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016-637-31-2201-LUP-2004-105
/ Application for Land Use Permit(*Non-shoreland*) 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 �v � flowage,lake or pond or does not have any of the above waterbodies located within the property's boundaries. � \ CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. � PRINT-USE BLACK INK OR PENCIL � � � � ��i ��e `l' ��Ri/a.-¢��,�l��z/`.S _ �I�I`V �C'.�Zn�'l�el� C 0 Owner Builder ' � " <' ✓� �� G/lp��/L,,' /!'L�Gr;� �'� ��. ,C3�x �7� �� Mailing Address Mailing Address � C�(e.�4�h� W� S��3�5 ��✓�r���l� �,�r- S� � 7J� � Ciry,State,Zip City,State,Zip` � 9�3 -����� �is-79'�--��3�. Daytime Phone Daytime Phone �' � I � Additional Information: Zone District:� e � Lot Dimensions: H Date lot was created: Acres ��� �/� o p I/ i Is there wetland neaz the proposed structure?If yes,how far y¢S ' ��� � � ' Building Land Use Floodptain:( j Yes O No � :R � ( )New ( )Filling '� p� Q�Addition O Dredging Driveway access off of a(Check one): � O� ( )Alteration ( )Grading ( )rrivate Rd �Tcwn Rd. o �, ( )Moving On ( ) ( )County Hvry ( )State Hwy �, � � ) � ) � � 0 t" Primary Structure Accessory Building Addition � ° (�Dwelling ( )Garage-attached/detached ( )Deck W I �Year round O#of caz stalls (�Q Porch � ( Seasonal O Storage Building �Enclosed � O Frame built on site O Screenhouse O Living room � ( )Modulaz/manufactured ( )Greenhouse ( )Kitchen � ( )Mobile/manufactured ( )Other ( )Bedroom � ' ( )Other primazy structure ( ) ( )Relocate/enlazge � ' ( � ( ) ( )#of new W � ' z Additional Information: p � � � � Type of Construction: �� �(�, �Frame ( )Log ( )Pole/metal ( )Block ( )Concrete i� ( )Other ,� b Construction Cost:Primary Structure$ � � :D � Accessory Building:$ Addition:$�"���or;.o r � � Deed:Vol 5� P g� Certified Soil Test# °Q z CSM:Vol Pg Lot# Sanitary Permit# � � Plat Envelope Or: �, � Condo Vol Pg Yeaz Installed: c�'o � Aff of ex septic Vol Pg Owner When Installed: " � Previous office approvals/actions: ' Variance:# LUP:# SP:# CUP:# Inspection Report:# Change of Zone District: a'���1 I 9 38�1 � ' . Describe the construction using these columns.List the dimensions of each structure in a separate colu�n.List each story,each addition,each alteration in a separate column. #1.Lh��o3���i`c!� #2. #3. #4. � Size fr.wide ft.wide ft.wide ft.wide ��- ft.long ft.long ft.long ft.long Floor azea 3/a-sq.ft. sq.ft. sq.ft. s9.fr• Hgt from grade to peak fr.hgt. ft.hgt. ft.hgt. Stories_� stories stories stories #of bedrooms Rear Lot Li e �L /�o �� N1�C�t#Sfl`F_�� � L____--� � Wg ��„ I��, � � � 1�� � �' ��a c��C �/d�I.SL� y ,�,,., � K ft°t �: �'j P �._ �p ` ,-„7.'�G+�' i �'"t� � � �� �R1I1�� C� k t R � ��__.��1- � r;�' � �.._. � � _ CR€r K ___� �'�.-_.__�' P°N� �.��. Fire Number and Name of Road ��p a`� �� ���`�'� � 1. Enter lot dimensions and indicate north by arrow. Si ature of Owner r Authorized Agent: 2. Indicate the location and size of the requested construction �/��',.�,._., , SignaWre activities. "�p I PnntName: L/4�he� /\p.bQr-S 3. Also,indicate the location and distance to the well, The above certlfies that ihe listed intormation and intentions are hue and cortect,that ali work shall be peAortned in compliance septic tank and drainfield,wetland areas,lot lines and to the with the requirements of the Sawyer County Zoning Ordlnance and ihe laws and regula�ons ot ihe State of Wisconsin,and if centerllne of the road. adinq as ownet(s)agent,has the permission of the ovmer(s)to peAortn the work 2quested on this application. The above persons/s hereby give permission for access to the property for onsAe inspection. Permit fee:$ � �.��� 1c, i ctc�� :,�� - �• -�;:r:�,:n� _ ;�. � � -�� f' April 27, 2004 - Issue Date Signature of Iss �ng ent April 27, 2005 50%Rule: AverageRoadSetback: Expiration Date Office Comments: � .� '� _r..._.,-.-----..__..._�...__.._.._., — � . , .__..._.�-.....__ . e..�.».i.._r..,_._._._...._..�..._..�.......-,..._._..- ' r � �' I / ��+� . 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