HomeMy WebLinkAbout016-637-21-2101-LUP-2004-229 Application for Land Use Permit(*Non-shoreland*) o o r
County of Sawyer � ��
PO Box 676 -Hayward WI 54843
715/634-8288 -
*Properiy 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 i_
the property's boundazies. �: �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED.
PRINT—USE BLACK INK OR PENCIL 1
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Owner Builder �� /-
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Mailing Address Mailing Address �
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City,S te,Zip City,State,Zip �
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Daytime Phone Daytime Phone
Additional Information: Zone District: - -'I r
Lot Dimensions: /:32o x l�Lf�
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Date lot was created: Acres: �✓� o
Is there wetland near the proposed structure?If yes,how far � �
Building Land Use Floodptain:( }Yes O No =° �
�f New ( )Filling � "
O Addition O Dredging Driveway access off of a(Check one): �
O Alteration O Grading O Private Rd O Town Rd. o
O Moving On O �County Hwy O State Hwy ti, �
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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 O Enclosed �
Screenhouse ( )Living room
(xl Frame built on site ( ) " �
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen �,� m
( )Mobile/manufactured ( )Other ( )Bedroom ;;� �
O Other primazy structure O O Relocate/enlarge r
� � ( � ( )#of new >
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Additional Information: >
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Type of Construction: � `�,
�f Frame ( )Log ( )Pole/metal ( )Block ( )Concrete —
( )Other .�
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Construction Cost:Primary Structure$ /5l L1' o
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Accessory Building:$ f,:' `-<^C' Addition:$ x� �d
#Z 3r53oc' � J
Deed:Vol Pg Certifie3 go;l Test# °Q
z
CSM:Vol Pg Lot# Sanitary Pertnit#_�— O��� � �
Plat Envelope Or: � �
Condo Vol Pg Year Installed: � �
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Aff of ex septic Vol Pg Owner When Installed:
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Previous office approvals/actions:
Variance:# LUP:# SP:# CUP:# aa\o`�
Chan e of Zone District: �� �'�
Inspection Report:# g
1923`)
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. Jwe-l���n #2. �Hc o�� #3. #4.
Size e2 0 . wide ,3 o ft. wide fr. wide ft. wide
3C ft. long �O ft. long ft. long ft. long
Floor azea �d � sq. ft. /Soo sq. fr� S9• �� S4• fr•
Hgt from grade !5 � to peak /S fr. hgt. ft. hgt. ft. hgt.
Stories / / stories stories stories
# of bedrooms�_
i :3�G� Rear Lot Line
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$`b
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-- B�`!D � _ __ 30' 6,•,9� i 0�� T 36D —
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': '15°
Fire Number and Name of Road � ��,�a �(�� �
1. Enter lot dimensions and indicate north by arrow. Signature of Owner or Authorized Agent:
2. Indicate the location and size of the requested construction �'
gnaWre
activities. �
PnntName: TCfru �� DA _
3. Also, indicate the location and distance to the well, The above certiees m he liste tortnation and intentiors are
true antl conect.,that all work shall be performed in comp iance
SeptiC tari1C anCl aI'alnflelC�, wet18[ld aze3s, lot lines and to tlle wN� the requiremenLs ot the Sawyer County Zoning Ordinance
and Ne Wws and regulations of the State of Wisconsin, and 'A
CCritCI'IiriE Of t118 i08(1. aciing as owner(s)agent,has me permission of Ne owner(s)to
perform ihe work requested on ihis application. The above
personsls he�eby give permission for access to Ne propeRy for
onsiteinspection.
Permit fee: $ I �5 � 5C�% �� a S
Ma� 7A 2004 ` —
Issue Date Signature ofIssui A e t
May 28 , 2005 50% Rule: AverageRoadSetback:
Expiration Date
Office Comments:
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