HomeMy WebLinkAbout032-540-22-5801-LUP-2004-081 Application for Land Use Permit(*Non-shoreland*) r/ .� ' . '
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 �
flowage,lake or pond or does not have any of the above waterbodies located within
the property's boundaries.
CONSTRUCTION SHArL�L NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. �
P�PI�n S K��7GYJ PRINT-USE BLACK INK OR PENCIL
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Owner ��� �•B:�ldex <'
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Mailing Address/ Mailin Address �
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Daytime Phone Daytime Phone �
Additional Information: Zone District: �L
Lot Dimensions:
Date lot was created: � . Acres: �� o �
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Is there wetland near the proposed structure?If yes,how faz �Ci G
Building Land Use Floodptain:� j I`es �[�No =R
(S�f New ( )Filling �
O Addition O Dredging Driveway access off of a(Check one): �
O Alteration (�Gradir.g O Private Rd �Q Town Rd. �
( )Moving On ( ) ( )County Hwy ( )State Hwy �,"', �
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Primary Shvcture Accessory Building Addition �
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(�Dwelling ( )Gazage-attached/detached ( )Deck W �
( )Year round ( )#of car stalls ( )Porch �
( )Seasonal ( )Storage Building ( )Enclosed � �
�jlj Frame built on site O Screenhouse O Living room �
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen `�
( )Mobile/manufactured ( )Other ( )Bedroom � �
( )Other primary structure ( ) ( )Relocate/enlarge �
� � ( ) ( )#ofnew . �
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AdditionalInformation: ' p
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Type of Construction: Ci� �
(�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete °
( )Other ,.d ,�
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Construction Cost:Primary Structure$ i7+ �Gb o
:D �
Accessory Building:$ Addition:$ �
�3i�l�lry�� �;�� il3 �'
Deed:Vol Pg Certified Soil Test# (��3- yCLS °O z
CSM:Vol Pg Lot# Sanitary Permit# (�y� OU(v 1' o� %b
Plat Envelope �r� c� �
Condo Vol Pg Year Installed: o �
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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:#
Inspection Report:# Change of Zone District:
3I3�oy
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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.
#L � �l �i r�' #2. #3. #4.
Size % ` ft. wide ft. wide ft. wide ft. wide
yt ft. long ft. long ft. long ft. long
Floor azea�sq. ft. sq. ft. sq. ft. sq. ft. .
Hgt from g�ade i� � to peak fr. hgt. ft. hgt. ft. hgt.
Stories j stories stories stories
# of bedrooms�
Rear Lot Line
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I. Enter lot dimensions and indicate north by arrow. Signature,of�ner Or Authorized Agent:
2. Indicate the location and size of the requested construction �/'i_�i�./� �i. �����
Sig re
activities. - �
PnntName: ��/Cf�HlG P/%t�'��"`
3. Also, indicate the location and distance to the well, The above certifies Nat ihe listed intormation and intentions are
We and correcL,that all work shall be performed in compliance
SCpt1C ta[l�c ancl dIalnfield, wetland azeas, lot lines and to the with the requiremenis ot the Savryer Counry Zoning Ordinance
and ihe laws and regulations of Me State of Wisconsin, and if
CCIItCi11IIe Of Y118 i08d. acting as ovmer(s)agent has ihe permission of the owner(s)to
perfortn ihe work 2quested on this applica6on. The above
personsls hereby give permission for access to the property for
onsAe inspecUon.
Permit fee: $ �•�
April 20 2004 -
Issue Date Signature ofIss 'ng ent
Apr i 1 2 0 , 2 0 0 5 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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SCALE : I INCH = 4 0o FEET FOR ASSESSMENT . USE ONLY NOT
DRAWN BY : a. M . E . DATE : 4 - � 2 - � 97g INTENDED TO SHdW CONCLUSIVE
COLON ( : ) INDICATES GOVT. LOT EV(DENCE OF OWNERSHIP OR
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