010-169-00-2400-LUP-2005-573 �
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Application for Land Use Permit: (*Non-shoreland*) o o .
County of Saw��er � � �'
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PO Box 676 - Hayward �%VI 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 bounda.ries. �^
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REi�UIRED PERMITS HAVE BEEN ISSUED. � ' �
PRINT-USE BLACK INK OR PENCIL �
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Owner Build��r �'
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Mailing Address Mailing Address �
�ctY �c��� � L S�.�_3 rb �
City, Sta , Zip City, State, Zip v1
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Daytime Phone Dayti�ne Phone s
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Additional Information: Zone District: � — �
v
Lot Dimensions: �°
(,L S
l/ � �
Date lot was created: p �cQ ��c�t /9.37 Acres: � 3� n
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Is there wetland near the proposed structure? If yes, how far � a
�
Building Land Use Floodplain: ( ) Yes ( )No ° s
(�'j New ( ) Filling � I�
O Addition O Dredging Driveway access off of a(Check one): �,
O Alteration O Grading O Pr•ivate Rd O Town Rd. o
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy �; �
( ) v�cve o%1 ( ) � �
0
� r
Primary Structure Accessory Building Addition � °
(� Dwelling (j�j Garage-attached/detached ( ) Deck �
(,t() Year round ( ) # of car stalls ( ) Porch �
( ) Seasonal ( ) Storage Building ( ) Enclosed �
( ) Frame built on site ( ) Screenhouse ( ) Living room �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen Cj
( ) Mobile/manufactured ( ) Other ( ) Bedroom o --
( ) Other primary structure ( ) ( ) Relocate/enlarge i "
� � ( � ( ) #�of new �
a�- �
Additional Information�V� DS J`�3 W� "�-�� � c` �> rt�� � ° �
-t�,�,, �•s`-Q,a'r''a C�ux'r`,�`eeP '�" a. �.Q"�a'`.''e�`'Z`'�'�.�.�?�'.�Qx":P� �
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Type of Construction:
(�Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete �
( ) Other
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Construction Cost: Primary Structure $!�, Oc�� � �
Accessory Bui ding: $ A��dition: $ ^ �
�33� 8Y �'
Certified Soil Test# � '3 -� `� � �G'L��� �
Deed: Vol Pg L ' � z
CSM: Vol Pg Lot# Sanitary Permit# B "3 — �� 3 ��3 0, �
Plat Envelope Or: �c�e 5 4 � i u�'��o. �2 f-(�c �� N
Condo Vol Pg Year Installed:� Y'e c o�h�� f ��m r� �
i � � �
Aff of ex septic Vol Pg O�vner When Installed: "
1
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Previous office approvals/actions: �
V arianc
e: # LUP: # SP: � CUP: # � r�� 3�G
Inspection Report: # Change of Zone District:
�'i�/--
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,
Describe the construction using these columns. Lis1: the dimcnsions of each structurc in a separate �
column. List each story, each addition, each alteration in a separate column.
#L �(�oi' I #2. �o � #3. Rvk C- #4. �
Size �, o fr. wide ft. wide ��ft. wide ft. wide
�ft. long ft. long .? � ft. long ft. long
.T:,
Fioor azea �L' ����' s ,-.,�� s fr. `>���C-- s ft. s ft.
� q. fr. q. q. q. ,
Hgt.from grade to peak ft. hgt. fr. hgt. ft. hgt.
Stories ' ?. stories stories stories
# of bedrooms_�
� 70o SF �of� �
Rear Lot Line
r (,�c7 `
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ay . so
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�p -� � - � (J�`v, �' -31 ,
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Fire Number and Name of Road [S 7 l,t� C Q v v � �c^i�'-�
1. Enter lot dimensions and indicate north by arrow. Signature�f Ovyrter o A orized Agent:
2. Indicate the location and size of the requested construction ) �
Sig Nre
activities.
PrintName: �{�(�IF � �� �Y\L; `=^.
3. Also, 1ncllCate the �ocatlon and d1StanCe to the Wel], The above certifes ihat the listed intormation and intentions are
We and correct.,ihat all work shall be performed in crompliance
septic tank and drainfield, wetland areas, lot lines and to the with ihe requirements of the Sawyer County Zoning OMinance
and the laws and reyulations oi ihe State of Wisconsin, and if
CCR2CTIlI1C Of t}1C I03C1. acting as ownef(s) aqent,has the permission of the ownehs)lo
peAortn the work requestetl on this application. The above
personsls hereby give permission for aceess to the property for
onsite inspection.
Permit fee: $ a- � 5 . O�'j
k�r ,n r-u ZO� �o(�— (�1������=i'/1/�"v
Issue Date Signature ofIssuing Agent
h^ �o r��r po 7 50% Rule: Average Road Setback:
Expiration Da e
Office Comments: �
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4 25 24 23
SOUTH LII� 165�
NW- E
3�� 3• 8 -3.9 3.10 -3. I I -3.12 -3.13 -3.14
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NOTE GAPS AND OVERLAPS E7GST MROUGMOUT MOSt OF SECTION 33. 7HERE �
ARE NUMFRWS CLOSURE FRRORS ANU DEE1D5 7HAT HAVE VAGUE PdNT OF �
BECINNINGS R/W CN15 ARE OF1FN NADE TO R/Y�5 iHAT HAVE BEEN
AL7Eqm NNICH AFFECT MOW ME PARCFl IS PUCFD. IT IS P059BI.E THAT 1
MANY OF THESE PROBLE115 DO NOT E)OSiIN THE FlELD, BUT RA7HFR IN 7HE M1�
OESCRIPtI0N5 iHEMSELVES. A 8E57-Fli MEM00 W/�S USED BUILDINC UPON Y
iHE MOSi RECENT CSM'S FOR MAPPINC PURPOSES MORE fiESEARCM AN�/OR '�'
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