016-637-11-2201-LUP-2008-277 Application for Land Use Permit: (*Non-shoreland*) o o x,"
County of Saw��er N �
PO Box 676 - Hayward �VI 54843 `J
715/634-8288 �
*Property that is not located within 300' of a creek, river or stream or within 1000' of a '6
flowage, lake or pond or does not have any of the ,�bove waterbodies located within 2
the property's bounda.ries. a
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL RE��UIRED PERMITS HAVE BEEN ISSUED. �
PRINT—USE BLACK INK OR PENCIL IT �
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Owner E'�� Builder ¢' �
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City, State,�Zip� City, State, Zip
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Daytime Phone Dayti�ne Phone
Additional Information:E�a%e �u-�r��K /l/���'k��Zone District: ��1 -�
.�C�v�dw', 11���l,vl�� 1�c�.vvtel�c R�k�c •�.I,c� �
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1,�:��,,u,� ���' �-'�� �� ���. •-�� Con Ki� S�v, ����i Lot Dimensions: ► �:;,��4 � i��� �7 �'
�A �id Se,F;��"S ner C
Date lot was created: Acres: ��;`� o !�
Is there wetland near the proposed structure? If yes, how far .� �
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Building Land Use Floodplain: O Yes � No ? �
( )New ( ) Filling � � �
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(�Q Addition O Dredging Driveway access off of a (Check onf,): � �
O Alteration O Grading O Pi•ivate Rd (�Town Rd. Q o
( ) Moving On ( ) ( ) County Hwy ( ) State H�vy
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Primary Structure Accessory Building Addition � � o
(�j Dwelling ( ) Garage-attached/cietached ( ) Deck � �
Q(� Year round O # of car stalls O Porch � �
( ) Seasonal ( ) Storage Building ( ) Enclosed � CD
O Frame built on site O Screenhouse (� Living room ��
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen jv � �
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( ) Mobile/manufactured ( ) Other ( ) Bedroam
O Other primary structure O O Relocate/enI',arge � � A
O O O #ofnew � �,,
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AdditionalInformation: O � �
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Type of Construction: $ N �
(,)�Q Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete O �
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( ) Other �
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Construction Cost: Primary Structure $ � �
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Accessory Building: $ A��dition: $ '�Z �`,]O_� � �
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Deed: Vo1 ,�37695 Pg Certiried Soil Test# °Q
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CSM: Vol Pg Lot# Sanitary Permit# � 7�
Plat Envelope Or: �,
Condo Vol Pg Year Installed: N, - ..�, �
Aff of ex septic Vol Pg Owner When Installed: � �
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Previous office approvals/actions: •
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Variance: # LUP: # SP: ;� CUP: # �
Inspection Report: # Change of Zone l�istrict: ���
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Describe the construction using these columns. Lisi:the dimensions of each strur.ture in a sep rate �
col List each story, each addition, each alteration in a separate column. �'� �
#1.�}-����v �,x� #2. �s Gr�S-� #3. ��=�..r�:a ... �:' � #4. L.i cl�n q 2.r��h .
Size ��f ft. wide �_ft. wide �ft. wi e � d ft. iw de
" ft. long "�« ft. long �� .-`' ft. long �/ ft. long
Floor area��sq. ft. sq. ft. ;;'� <.: sq. ft. 2/Z� sq. ft.
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Hgt.from grade��to peak ', ::� ft. hgt. '. � ft. hgt. ft. hgt.
Stories�_ _�stories �_stories � stories �
# of bedrooms ?�
Rear Lot Line
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Fire Number and Name of Road `� v�►�S �i C.�t�a �� �
l. Enter lot dimensions and indicate north by arrow. Signature of C)wner or.Authorized Agent:
2. Indicate the location and size of the requested construction ,'_�'� , s ._, �� .� �� _ta( t sr � ;;
Signature
activities. � �
PrintName: �•. z / 1 y't„' �t'��i.
3. Also, indicate the location and distance to the well, The above certifies that the listed in ormation and intentions are
true and correct.,that all work shall be performed in compliance
septic tank and drainfield, wetland areas, lot lines and to the with the requirements of the Sawyer County Zoning Ordinance
and the laws and requlations of the State of Wisconsin, and if
centerline of the road. a�t��9 as ow�er�s�a��e�t,has the permission of the owner(s)to
perform the work requested on this application. The above
persons/s hereby give permission for access to the property for
onsite inspection.
Permit fee: $ �'.s �' 1�.��(yy
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Issue Date Signature of Issuing Agent
��,��s�.. z�, Zap9 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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