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HomeMy WebLinkAbout024-841-01-1104-LUP-2004-537 Application for Land Use Permit(*Non-shoreland*) o o� �,-. County of Sawyer � � PO Box 676 -Haywazd WI 54843 ,c�S f�(y- 715/634-8288 _ 00 � *Property that is not located within 300'of a creek,river or stream or within 1000'of a 6-- S flowage,lake or pond or does not have any of the above waterbodies located within 1 the property's boundaries. � CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN[SSUED. a � PRINT-USE BLACK INK OR PENCIL 7� �1 C ` �" � y�o141 Y� J jo5 j"ro rv� S V'�awv� J\O$'�'�^4 y`�+ n' �IIF� Owner / Builder J / <' �3��� N La�SYn �d ��0 Z 7 /V �u rScs� �d �. Mailing Address Mailing Address O � �la4w�.�1 t�,- .���y� f���,Y� W; s��y 3 � City, tate,Zip City, tate,Zip 7�s -��y— �o�� 7�- c�Y-Go�� � � Daytime Phone Daytime Phone Additional Information: �Zone District: ��� Lot Dimensions: �I� � X �6`{.3�O/ Q Qa/� U Date lot was created: U""�5'�� Acres: 2+�.1 dl n 0 Is there wetland near the proposed structure?If yes,how faz N 0 G � Building Land Use Floodptain:� )Yes (X)No � � QD)New ( )Filling � O Addition O Dredging Driveway access off of a(Check one): � O Alteration O Grading j�)Private Rd O Town Rd. o O Moving On O O County Hwy O State Hwy ti � ) � ) o S r Primary Structure Accessory Building Addition � ° (jC)Dwelling (�O Garage-attached/detacbed ( )Deck w -0 � (�Year round (2)#of car stalls O Porch �= T � ( )Seasonal ( )Storage Building - ( )Enclosed � �-• � (X)Frame built on site O Screenhouse O Living room � � � ( )Modulaz/manufactured ( )Greenhouse ( )Kitchen Q � ( )Mobile/manufactured ( )Other ( )Bedroom a � ( )Other primary structure ( ) ( )Relocate/enlarge �. � � ( ) ( )#ofnew Z � � ��r � AdditionalInformation: � < � O �, � � i o Type of Construction: � 0 ('�.Frame ( )Log ( )Pole/metal ( )Block ( )Concrete {,� ( )Other ro �Construction Cost:Primary Structure$ �y�j�00 � � Accessory Building:$ Addition:$ � --C fL' rl 3Zy yv/ �u � Deed:Vol Pg Certified Soil Test# 0�- �3�j °Q z CSM:Vol a�P Pg c��o Lot#�� Sanitary Permit# ��-�--3��"I � � Plat Envelope Or. ^, 00 ,� Condo Vol Pg Yeaz Installed: � Aff of ex septic Vol Pg Owner When Installed: � � % Previous office approvals/actions: %� Vaziance:# LUP:# SP:# CUP:# Inspection Report:# Change of Zone District: C� ����2`� �� �\r\\�� \} a���� 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. #L L #2. %;��_,�r,� #3. #4. Size ft. wide � I ft. wide fr. wide fr. wide _�_ft. long 3� ft. long ft. long ft. long Floor azea /e� sq. ft. ��a sq. ft. sq. ft. sq. fr. Hgt.from gcade �� to peak ft. hgt. ft. hgt. ft. hgt. Stories r stories stories stories # of bedrooms ? Rear Lot Line �23 � 1.2 T N � � � � = 1�r �� � � S � � �� 4� ��o' � r� g"��e � �c�( � �° \� Qr��qi� �� 3y5 � v3 Fire Number and Name of Road 1. Enter lot dimensions and indicate north by azrow. Signa f er o Authorized Agent: 2. Indicate the location and size of the requested construction --� Signature activities. PnntName: �hAW✓� �o � c rn 3. Also, indlCate the IoCatlon and d15tanCe to the Well, The above ceNfies that Ne listed i rmation and inten�lons are Vue and correct., ihat all work shall be peAormetl in compliance septic tank and drainfield, wetland areas, lot lines and to the w�m me req��reme�r� or me sawyer co�ory zo�m9 ord'�oa�ce and Ne laws and regulations of the Sfate of Wiscronsin, and if COriYCI'11riE Of 1�18 I03d. ading as owner�s)agent,has�he permission of ihe owner(s)to pedorm the work requestetl on this application. The above personsls hereby give permission for axess to lhe property for onsite inspection. Permit fee: $ � � S`�� September 28, 2004 �,( �P�/A `� `P.�,1= � � .l.c-� Z�- Issue Date Signature ofIss g nt � September 28, 2005 50% Rule: Average Road Setback: _ Expiration Date Office Comments: /� aza-au.oi imi /, /� � 02�-841-01 1201 d� o`� . �' od . f OIa-BLt-01 1103 �` NW—NE �� NE—NE ��Q� •i�' 1G IB �> 1 ax�-eai w�-au ozr-au ou-ea o� i�a� ai nos m iws oi naa o`` d. 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