HomeMy WebLinkAbout012-640-09-2113-LUP-2004-028 ,�/ .
Application for Land Use Permit r ,�
County of Sawyer � � O
PO Box 676 -Hayward WI 54843 v
715/634-8288 � �
The undersigned hereby makes application for a Land Use Permit and agrees that all wark �
shall be done in compliance with the requirements of the Sawyer County Zoning Ordinance �
and the laws and regulations of the State of Wisconsin. m �
NO CONSTRUCTION MAY BEGIN UNTIL ALL PERMITS HAVE BEEN ISSUED. � O
PRINT—USE BLACK INK OR PENCIL
�'�R F3 H� t"' /��76R �
KF�7rfl�EEW �PYE�S �R� �NrERTRiSES/G�.A2nl�efc/ Q.
Owner Builder °'
,/ <'
/ 709 �/�GCR6R ST 9/S� \h/ �i/�/So/�' /�D o'
Mailing Address Mailing Address � �
�R �i.vE V�/i ��No'� Hs��vvs�,�� 1�/� h�8�3 �
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City,State,Zip City,State,Zip �
7/5 �f62 9 �3/ �
Daytime Phone Daytime Phone �,
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Additional Information: Zone District �\�`� \
S
Lot Size �'�-� �1
Date lot was created Acres 2- � q c RES b
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Is the property in a Shoreland District?(within 1000'of a lake or pond,within 300'of a river, In
creek or stream) If yes,how faz from the shoreline&water name: i,f/E5i FaRK C'!/iPP�Wi� �
Is there wetland near the proposed structure?If yes,how far /�� o
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Building Land Use '�
UC)New ( )Filling � Floodplain:( )Yes ( )No # �
( )Addition ( )Dredging *� G�
( )Alteration ( )Grading Chippewa Flowage: ( )Yes ( )No � �
( )Moving On ( ) � o
( ) ( ) Driveway:( )State ( )County ( )Town Rd. N
Primary Structure Accessory g ; Addition �
(�Dwelling �Garag -attach detached O Deck o
(,)C)Year round O#of c s alls O Porch p �
( )Seasonal ( )Storage Building ( )Enclosed �v
O Frame built on site O Screenhouse O Living room N �
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen �
( )Mobile/manufactured ( )Other ( )Bedroom �
( )Other primary structure ( ) ( )Relocate/enlazge \
( ) ( ) ( )#ofnew >
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Additional Information: "
b
' °� �
0
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Type of Co�struction x�
(�Frame � ( )Log ( )Pole/metal ( )Block ( )Concrete �
( )Other �
Construction Cost:Prunary Struchue$ /So 0 0o O
Accessory Building:$ Addition:$ � z
7y
Vol � 'I Pg 3�`-� of Deed Certified Soil Test# �y-�/V� \ O
CSM Vol Pg Lot# Sanitary Permit#��- D�`� �
Plat Envelope Or: ��� ��`°��('� �
Condo Vol Pg Year Installed
AfF of ex septic Vol Pg Owner When Installed:
Gazd Gazebo Vol Pg
,
Previous Variance: LUP: Inspection Date: ��l�����
�I 3 35�
Describe the construction using these columns. List the dimensions of each structure in a separate _
column. List each story, each additio�,+ each alteration in a separate column. •
#1. 'J�-- #2. ��+��`r'`' `=�-`"` #3. #4.
Size � 6 ft. wide � ` ft. wide ft. wide ft. wide
N O ft. long �� ft. long ft. long ft. long
Floor azea /`{5'O sq. ft. . " �/ sq. ft. sq. ft. sq. ft.
Hgk firom gade 2 / to peak ��I ft. hgt. ft. hgt. ft. hgt.
Stories� _� stories stories stories
#ofbedrooms 2
Lot Line or Lake/River name:
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Fire Number and Name of Road
1. Fill in lot dimensions and indicate north by arrow. Signature of Owner or Authorized Agent:
2. Indicate location and size of existing and new structures.
3. Indicate location of well, septic tank, drainfield. �� � �
4. Indicate distance to existing struchues, lot lines, septic system. P�f�R I� C�AR�b CCC./
5. Indicate distance to the ordinary high-water mazk of any lake,
pond, river, stream, creek, and name the body of water. Prin�Name:
The above certifies that the listed infortna6on and inten6ons are
6. Indicate any grading or clearing in excess of the construction site. we and co�ec+.rne ato�e Perso�s�s ne�eny 9�Ye pem,ission for
access to ihe pmperty foronsite inspection.
7. Indicate distance to any wetland. �
PemutFee: ��; ��1C--
February 19, 2004 � -
Issue Date Signature ofIss 'n A ent
February 19, 2005
Expiration Date
Office Comments:
Inspection Date: 50%Rule Applies: Avg. Setback: Within Reservation boundaries:
Restrictions and other information:
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