HomeMy WebLinkAbout024-641-22-4101-LUP-2004-396 . �
Application for Land Use Permit(*Non-shoreland*) o o .
County of Sawyer �
PO Box 676 -Haywazd WI 54843 O
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 boundaries.
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. ,
PRINT-USE BLACK INK OR PENCIL
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Owner Builder N' �
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Mailing Address Mailing Address �
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Ciry,State,Zip ;'� �. �-.�' � City,State,Zip
Daytime Phone Daytime Phone /
Additional Information: Zone District: �'�R-�
Lot Dimensions:
Date lot was created: Acres: �y•l� n
Is there wetland near the proposed structure?If yes,how faz �
Building Land Use Floadptain:( j Yes ('f�No =°
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(�V�New ( )Filling
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O Addition O Dredging Driveway access off of a(Check one): �
O Alteration O Grading (�)Private Rd O Town Rd. o
O Moving On O '( )County Hwy O State Hwy r."',
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Primary Structure Accessory Building Addition � °
�lDwelling ( )Garage-attached/detached ( )Deck w
�('J Year round ( )#of caz stalls ( )Porch �=
O Seasonal O Stoxage Building O Enclosed �
O Frame built on site O Screenhouse O Living room
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen
( )Mobile/manufactured ( )Other ( )Bedroom -
( )Other primary structure ( ) ( )Relocate/enlarge
� � � � ( )#of new
Additional Information: �
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0
Type of Construction:
(7)Frame ( )Log ( )Pole/metal ( )Block ( )Concrete
( )Other .ti �
Construction Cost:Primary Structure$ � �
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Accessory Building:$ Addition:$ �
� �857'7 �,
Deed:Vol Pg Certified Soil Test# ��/'//S � Z
CSM:Vol Pg Lot# Sanitary Permit# �y'.�SB o. �
Plat Envelope ��� � I
Condo Vol Pg Year Installed: � �
Aff of ex septic Vol Pg Owner When Installed:
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Previous office approvals/actions:
Variance:# LUP:# SP:# CUP:# zI0`�
Inspection Report:# Change of Zone District: $� f
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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. �-o �I- #3. i�e,�' #4.
Size ft. wide �� ft. wide � o ft. wide ft. wide
ft. long zco ft. long o� �e ft. long ft. long
Floor area sq. ft. yl � sq. ft. z(�� sq. ft. sq. ft.
Hgt. from grade to peak ft. hgt. ft. hgt. ft. hgt.
Stories stories stories stories
# of bedrooms
{35 y Rear Lot Line
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Fire Number and Name of Road y � ' ;` �
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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 ,t i` ° ��
Sign�ture
activities. � ,��} � � ��� j � ,��� ,>
Print Name:
3. Also, indicate the location and distance to the well, The above certifies that the listed i formation and intentio�e
true and correct., that all work shall be performed in compliance
with the requirements of the Sawyer County Zoning Ord�nance
septic tank and drainfield, wetland areas, lot lines and to the and the laws and regulations of the State of Wisconsin, and �f
acting as owner'(s) agent, has the permission of the owner(s) to
centerline of the road. perfo�, the work requested on this application. The above
personsls hereby give permission for access to the property for
onsite inspection.
Permit fee: $ 3� °�'�
Au�ust 4 2004 +
Issue Date Signature of Iss in ent
August 4 , 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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