HomeMy WebLinkAbout008-937-04-5210-LUP-2004-156 R
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
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 PERMITS HAVE BEEN ISSUED. �2 !
PRINT-USE BLACK INK OR PENCIL b
d � _ �u�e.�Fs S�C�' � � �
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Owner Builder c;
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a��C¢�a/V D L �f�4-iis �_ �
Mailing Address Mailing Address �
�r�.c1i c,vood c,v r S'�8 c-7 ;�
City, State, Zip City, State, Zip
�_ -7�i�
Daytime Phone Daytime Phone �
Additional Information: Zone District: 1�K—�
Lot Dimensions: �
t was created: Acres: �. ��0 n �
Date lo o �
Is there wetland near the proposed structure? If yes, how far /�t� �
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Building Land Use Floodp�ain:( j Yes (�No `� r
(�New ( ) Filling �
O Addition O Dredging Driveway access off of a(Check one): �,
O Alteration O Grading O Private Rd O Town Rd. o
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy ; �
� ) � ) o �
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Primary Structure Accessory Building Addition � °
( ) Dwelling ( ) Garage-attached/detached ( ) Deck W
( ) Year round ( ) # of car stalls ( ) Porch �
( ) Seasonal (X) Storage Building ( ) Enclosed �
( ) Frame built on site ( ) Screenhouse ( ) Living room �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen O�
( ) Mobile/manufactured ( ) Other ( ) Bedroom .-
( ) Other primary structure ( ) ( ) Relocate/enlarge � �
� � ( ) ( ) # of new .A
w
AdditionalInformation: � A
O �
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Type of Construction: �
(�Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete �
( ) Other �
b y
Construction Cost: Primary Structure $ ^ � �
Accessory Building: 9'i�_ (}L�� Addition: $ -- � �
,-.
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Deed: Vol�_Pg I�Z _ Certified Soil Test# g7- c�77 �' z
CSM: Vol �t� Pg �Ol Lot# 1 Sanitary Permit# 9�-��� � 7�
Plat Envelope � 57 q? Or: t; �
Condo Vol Pg Year Installed: �
Aff of ex septic Vol Pg Owner When Installed: � �
,
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Previous office approvals/actions: O
Variance: # LUP: # SP: # CUP: #
Inspection Report: # Change of Zone District:
���:�/oy
�133
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. #2.S�d G g(L�q #3. #4.
Size .wide ft.wide d ft ide .wide
ft.long �l7 fr.long .long ft.long
Floor area sq.ft. �e2D sq.ft. sq.ft. sq.ft.
Hgt.fro to peak �� ft.hgt. .hgt. ft.hgt.
Storie �_stories s ries stories
#of drooms
Rear Lot Line
5� ����� ���6,�
Fire Number and Name of Road � 'a���O /U U L I ��� ��
1. Enter lot dimensions and indicate north by arrow. Sign e of Owner or oriz gent:
2. Indicate the location and size of the requested construction
Signature
BCtIV1t1eS. PnnWame�. 1C i Gl.r.r d � U G��-S
3. Also,indicate the location and distance to the well, Tne e�o�e cert�fies mac ma r5ted mrormauo�eod�me�nors are
irue and covect,that all work shall be performed in comp iance
septic tank and drainfield,wetland areas,lot lines and to the w�m me req���eme�c�or me sawyer co�ory zomo9 om��,ao�
and the Iaws and regulations of the State of Wisconsin,antl I(
Ceri10TI1RC Of t}10 L03d. acfing as ownel(s)agent,has the permisslon o(the owner(s)to
perform ihe work requested on this applicalion. The above
personsls hereby give pertnission for aceess to the propedy for
onsite inspedion.
Permit fee:$��f��
Mav 10, 2004 '
Issue Date Signature of Is 'n gent
May 10, 2005 50%Rule: AverageRoadSetback:
Expirarion Date
Office Comments:
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