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026-131-00-2300-LUP-2004-424
� Application for Land Use Permit(*Non-shoreland*) o 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 7� � flowage,lake or pond or does not have any of the above waterbodies located within �� - �—��S ��T the property's boundaries. � CONSTRU TION ALL NOT BEGIN UNTIL ALL REQUIKED PERMITS HAVE BEEN ISSOED. ` ' � -�� ���b yy�p� PRINT-USE BLACK INK OR PENCIL �� , P , �� 9 � , �,,C -�'� /J , � _�, r i; � � /^�� � �,', a Owner Builder N' � l'�.� �r� �c_� � rn� �' Mailing Address Mailing Address � J � �'� �� ��'� �;^1, rn -�x � ., City,State,Zip City,State,Zip -- i ��„� -�✓`� "iC > 7= �� , � DaytimePhone� _ ` , _: .,ry-` DaytimePhone � � �', _,_ . .. �� ,G Additional Information: Zone District: ,^'E��,� Lot Dimensions: `": �' �_. 7 Date lot was created: Acres: l 3 S o � E Is there wetland near the proposed structure?If yes,how far � y � Building Land Use Floodptain_O Yes O No =° �New ( )Filling � � O Addition O Dredging Driveway access off of a(Check one): � O Alteration O Grading O Private Rd O Town Rd. o ( )Moving On ( ) ( )County Hwy ( )State Hwy r."', � � ) � ) o � t" Primary Structure Accessory Building Addition � ° (�Q Dwelling ( )Garage-attached/detached ( )Deck � ( )Year round ( )#of caz stalls ( )Porch 'J O Seasonal O Storage 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 �' AdditionalInformation: c ' c w,��, n' � r Type of Construction: C 1y � SL, (�f Frame ( )Log ( )Pole/metal ( )Block ( )Concrete � r� ( )Other .� � Construction Cost:Primary Structure$ � � Accessory Building:$ Addition:$ � (sl �3tq 79� � ^� Deed:Vol Pg Certified Soil Test# U�- a75'�7 °' z CSM:Vol Pg Lot# Sanitary Permit# ��- ,�9 j b� � Plat Envelope �r� �' � � Condo Vol Pg Yeaz Installed: � � � Aff of ex septic Vol Pg Owner When Installed: " i C,+ Previous office approvals/actions: Variance:# LUP:# SP:# CUP:# Inspection Report:# Change of Zone District: �\��p� � a�sya Describe the construction using these wlumns. List the dimensions of each structure in a separate • column. List each story, each addition, each alteration in a separate column. #1. #2. #3. #4. Size�ft. wide ft. wide ft. wide fr. wide �f[. long ft. long fr. long ft. long Floor azea `n � sq. fr. sq. ft. sq• ft• S4• fr� Hgt.from grade to pealc i:,� ` fr. hgt. fr. hgt. ft. hgt. Stories � stories stories stories # of bedrooms�;� Rear Lot Line �`, � , � . � _ � _ , — I �. , 'y� � iI /^2� I . . .__.. _ ----- . ,- . / --_ , }-' � ,�c - � . `'�_- � � ._ ��� � � � ��� � -, �� � � �t. � ' ----- - i 1 / I 1__ �`; _ � , b' �/ ..,- �� -� , , �, Fire Number and Name of Road ��, �! � �'��� �' r �� � 1. Enter lot dimensions and indicate north by arrow. Signature of Owner or Autborized Agent: 2. Indicate the location and size of the requested consriuction d,. � —>-�-�-_ SignaNfe activities. ;,' - . - :l� c" Pnnt Name: - i� � �� ',� 3. Also, indlcate YSle location and dlstance to the Well, The above caNfies tnat the Ilsted infortnatlon and Intentions are` true and corted.,that all work shail be perfortned in compliance septic tank and drainfield, wetland azeas, lot lines and to the with the requirements of the Sawyer County Zoning Ordinance and the laws and regulafions of the Shate of Wisconsin, antl if CCnteillnC Of tlle IoBd. acting as owner(s)agent, has the permission of the owner�s)to pedortn the work requesled on this appllcation. The above personsls hereby give permission for aaess to the pmperry for � onsite inspection. Permit fee: $ f � ��� � �S % �" Au�ust 11, 2004 Issue Date Signature of Issui e t August 11, 2005 50% Rule: AverageRoadSetback: Expiration Date Office Comments: ,Obb � � .eF, __. . i£ N�i g "�v�� � � �,2. �i 5,.�"i��n�,A� � �';1, . � � � � 'p ��1 � v�, _ �1: � �� S / 4 �1� �:�� ' � iV� oj� vi � � . 1��` �,$ , •y�f� ". h)� � ' _ � 1 v _ _, � i '' a, ..� e �'' � . , ,. 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