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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�' � � � � Owner Builder c; � 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� � � 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 � � r 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 � � � Type of Construction: � (�Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete � ( ) Other � b y Construction Cost: Primary Structure $ ^ � � Accessory Building: 9'i�_ (}L�� Addition: $ -- � � ,-. � 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: � � , � 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: G��2�f trt�0 4u(tV�`( MA�_ . ��rk o� �sv�rnvu�Kk �ok 2 hu�kto�� ��,'l�1 (�aW '�iwh o� �dat,w�Jccr h9u�yav �O..V�i�. � � � � � . 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