HomeMy WebLinkAbout014-842-16-2108-LUP-2004-624 Application for Land Use Permit(*Non-shareland*) o o �
County of Sawyer �
PO Box 676 -Haywazd 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 boundazies. `
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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Ma ling Address Mail' g Address O
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City,S te,Zip City, ate,Zip �
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Daytime Phone Daytime Phone
Additional Information: �e District /�'� / �
Lot Dimensions: �
7 n
Date lot was created: /0 !//6y Acres �=C � o
Is there wetland near the proposed structure?If yes,how faz /�(') � �
Building Land Use Floodptain:� )Yes ,(/jNo =°
�ew ( )Filling �
Dred m Drivewa access off of a(Check one): �;
( )Addition ( ) g� g Y .
O Alteration O Grading O Private Rd ,(�Town Rd o
( )Moving On ( ) ( )County Hwy ( )State Hwy �,, �
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Primary Structure Accessory Building Addition � °
�(�fDwelling ( )Garage-attached/detached ( )Deck W
�'Yeaz round ( )#of car stalls ( )Porch :
O Seasonal O Storage Building O Enclosed �
O Frame built on site O Screenl�ouse O Living room �
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen '� C_
( )Mobile/manufactured ( )Other ( )Bedroom ,C �
O Other primary structure O O Relocate/enlazge I
� � � � ( )#of new �
AdditionalInformation: � P
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Type of Construction: �
,,(/jFrame ( )Log ( )Pole/metal ( )Block ( )Concrete �'
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( )Other ..3
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Construction Cost:Primary Structure$ ���'� L��� �\ � �
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Accessory Building:$ Addition:$ � �,
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Deed:Vol ,' Pg Certified Soil Test# .,.L7;���G) °0 z
CSM:Vol�Pg '��.�'. �ot# Sanitary Permit# C y- �!�r�' o, �
Plat Envelope Or: n� h�
� ICondo Vol Pg Year Installed: � �
Aff of ex septic Vol Pg Owner When Installed: '-'
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Previous office approvals/actions: pp
Variance:# LUP:#�_SP�# CUP:#
Inspection Report:# Change of Zone District: �DI��1D�
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Describe the construction using these columns. List the dimensions of each structure in a separate
colr�mn. List each story, each addition, each alteration in a separate colmm�.
#l. �11(,,. ,� #2. �l ���` ' #3. #4•
Size �, G ft. wide �' t. ft. wide ft. wide ft. wide
c� � ft. long '? ` ft. long ft. long ft. long
Floor area 'j lF•' sq. ft. 1�,+l1 " sq. ft. sq. ft. sq. ft.
Hgt fivm grade . ,% ^ to p�k ft. hgt. ft. hgt. ft. hgt.
Stories i _�_ stories stories stories
# of bedrooms �z
!/�U o�u./ Rear Lot Line
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Fire Number and Na�ne of Road �
1. Enter lot dimensions and indicate north by azrow. Signatu�e of_Owner',of At�tho�ized Agent:
2. Indicate the location and size of the requested construction _s�-�.7G�_--
SignaNre
activities. —
PdntName: � .�� '-�3`"G�����
3. Also, indicate the location and distance to the well, The above certifies ihat tlre fsted iriformadon and intendons are
We aM carect, tlwt all work shall be pertamed in mmpliance
septic tank and drainfield, wetland azeas, lot lines and to the '� � �9uirements of the Sawyer County Zonirg Ordinance
aM tl�e gws aM regulations of tl�e State of Wisconsin, and if
centerline of the road. a� �s�'(5) aye�t n�s +ne pa�ssp� or me owneds� co
perform the xroAc requested on ihis appliption. The above
personsls he�eby give permission for a�ess M ihe property for
onsMeinspection.
Pernut fee: $ cZ C�Z-'i
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Date Issued October 29 , ?_004 F.xpires October 29 , 2005
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