HomeMy WebLinkAbout010-941-21-3405-LUP-2000-277 " Application for Land Use Permit
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County of Sawyer � ° ,I'
PO Box 668 - Hayward WI 54843
715/634-8288 '
The undersi�ned hereby makes application for a Land Use Permit and agrees that all �vork
shall be done in compliance with the requirements of the Sa�vyer County Zoning Ordinance
and the laws and regulations of the State of Wisconsin.CONSTRUCTION MAY NOT
BEGIN UtiTIL THE PER�tiIIT IS ISSUED.
PRINT — USE BLACK INK OR PENCIL � �
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Mailing Address Mailing Address
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City, State, Zip City, State, Zip
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Daytime Phone Daytime Phone ,
Buildin� Land Use _
( ) Ne��� ( ; Filling Zone District �
�' j Addition ( ) Dredgin� �,
O Altera?ion O Grading Lot Size � � �
� ) Movin� On � ) �'°5 . �.m_�_ / I.�.
T--- Acres �� � ��1� J
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Primary Structure Accessory Buildin� Addition '
( ) Dwelling ( ) Gara�e-attached/detached �Deck �� �
(���Year round O # of car stalls O Porch i � ��
( ) Seasonal ( ) Stora�e Building ( ) Enclosed �� ;
O Frame built on site O Screenhouse O Living room � �
( ) Nlodular�manufactured ( ) Greenhouse ( ) Kitchen � � ��(n
( ) Mobile/manufactured ( ) Other ( ) Bedroom �i� '�,�
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( ) Other primary structure ( ) ( ) Relocate�enlarge ��. >
� ) ( ) ( ) # o�f new � ��
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Type of Construction �`� '
( ) Frame ( ) Lo� ( ) Pole/metal ( ) Block ( ) Concrete ���� I�
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� ) Other l ;=:./ . � . - � � , �
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Construction Cost S ���c:.-�--' F�
Vol�_Pg � 7 of Deed Certified Soil Test # � ' -� � � � � �' ��
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CSM Vol __�_3 Pg 1� ' Sanitary Permit #_ ' ` z� -�' __ � �z
Plat Envelope �r� �(� i�~
Condo Vol Pg Year Installed /�"�=-� � �, �
Aff of e� septic �' P O��'ner �Vhen Installed: � � �b
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- Application for Land Use Permit — Page 2
Describe Construction: List dimensions of each structure, story, addition, or alteration. �
# 1 . � � ; ; #2. #3. #4. .
Size �' �� �ft. �vide ft. wide ft. �vide ft. wide
, C� � �ft. long ft. long ft. long ft. long
Floor area ��� sq. ft. sq. ft. sq. ft. sq. ft.
H�. fi-om grade /C� to peak ft. hgt. ft. hgt. ft. hgt.
Stories � stories stories stories
# of bedrooms �
rear lot line or «�aterline of �I�ia lake/river
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In the box sketch in: � � , \ ,,'
Location and size of all ,h ZU ��
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existing and proposed stnictures. � � � ,� r��'�� L�� `�
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Location of septic system.
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Indicate distance to: � a-1��'S{ � � �� � � ,
�Vaterline/Wetlands � i�, �
Road � � �
Lot lines � /� ��— � �
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Septic systenvpri��y � ' ' ���' .
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Distance behveen structures. �, ' ,����CpJ �Q`� ;
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Indicate �'orth. - - � �` ''
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Fire �'umber: i��
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Signature o O���ner •�/
The abo�•e certifies that the listed
infonnation and intentions are true and -
correct. The abo��e person;'s' hereby
��i��e ermission for access to the
propPty for onsice inspection. ------- centerline of ���r � ' � � -. ' road-------
Issue Date June 20 , 2000 Expire Date June 20 , 2001
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Document Number: � 7 � 9 2 q
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SEPTIC TANK MAINTENANCE AFFIDAVIT
This affidavit made and entered into this Z°d day of N`""` ' "` w }�
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December , jg 98 �y !i„cme��ad Ior re--ord ti�3��,d�y at
- . . QE�_AJ19 9�a19�4Se'dock
Michael D . Moreno — __Q_r: an:i rewrdeg o,s����i �$/a �
of iinco,os on pa4e�47___
lmown as owner(s) of property identified by Pazcel Identification
NumbC[(s): 010-941-21 3405 �b�n � � 4 t�g:ster
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Dcpury
WHEREAS, application has been made for a sanitary permit on the
1'ollowing described pazcel, to wit: �,i.��,t,o;
LAND DESCRIPTION Sawyer Counry Zoning&Snnitntim
PO 8oz 668
Hayward,Wi 54843•0668 J yj
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That part of the SF.,'—, SW1 , Section 21 , Tow❑ 41 North , Range 9 West
de�cribed as Lot 1 in Volume 13 of Certified Survey Maps , page
197 , Survey No . 3195 ��s�� ,y �,,,,R�Rerj /�9N� , Nyycvi�R!? cvis
AS OWNER(S) of the property described above, I (we) agree to submit to the County of Suwyer a
certification form (to be provided by the County), at my(our) expense, every three years and signed by a
ticensed Master Plumber, Mester Plumber Restricted 3ewer, a licensed septage hauler or licensed p:umbing
inspector. The form shall state and certify the following:
1) The current operating condicion of the,priv8te sewage system, and
2) That the septic tank was recently pumped by a lieensed septic tank pumper or it was inspected and is less
than one-third full of sludge.and scum.
I (we), the undersigned, have read the above requirements and agree to maintain the private sewage system in
accordance with applicable state standards.
'Ihis AFF7DAVIT is to run as a covenant with the deed and shall be so recorded at the expense of the owner{s}
and be binding on all successors and assigns of said paKcel of land.
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OMiv��e 1����n� � Datc: �/ '�X°�' OC � ��
, Date:
STATE OF WISCONSIN:
Personally came befora me this Z n d day of De c em b e r , 19 �8 the above
named person(s) who executed the foregoing instrument and acknowledge the same.
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" Susan K . Ross
Notarxpukaji�� State of Wuconsin
Mkacmrtiiss�on�expires Jan . 13 , 2002
'Iliis inswment was drafted by:
Susan K. Ross � ��� �''� �
voL 65 � Pc184