HomeMy WebLinkAbout008-937-08-5104-LUP-2004-663 �
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. �p
PRINT-USE BLACK INK OR PENCIL 'S
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Owner Builder �
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ailing Address Mailing Address �
�;�h r, cnc �� S�8/7 � i r���.�c�c� Gc1� S�gl'� �
Crty, State, Zip City, State, Zip
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�aytime Phone T Daytime Phone
Additional Information: Zone District: �� y�yr/ �f � iQ � � �
Lot Dimensions:
Date lot was created: ///o-OY Acres: 3 , �o'� n
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Is there wetland near the proposed structure? If yes, how far �PS- 1Vd��������i n�S � ''
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Building Land Use Floodptain:-( j �es ( j No �°
(�New ( ) Filling � (_
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( ) Addition ( ) Dredging Driveway access off of a(Check one): � � �
( ) Alteration ( ) Grading ( ) Private Rd ( ) Town Rd. o ",� (�
( ) Moving On ( ) (� County Hwy ( ) State Hwy N �
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Primary Structure Accessory Building Addition Z� �
( ) Dwelling ( ) Garage-attached/detached ( ) Deck � W
( ) Year round ( ) # of car stalls ( ) Porch �`'-'
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( ) Seasonal � Storage Building ( ) Enclosed �
(� Frame built on site ( ) Screenhouse ( ) Living room �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen
( ) Mobile/manufactured ( ) Other ( ) Bedroom
( ) Other primary structure ( ) ( ) Relocate/enlarge ' '
( ) ( ) ( ) # of new
Additional Information: �
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Type of Construction: z
( )Frame ( ) Log (�j Pole/metal ( ) Block ( ) Concrete
( ) Other
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Construction Cost: Primary Structure $��Q� �� � �
Accessory Building: $ Addition: $ �
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Deed: Vol '�J'' Pg � Certified Soil Test# �
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CSM: Vol -��Pg l`��'� Lot# � Sanitary Permit# � �
Plat Envelope �� `�"�� �'`� Or: �
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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: p�}; ��- _ �� ��d�
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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 . #2. #3. #4.
Size�_ ft. wide ft. wide ft. wide ft. wide
�_ ft. long ft. long ft. long ft. long "
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Floor area —�'--,��- sq. ft. sq. ft. sq. ft. sq. ft. � .
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Hgt. from gracie _� to peak ft. hgt. ft. hgt. ft. hgt. r � `
Stories � stories stories stories �
# of bedrooms
Rear Lot Line �- • '
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Fire Nu4nber and Nar�re of Road c � .-� r • � ^ _
1 . Enter lot �imensions"and indicate north by arrow. Sig atu of 0 ner or thori e Agent:
2. Indicate t�he lo�ation and size of the requested construction
/ Signature
activities. �
Pri ame: �
3. Also, indicate the location and distance to the well, e above certifies that the listed information and intentions are
true and correct., that all work shall be performed in compliance
septic tank and drainfield, wetland areas, lot lines and to the with the requirements of the Sawyer County Zoning Ordinance
and the laws and regulations of the State of Wisconsin, and if
centerline of the road. aot��9 as ow�er�s> a9e�t, has the permission of the owner(s) to
perfortn the work requested on this application. The above
personsls hereby give permission for access to the property for
onsite inspection.
Permit fee: $ '��d � ��
November 17 , 2004 � _
Issue Date Signature of I uin Agent
November 17 , 2005
50% Rule: Average Road Setback:
Expiration Date
Office Comments:
CERTIFIED SURVEY MAP
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