022-739-27-1201-LUP-2008-145. v
Application for Land Use Permit: (*Non-shoreland*) � ,�
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County of Saw�,�er � �
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PO Box 676 - Hayward �%VI 54843
715/634-8288 �
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*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 ,�bove waterbodies located within
the property's bounda.ries. `�`�
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REi�UIRED PERMITS HAVE BEEN ISSUED. � r
PRINT-USE BLACK INK OR PENCIL
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Owner Build�er �' �
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Mailing Address Mailing Address O
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City, State, Zip City, State, Zip
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Daytime Phone Daytime Phone �"
Additional Information: Zone District:
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Lot Dimensions: �
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Date lot was created: Acres: n
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Is there wetland near the proposed structure? If yes, how far /�� � �
Building Land Use Floodplain: O Yes (�No � ` �
�New ( ) Filling -a � ���
O Addition O Dredging Driveway access off of a(Check onf:): o �, �t,�
( ) Alteration ( ) Grading ( ) Pr•ivate Rd ( ) Town Rd. (v o .
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy i" i; �-°
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Primary Structure Accessory Building Addition .p � °
O Dwelling O Garage-attached/cietached O Deck � �
( ) Year round ( ) # of car stalls ( ) Porch N �
( ) Seasonal ( ) Storage Building ( ) Enclosed � �
O Frame built on site O Screenhouse O Living room � �
( j Modular/manufactured ( ) Greenhouse ( ) Kitchen �' �
( ) Mobile/manufactured �Other ( ) Bedroom � � .-
O Other primary structure O iJ� r�l� �� O Relocate/en�,arge + A
� ) ( ) 5/��� ( ) # of new �
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AdditionalInformation: ` .�
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Type of Construction: �� j�
( ) Frame ( ) Log ( ) Pole/metal (�Block ( ) Concrete p
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( ) Other ,.d' �
Construction Cost: Primary Structure $ � �
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Accessory Building: $ �-��' � � Addition: $ �
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�' ' (P�5�,�' �g � 3 j Certified Soil Test# ��' �� � d"
�eed: v o� � Z
CSM: Vol Pg Lot# Sanitary Permit# o � " %y� o, �
Plat Envelope Or� N
Condo Vol Pg Year Installed: vZ-� � / �
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Aff of ex septic Vol Pg Owner When Installed: � `-'
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Previous office approvals/actions: p 5 - 3`i3 �
Variance: # LUP: # ��- �/d SP: � CUP: #
Inspection Report: # Change of Zone l�istrict: 0
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Describe the construction using these columns. Lis1: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 2, � ft. wide ft. wide ft. wide ft. wide
�ft. long ft. long ft. long ft. long � �
Floor area ' "a. �. sq. ft. sq. ft. sq. ft. sq. ft.
Hgt.from grade��to peak ft. hgt. ft. hgt. ft. hgt.
Stories � stories stories stories
# of bedrooms�/v n%� �
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` Rear Lot Line
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Fire Number and Name of Road ��r�� `";� ��� �'!� �E': . �_ ��` ` "� `�
1. Enter lot dimensions and indicate north by arrow. Signatu of C)wner or uthori Agent:
2. Indicate the location and size of the requested construction �'
Signature
activities. �7 / a
Print Name:,�/�/� �r .6 ;r�
3. Also, indicate the location and distance to the well, The above certifies that the listed information and intentions are
true and correct.,that all work shall be perfortned 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 reculations of the State of Wisconsin, and if
centerline of the road. a�t��9 as oWner�s�a��e�c, 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 propeRy for
onsite inspection.
Permit fee: $ %�� r E' �
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Issue Date Signature of Issuin Ag t
ZUO 50% Rule: Average Road Setback:
Expiration D e
Office Comments: ,
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