HomeMy WebLinkAbout010-841-27-5317-LUP-2004-445 . 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 �s` �'
the property's boundaries. � �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUEA '
PRINT—USE BLACK INK OR PENCIL i�j �
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Mailing Address Mailing Address � � �
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City, State, Zip Y� P (1
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Daytime Phone Daytime Phone .� �
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Additional Information: Zone District: �2`� �,
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Lot Dimensions: ������ Y X � (� �(? �,.� C=
Date lot was created:
� � �r �J' Acres: �� � I o_F �
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Is there wetland near the proposed structure? If yes, how far ' �' � ��� `��
Building Land Use Floodptain:-( j �es (j�No ' ��
( )New ( ) Filling �
Q� Addition O Dredging Driveway access off of a(Check one): �,
( ) Alteration ( ) Grading (�Q Private Rd ( ) Town Rd. o
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy N �
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Primary Structure Accessory Building Addition � °
( ) Dwelling ( ) Garage-attached/detached ( ) Deck W
�Year round ( ) # of car stalls (� Porch �
O Seasonal O Storage Building Q� Enclosed � ,�1
G�j Frame built on site O Screenhouse O Living room �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen �,
( ) Mobile/manufactured ( ) Other ( ) Bedroom � .-
( ) Other primary structure ( ) ( ) Relocate/enlarge � '
� � O O # ofnew `��=
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AdditionalInformation: .'_, �
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Type of Construction: <3�
�1 Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete �� �
( ) Other l ^
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Construction Cost: Primary Structure $ � �
Accessory Building: $ Addition: $ �,C;-� �� �% � �
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Deed: Vol ��` � �T Pg �/'` �� Certified Soil Test# p Z.-YZ,� `�' z'
CSM: Vol � Pg ��X��Lot# J� Sanitary Permit# --r ,--c-,' ;J�- +�(({� o, 7�
Plat Envelope �'� �� Or: �, !
Condo Vol Pg Year Installed: ,� i;!��� .=� � �
Aff of ex septic Vol Pg Owner W en stalled• � � �
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Previous office approvals/actions: �
Variance: # LUP: # SP: # CUP: # � ����
Ins ection Re ort: # Chan e of Zone District: � \
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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 fr. wide
�,Z ft. long ft. long ft. long ft. long
Floor azea ���' sq. ft. sq. ft. sq. ft. sq. ft.
Hgt.from giade�?1 to peak ft. hgt. ft. hgt. fr. hgt.
Stories � stories stories stories
# of bedrooms Li
Rear Lot Line
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Fire Number and Name of Road / 3 � �� (.� �!�r�//-tL� ��,�
1. Enter lot dimensions and indicate north by azrow. Signa r of wne'or uthorized Agent:
2. Indicate the location and size of the requested construction � � �' ,�.-�_
SignaNre
activities. �� -
nnt Nema: rl����lU tL � � 7r�-1�-�
3. Also, indicate the location and distance to the well, The above certifes ihat the listed infortnation and intentions are
We and correct., that all work shall be peAormetl in cnmpliance
septic tank and drainfield, wetland areas, lot lines and to the wtm me ���remen�s or me sawye� co��ry zo���9 ommance
and ihe laws and regulalions of the State of Wisconsin, and i(
CenteI'llne Of thC I08d. acting as owner(s)agent, has the permission of the owner(s)to
pedorm the work requested on this application. The above
personsls hereby give permission for aceess to the property for
onsiteinspectlon.
Permit fee: $ 7 �. 00
August 19, 2004 — G�"
Issue Date Signature of Issu� A e t
August 19, 2005 50%Rule: Average Road Setback:
Expiration Date
Office Comments:
3 0�
GURVE DATA
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