HomeMy WebLinkAbout024-773-00-1100-LUP-2004-037 �-,�J� ai �\
Application for Land Use Pernlit �/l(�'����„ o ��
County of Sawyer � D
PO Box 676 -Haywazd WI 54843 v �
715/634-8288 �
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The undersigned 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 O
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Owner Builder �
i�.o. �3 ok ��7 I? o. (3 ox y�7 0 �
Mailing Address Mailing Address � �
�1�1 S'(.�A�1�, (a.�r s v��/3 L(;4;- ,Ftk r}� Lu_Z s�/��/? �� �
City,State,Zip City,State,Zip y
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7/5-�-3Y- �>��' 7�s--�3�/-X9�6' e z;
Daytime Phone Daytime Phone � �
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Additional Information: Zone District 12lZ / �
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Lot Size �G 0 X�G G �
U
Date lot was created ZG G�, Acres �, � 5 -��' n
Is the property in a Shoreland District?(within 1000'of a lake or pond,within 300'of a river, i o
creek or stream) If yes,how far from the shoreline&water name: bTG /ZO(1 u� L�K F_ o
Is there wetland near the proposed structure?If yes,how far �0 0 � o
�
Building Land Use �
�New ( )Filling � Floodplain:( )Yes �No # �
( )Addition ( )Dredging � �
( )Alteration ( )Grading Chippewa Flowage: ( )Yes (�No �
( )Moving On ( ) � o
( ) ( ) Driveway:( )State ( )County (�Town Rd.
Primary Structure Accessory Bu�'ld'�g Addition � w
(5O Dwelling ,= . OC)Gazag attach detached (}�Deck �
(Y�Yeaz round O#of caz stalls �Porch �
O Seasonal O Storage Building (�Enclosed O
(�Frame built on site O Screenhouse O Living room �
( )Modular/manufactured ( )Greenhouse ( )Kitchen �
( )Mobile/manufactured ( )Other ( )Bedroom o
( )Other primary structure ( ) ( )Relocate/enlarge "
( ) ( ) ( )#of new o >
c v�
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Additional Information: °
� � �Type of Coristruction �
�Q Frame � ( )Log ( )Pole/metal ( )Block ( )Concrete �
( )Other � '
Construction Cost:Primary Structure$ ��0�C 0 D, c�o
� � �
�d
Accessory Building:$ Addition:$ z
�13%%/5 v = �
Vol 7c�9 Pg //R of Deed Certified Soil Test# O�l-�l�/
CSM Vol Pg Lot# Sanitary Permit# D y-D/A
P1atEnvelope Or: �.°�Zi���S �
— �
Condo Vol Pg Year Installed
Aff of ex septic Vol Pg Owner When Installed:
Gard Gazebo Vol Pg
Previous Variance: � LUP: Inspection Date: �������
�3(0�5 �"
Describe the construction using these columns. List the dimensions of each structure in a separate
column. List each story, each addition, each alteration iu a separate column.
#1. 8ort+ �u�-r ra�i3 #2. oP� A�cK �o�� #3. �ucc�s�� PoQer� tt4. ffrv�leN€a �r�,�cC
Size S� ft. wide d� ft. wide � 8 �_ �. widc a� ft. wide
� O ft. long P O ft. long a o � ft. long _ �a It. long
— �
Floor area a o a o sq. ft. �sq. ft. 3�0 / 9Z sq. R. 5��sq. ft. •
Hgk from grade a� to peak�_ ft. hgt. b' 1 S- ft. ligt. � o ft. hgt. .
Stories / ��� _�stories 1 _�stories �_stories
# o£bedrooms�_ ��.��� ���� �
F�cN u N�r /o Yo C�`
�oF-r 3bo °°�D� Lot Line r Lake/Rivername: ��G RouN D LA K�
� � 300 ' -7 '
g� �
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- .Fire Number and Name of Road Qu s 5� �c�AD
1. Enter lot dimensions and indicate north by azrow. Si ure f ner r t thorized Agent:
2. Indicate the location and size of the requested construction �
S�gnaNre
activities.
PnnlName:
3. Also, indlC2te tlle IoCation and d15tanCe to the well, The above certifles ihat the listed intormation and intentions are
hve and correct.,that all work shall be pertormed in compliance
septic tanic and drainfield, wetland azeas, lot lines, with the requirements of ihe Saxyer County Zoning Ordinance
_..---__.\ and Ne laws and regulations of the State of Wisconsin, and if
Cent0111riC Of t110 I03d and W1teIbodle5. �.-----<���� \ acting as owner(s)agent, has ihe permission ot the owner(s)to
, ' peAorm the work requested on this applicaflon. The above
LT �a�
� /L��� � c/ J personsls hereby give permission for access to iha pmperty lor
�, �- � onsite inspection.
Permit fee: $ � �S �`� L�%- � �%
Total land azea within 300' of the waterbody: (A) � 7 > � ��
Tota1 impervious surface azea [including this project] (B) � q9 �
(B)/(A) x 100 = % Used 3 ,5,_(Shall not exceed 15%[or 25% with a conditional use permit].)
Shoreline Vegetation Protection Area: Mitigation Required? O Yes �f No
March 3, 2004 -
Issue Date Signature of Is 'n ent
March 3, 2005 50°/a Rule: Average Road Setback:
Expiration Date
Office Comments: �(La2. �. �/� OS -S �/ ? y� wru.�,�G�� � � /�/9/dJ�--
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THIS MAP IS FOR ASSESSMENT USE ONLY AND IS NOT INTENDED :
TO SHOW CONCLUSIVE EVIDENCE OF OWNERSHIP OR BOUNDARY � •7 • 2
LOCATIONS.
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