HomeMy WebLinkAbout002-839-05-5417-LUP-2001-547 �7S`i°
Applicati�n for Land Use Permit L'
County of Sawyer v �
PO Box 676 -Hayward WI 54843 ',� �
715/634-8288
The undersigned hereby makes application for a Land Use Permit and agrees that atl 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.CONSTRUCTION b1AY NOT ,
BEGIN UNTIL THE PERI�IIT IS ISSliED. � �
�' i PRINT-USE BLACK INK OR PENCIL �
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���'LT�`�l��1t ,d��1ar�, 11i�ltt� ��� 1\t`W1S ` o �
wner Builder ' O
_o���'o � l ��241-V i Fu� ���� 1?��q� \!J Qe�e nSo l ��� �
Mailing Address Mailing Address �
� C� � �r;SSe �i,�� ��U.^�1 ���.�ur� �` 5`1��1 s �
City,State,Zip � City,State,Zip �
1C�%�? ' �4R ��i�4�' ,)�� (s�`I �`'11S
Daytime Phone Daytime Phone
Building Land Use �
O New O Fillin� Zone District � I
( )Addition ( )Dredgin�
( j Alteration O Grading Lot Size n
( )Movin�On ( ) � ��
(r)��et,;; rnoF ( ) Acres_ �3 9 �
�' �v
Primary Structure Accessory Building Addition � g �,
O Dwelling O Garage-attached/detached O Deck � o
O Year round O#of car stalls O Porch y� "
( )Seasonal ( )Stora�e Building ( )Enclosed � �
( )Frame built on site ( )Screenhouse ( )Living room �
( j Modular/manufactured ( )Greenhouse ( )Kitchen ��
( )Mobile/manufactured ( )Other ( )Bedroom r
( )Other primary structure (��'y�f�{`�--,•� ( )Relocate/enlarge '1 =
� ) ( ) ( )#of new Cn
C.1
Type of Construction o :
( )Frame ( )Lo� ( )Pole/metal ( )Block ( )Concrete �J �
( )Other -� �
d ^
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Construction Cost$ `�j.`�_,��,�.`'" -�
�
Vol��Pg /r�7 of Deed Certified Soil Test# 9j „„
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CSM Vol Pg Sanitary Permit# 7� - `1v 7 U ? z
Plat Envelope Or: q�/-S�'j � �'
Condo Vol Pg Year Installed � I 1 Q�
Aff of ex septic V P Owner When Installed: f ���
`I3�1�1
Application for Land Use Pernut — Page 2 '
Describe Construction: List dimensions of each structure, story, addition, or alteration.
#1. #2. #3. #4.
Size ft. wide ft. wide ft. wide ft. wide
ft. long ft. long ft. long ft. long
Floor area sq. ft. sq. ft. sq. ft. sq. ft.
Hgt. fivm g�ade to pealc ft. hgt. ft. hgt. ft. hgt.
Stories stories stories stories
# of bedrooms
rear lot line or waterline of lake/river
In the box sketch in:
Location and size of all
existin� and proposed structures.
Location of septic system. 30
Indicate distance to:
Waterline/Wetlands
Road
Lot lines
Septic system/privy
Well
Distance beriveen structures.
Indicate North.
Fire Number:
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Sigoature of Owner
The above certifies that the listed
information and intentions are true and
coaect.The above person/s/hereby
give permission for access to the
property for onsi[e inspec[ion. ------- CCttteiline Of i0ad-------
IssueDate October 3 , 2001 ExpireDate October 3 , 2002
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Office Comments: ���%fa's°�� ����
Signature of Zoning Administrator
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FOR ASSESSMENT USE ONLY _
. NO7 IN7ENDE� TO SHOW CON- S EC . 5 T W P. 39 N . R . 8 W .
CLUSIVE EVfDENLE OF OWNER-
SHIP OR OOUNDARY IOCA-
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