structure Accessory Building Addition � °
j�l Dwelling ( ) Garage-attached/detached ( ) Deck W
( ) Year round ( ) # of car stalls ( ) Porch �
(� Seasonal (�Storage �g A�f'�e� O Enclosed �
( ) Frame built on site ( ) Screenhouse ( ) Living room � �t,, �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen � t;�� ���
( ) Mobile/manufactured ( ) Other ( ) Bedroom �
O Other primary structure O O Relocate/enlarge o A �,.
� ) � ) O # ofnew , ; r�
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AdditionalInformation: � .� �
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Type of Construction: ��;
(�fi Frame ( ) Log ( )Pole/metal ( ) Block ( ) Concrete .
( ) Other y
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Construction Cost: Primary Structure $_�0 6 � �
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Accessory Building: $ Addition: $ � ��,.
�3/B(0106 � .-�
Deed: Vol Pg Certified Soil Test#__�%'�- � Z
CSM: Vol �3 Pg 2 3( Lot# 1 Sanitary Permit# CS�`r� ��� o, �
Plat Envelope � �0� �r� N y'
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Condo Vol Pg Year Installed: �
Aff of ex septic Vol Pg Owner When Installed: `-' �
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Previous office approvals/actions: �
Variance: # LUP: # SP: # CUP: #
Inspection Report: # Change of Zone District: �oa
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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. �r�cfY,loir #2.� (�oa,O" #3. #4.
Size��fr.wide �!S ft.wide fr.wide 8.wide
< <aFt.long o2(D ft.long ft.long fr.long
7
Floor azea sq.fr. 5�l�8 Sq•ft• sq.ft. sq.ft.
Hgt.from gade to peak fr.hgt. ft.hgt. ft.hgt.
Stories�_ stories stories stories
#of bedrooms �
Rear Lot Line
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Fire Number and Name of Road C�� .1�
1. Enter lot dimensions and indicate north by arrow. Sign re of,Ovyr�(or Authorized Agent:
2. Indicate the location and size of the requested construction Chi*.a�'��'
��� Signatufe
activities. � /_
PrintName: ���'t'r�- �-�L�LC'-1.J1�C-�
3. Also,lndicate the locatlon and dlstance to the well, The above ceNfes that the listed information and intentions are
We and correct.,Nat all work shall be performed in compliance
Sept1C t8C11C and d711nf eld,wetlanC�azeas,lot llnes and to tlle with the requiremenLs ot the Sawyer Counry Zoning ordinance
and the laws and regulalions of the State o(Wisconsin,and if
C8ri2C111R0 Of YZ1C I08d. ading as ownef(s)agent,has the permission of the owner(s)lo
peAorm ihe work requested on this application. The above
personsls hereby give permission for aceess to the pmperty for
`^` cnsita�cspz��o�.
Permit fee:$ /� u
July 27 2004
Issue Date Signature ofI in gent
July 27, 2005 50%Rule: Average Road Setback:
Expiration Date
Office Comments:
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