HomeMy WebLinkAbout010-941-25-4301-LUP-2004-149 Application for Land Use Permit(*Non-shoreland*) o � �
County of Sawyer ,�, �-
PO Box 676 -Haywazd WI 54843 �
715/634-8288 y�
*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
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the property's boundaries. - �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED.
PRINT-USE BLACK INK OR PENCIL �
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Owner ` Builder �' ��
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Mailing Address Mailing Address O �
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City, tate,Zip City,State,Zip
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Daytime Phone Daytime Phone =
Additional Information: Zone District:��
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Lot Dimensions: �
Date lot was created: �� Acres: �`� n
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Is there wetland neaz the proposed structure?If yes,how faz �D G
Building Land Use Floodplain:� j Yes (�No :°
�New ( )Filling � �
Dred in Drivewa access off of a(Check one): `D
)Addition ( ) g g Y ?�
O Alteration O Grading O Private Rd �,Town Rd. o
O Moving On O O County Hwy O State Hwy i.w,
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Primary Structure Accessory Building Addition �
( )Dwelling ( )Garage-attached/detached ( )Deck W
( )Year round ( )#of caz stalls ( )Porch �
O Seasonal O Storage Building O Enclosed �
O Frame built on site O Screenhouse O Living room ��
( )Modulaz/manufactured ( )Gieenhouse ( )Kitchen _ _
S )Mobile/manufactured �Other ( )Bedroom �
�)Other primary structure �( )��� <�����M1� ( )Relocate/enlarge
� � � -��l �1 ( ) tk �'c,;fC�rc,�%v�dS ( )#of new
Ad� �c v�e;t.���� � ��-., -�
iitional Information: ��1�:-��, � ��� ��-����� <
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Type Construction: q�
( )Frai ( )Log �P le/metal ( )Block ( )Concrete �,,
( )Other .-�
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Construction C t: rimary Struc $����'�C'�' ��rvr.�cl) � �
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Accessory Building:$ �''� d �ec�) Addition:$ z� .�
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Deed:Vol y�-= Pg �7 '�`` Certified Soil Test# °Q z
CSM:Vol Pg Lot# Sanitary Permit# O � - `/� ? o, '`�
Plat Envelope Or: N
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Condo Vol Pg Yeaz Installed: �
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Aff of ex septic Vol Pg Owner When Installed:
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Previous office approvals/actions: � ; ` �'
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Variance:# LUP:# C��� +=;?� SP:# CUP:#
Inspection Report:# Change of Zone District: ����b�
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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 . po�l �r-� �) �;ti . #2• �,arc�5s��,� S l-�-� #3. � #4. ,
Size Ic� ft wide ; � ft. wide ft. wide ft. wide
�_ ft. long �� `� ft. long - ft. long ft. long
Floor area �`�`� sq. ft. :� sq. ft. �� j �� sq. ft. sq. ft.
Hgt. from grade � �O to peak � ft. hgt. i �: � ft. hgt. ft. hgt.
Stories � �_ stories ( stories stories
# of bedrooms �,� }-
Rear Lot Line
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Fire Number and Name of Road I �` l �� �, �c-�,,, �-��_ �- , �� , I I � ��
1 . Enter lot dimensions and indicate north by arrow. Sign ture of Owner or Authorized Agent:
2. Indicate the location and size of the requested construction �c� �� -
Signature
aCt1V1t18S. Pnnt Name: ��:�c.'��� l. I �� -�-��� °� \�
3. Also, indicate the location and distance to the well, The 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. a�t��s as ow�er�s� a9e�t, has the permission of the owner(s) to
perform the work requested on this application. The above
personsls hereby give permission for access to the property for
onsite inspection.
Permit fee: $ �I/U F� �
May 5 , 2004 —
Issue Date Signature of Is in gent
May5 , 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments: �� X `(Y�.�-�
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+oo o zoo aoo aoo isoo Information contained on thi�
odvisory. Map accuracy is lir
quality of the public records
( IN FEET ) Was prepared. It is not inten
substitute for on accurate ti�
1 inch = 400 ft.