032-538-09-3302-LUP-2008-060 � y
� Application far Land Use Permit(*Non-shoreland*) o 0
� County of Sawyer � O
J/ PO Box 676 -Haywazd WI 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 boundazies. y �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED.
PRIN1'-USE BLACK INK OR PENCIL
, � �
��� na�e n� � a
Owner �/y�3y�6 �'�',d/ �� Buil e�� �� <'
��. � � .�,�., � ��z, w .��.-� � �� �� (�
Mailing Address � Mailing Address �
) �P/Y1 � /� �� �
City, tate,Zip City,State,Z�i
�(�'��i'qLP �i�--a��o- �Nn.E'�7 Cv-cd .5 y$9�
Daytime P one S yZ$— Daytime Phone
Additional Informpatiofn: Zone District: �-� �
��Q�..M111!�M1�IT GrUI'tQ.Q/�GC � �
V
�`����N�f Lot Dimensions:
Date lot was created: Acres: (o. ,�13 n
Is there wetland neaz the proposed structure?If yes,how faz G �
Building Land Use Floodpkain:� j Y2s ( j No =R
x
(�New ( )Filling ; �"
O Addition O Dredging Driveway access off of a(Check one): �
( )Alteration ( )Grading ( )Private Rd ( )Town Rd. o
O Moving On O O County Hwy O State Hwy i."',
�
� ) � ) o �
t"
Primary Structure Accessory Building Addition � °
�Dwelling (�j Gazage-attached/detached ( )Deck w
( )Yeaz round ( )#of caz stalls ( )Porch �=
O Seasonal O Storage Building O Enclosed �
O Frame built on site O Screenhouse O Living room U,
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen �
( )Mobile/manufactured ( )Other ( )Bedroom g� �
( )Other primary structure ( ) ( )Relocate/enlazge '
� � ( � ( )#ofnew �
0
Additional Information: >
�
�
0
Type of Construction:
(�j Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �0
( )Other ,,d ..3
Construction Cost:Primary Structure$ /�i���9 D � �
Accessory Building:$ Addition:$ � (�
�, I°�o
Deed:Vo1�7 Pg� Certified Soil Test# 9Z'/y3 Ol'L/U2 °Q z
CSM:Vol Pg Lot# Sanitary Permit# qZ-/Q5 �1-3(�8 � �
PlatEnvelope Or: ''�' �yh"����� " �
N
Condo Vol Pg Yeaz Installed: �
� �
Aff of ex septic Vol Pg Owner When Installed:
�
�
Previous office approvals/actions: 0y_5� f�
Variance:# LUP:# 9 -z3y SP:# CUP:#
Inspection Report:# Change of Zone District: 9(D-03/ �1��,(D�'
1
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a��y
. �
� Describe the construction using these columns. List the dimensions of each structure in a separate
column. List each story, each addition, each alteration in a separate column.
#1. �t�� #2. �v - c-�(�' #3. #4.
Size 3 � ft. wide ZG, ft. wide ft. wide ft. wide
S I �u� �a.�
ft. long� ZL ft. long ft. long ft. long
Floor area �`� r/'�� sq. ft. (r 71F'sq. ft. sq. ft. sq. ft.
Hgt.from grade �� to pealc Z �� ft. hgt. ft. hgt. ft. hgt.
Stories � _� stories stories sYories
# of bedrooms Z
Rear Lot Line
E�YSf. ��
�,� � � ��� z � ° �
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!fe ehn /t�,n.d.
Fire Number and Name of Road
1. Enter lot dimensions and indicate north by arrow. Si re o Ownfe ��r th/onriz.e-d,,A ent:
2. Indicate the location and size of the requested construction 9�� /r�`F�t/.i Y/"""��
. �� SgnaWre
activities. '��L�p d P�'�'/�
Pnnt Name7
3. Also, 1nC�lCate tlle ]OCatlon and d1StanCe to i.11e well, The above ceNfes ihat the listed intormation and intentions are
true and correct,that all work shall 6e peAormed in compliance
Sept1C tank and dTalnfteld, wetland are3s, lot 11nes and to the with ihe requirements of the Sawyer County Zoning Ordinance
and the Wws and regutalions of the Sfate of Wisconsin, and if
Centerline of the road. acfing as ownet(s)agent, has the permission of the owner(s)to
perfortn the work requested on this application. The above
persons/s hereby give permission for aceess to Ne propeAy for
onsite inspection.
Petmit fee: $ Z UC�
���0
Issue Date Signature of Is ing A ent
n,�_���_ 50%Rule: Average Road Setback:
Expiration ate
Office Comments:
032-538-09 2203 �
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LOCATED NT lIEAN �IT
FOR NAPPING PlNiPO$ES.
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R MMPING RIRPOSES
032-538-09 3302
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032-538-09 33Q7 �ESw�AHLO`BOUNO�EO��TNETEAIt BY
L.99AC. � R[�• YNICH 1S MQ� IN TIE SY-SY. �
SECTION UNE DATA AND SEC110N SUBDIVISION PROVIDED BY
��� � 1--7� J����'� ���7 SAWYER COUNTY SURVEYORS DEPARTMENT, LANONET WDNR