HomeMy WebLinkAbout014-842-15-4201-LUP-2004-670 Application for Land Use Permit o o �
County of Sawyer � � O
PO Box 676 -Haywazd WI 54843
715/634-8288 ' �
The undersigied hereby makes application for a Land Use Permit and agrees that all work
shall be done in compliance with the requirements of the Sawyer County Zoning Ordinance `. �
and the laws and regulations of the State of Wisconsin. �
NO CONSTRUCTION MAY BEGIN UNTIL ALL PERMITS HAVE BEEN ISSUED.
PRINT—USE BLACK INK OR PENCIL �
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Owner Builder �
�1318s�� _�pr�n.�-� DC� /3/fs iJ ,ffw�/ �D s�
Mailing Address —� Mailin Address � �
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�.-� �,or R�i C�� S�s�f� �a-�7,aR/J f l�f. �5°�`-/3 �
City,State,Zip ity,State,Zip
��°r- ��O- ��1(3 7�s��3�- 3366
Daytime Phone Daytime Phone
Additio�nal�Information: J Zone District %�-� �
1-{�rG�1Q,Cc�`�i �UQ'r1'F9- ,Z�YS�•
l�'D l�X 2� �rN�� Lot Size
�{Cty�2+d,t�"iZ S'Y�(�/3 SS?-7l00-�/�/�3
Date lot was created Z Bo� Acres /. 2�
Is the property in a Shoreland District?(within 1000'of a lake or pond,within 300'of a river,
creek or stream) If yes,how faz from the shoreline&water name: A/�
Is there wetland near the proposed structure?If yes,how far��S s��� o
�
�Buil mg Land Use '�
Iew ( )Filling Floodplain:( )Yes (1�'PVo # ;;
( )Addition ( )Dredging � G�
( )Alteration ( )Grading Chippewa Flowage: ( )Yes ( �To � ,°�,
( )Moving On ( ) � o
( ) ( ) Driveway:( )State �ounty ( )Town Rd. •
. f
Primary Structure Acce sory Building Addition �0
( )Dwelling �azage-attached/detached ( )Deck �
O Year round O#of caz stalls 2, O Porch �
( )Seasonal ( )Storage Building ( )Enclosed �
O Frame built on site O Screenhouse O Living room � p
( )Modular/manufactured ( )Greenhouse ( )Kitchen � �
( )Mobile/manufactured ( )Other ( )Bedroom � r
( )Other primary structure ( ) ( )Relocate/enlarge � �
( ) ( ) ( )#ofnew <
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m
Additional Information: "
CIOSLr� l�e IC�,Z�o`I ''y
� �
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Type of Construction x�
�ame � ( )Log ( )Pole/metal ( )Block ( )Concrete �
( )Other �
Construction Cost:Prunary Structure$ - __ (�+
AccessoryBuilding:$ /rOOD Addition:$ Z
-C. 7y
Vol y9% Pg��of Deed Certified Soil Test# 4y-y93 O
CSM Vol Pg Lot# SanitaryF�ermit# 9y-y3z �(`
Plat Envelope �,r:�" �
Condo Vol Pg Y�ar Installed
AfF of ex septic Vol Pg O�Jner When Installed:
Gard Gazebo Vol Pg
gn—58L t'l.h�p`�
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Previous Variance: LUP: 9`�"5yb Inspection Date: � ��n
,�
II�S�3
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 fr.wide ft.wide '•
2`�� ft.long ft.long ft.long ft.long
Floor azea�r.'_��sq.ft. sq.ft. sq.ft. sq.ft.
Hgt.from gade �3 , to peak ft.hgt. ft.hgt. ft.hgt.
Stories_� stories stories stories �
#of bedrooms�_
C ���� ` =-�
Lot Line or Lake/River name:
GrY ��. Oo �
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Fire Number and Name of Road /3/p Sw GrY � 40
1.Fill in lot dimensions and indicate north by anow. 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 structures,lot lines,septic system.
5.Indicate distance to the ordinary high-water mark of any lake,
pond,river,stream,creek,and name the body of water. P�n�Name:
The above certifes that the listed in(ormafion and intentions are
6.Indicate any grading or clearing in excess of the construction site. access m meeP o�e�y roons c rs�sPeaQeneby y�Ye ve��55�0�ror
7.Indicate distance to any wctlanu.
Permit Fee:
NOvember 29, 2004 '
Issue Date Signature of Iss 'n gent
Novemaber 29, 2005
Expiration Date
Office Comments:
Inspection Date: 50%Rule Applies: Avg.Setback: Within Reservation boundaries:
Restrictions and other information:
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