HomeMy WebLinkAbout008-937-30-3204-LUP-2004-268 Application for Land Use Permit (*Non-shoreland*) o 0
� ,r County of Sawyer � � - � -
'` � ' �- ''' '" f " 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 ar 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. �
PRINT—USE BLACK INK OR PENCIL 1
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Owner Builder �:
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Mailing Address Mailing Address O �
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City, State,�Zip City,�State, Zip
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Daytime Phone Daytime Phone _
Additional Informatipn: Zone District: tf ` �
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n ,. ,�,����; ���y- Lot Dimensions:
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Date lot was created: ,'�� i -, Acres: ! o
Is there wetland near the proposed structure? If yes, how far ' � �
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Building Land Use Floodptain:(���-j �es� ( )�No ���� ���
(�New ( ) Filling � �� �
O Addition O Dredging Driveway access off of a(Check one): �,
( ) Alteration ( ) Grading ( ) Private Rd Q� Town Rd. o
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy �, �
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Primary Structure Accessory Building Addition � °
� Dwelling ( ) Garage-attached/detached ( ) Deck W
(�Year round O # of car stalls O Porch �
O Seasonal O Storage Building O Enclosed �
( ) Frame built on site ( ) Screenhouse ( ) Living room �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen �}
( ) Mobile/manufactured ( ) Other ( ) Bedroom fi,
( ) Other primary structure ( ) ( ) Relocate/enlarge �
� ) ( ) ( ) # of new ,,� "� , �
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AdditionalInformation: �� �
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Type of Construction: � �'
(�Q Frame ( ) Log ( )Pole/metal ( ) Block ( ) Concrete �
( ) Other ,..d y
Construction Cost: Primary Structure $ � �
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Accessory Building: $ � % Addition: $ � _
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Deed: `voi i g Certiiied Soii Test# C��- ��c � � 'z
CSM: Vol �� Pg °�3� Lot# � Sanitary Permit# C?�l - I qa� o, �
Plat Envelope Or: N --�
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Condo Vol Pg Year Installed: � �
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Aff of ex septic Vol Pg Owner When Installed: "
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Previous office approvals/actions: `
Variance: # LUP: # SP: # CUP: # � \�
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Inspection Report: # Change of Zone District: lg
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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. n« � , . , , � ; #2. �� #3. � � #4. ,. .
Size �C� ft. wi�e ft. wide ft. wide ft. wide
p-! ft. long ft. long ft. long ft. long
Floor area /? /,.,:) sq. ft. sq. ft. sq. fr. sq. ft.
Hgt.from gade to peak ft. hgt. ft. hgt. ft. hgt.
Stories�_ stories stories stories
# of bedrooms ,`{
Rear Lot Line
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Fire Number and Name of Road �� ( ly �F � ���'�%' ' �--
1. Enter lot dimensions and indicate north by arrow. Signature of Owner or Authorized Agent:
2. Indicate the location and size of the requested construction _
SignaNre
activities. � �� �
Pnnt Name: i. '��'r �
3. Also, indicate the location and distance to the well, rne a�o�a oert�fieg met me rstee mro�at�o� e�d �n�em�o,5 a�e
true and conect., that all work shall 6e peAormed in compliance
septic tank and drainfield, wetland areas, lot lines and to the w�m me req�o-eme�c5 or me sewye� co�o�y zo���9 ordma�ce
and the laws and regulations of the State of Wisconsin, and if
COritCIllriO Of t110I08d. acting as owner(s)agent, has the permisslon of the owner(s)to
pedortn the work requested on ihis application. The a6ove
personsls hereby give permission for axess to the property for
onsite inspectian.
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Permit fee: $ <�->;-=. �
June 15 2004
Issue Date Signature of Is uin ent
June 15, 2005 50% Rule: Average Road Setback:
Expiration Date
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Office Comments:C, .� . _ � � ,
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SEE CSM 25/213
SCALE: I INCH=400 FEE
DRAWN BY: �
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