002-940-20-4301-LUP-2004-030 � �S���/� �'. ������-- �
Application for Land Use Permit �, ,�
County of Sawyer ° �
PO Box 668 - Hayward WI 54843 �
715/634-8288
The undersigned hereby makes application for a Land Use Permit and agrees that all work �
shall be done in compliance with the requirements of the Sawyer County Zoning Ordinance 1
and the laws and regulations of the State of Wisconsin.CONSTRUCTION MAY NOT a��
BEGIN UNTIL THE PERMIT IS ISSUED. �
PRINT-USE BLACK INK OR PENCIL � '�
�
� 1 a
� � ✓��fSv ,� '�� � ° `
�'a•���.;tr:'� _.�r�5' t✓�.,o�, d,�•=� �.
Owner Builder = p
Z1 �,t j � , �
� � . Y� �� 1�r:1 1��' �:_�� �,+F��1 t r f;. t't�.� `rC, i����� �
f .�
Mailing Address 4 Mailing Address
� ' ��► `` �- ����,.� � ' �� ��
� i� ,,� a�� .s�� �f� �
City, State, Zip City, ate, Zip �
���, - �;► '�-.3y 2 �'7 7�S ... � .�.�G �- �''�,�� �
M
Daytime Phone Daytime Phone
Building Land Use �
�New O Filling Zone District � � �
( ) Addition ( ) Dredging
O Alteration O Grading Lot Size � .,,,
( ) Moving On ( ) ° �_�'
( ) ( ) Acres �'� � �: -
. �
., � ,,,�
Primary Structure Accessory Building Addition �
(}�Dwelling r,(-� Garage-attache etache O Deck r� o
� (� Year round (,�'j# of car stalls ( ) Porch SL; '"
( ) Seasonal ( ) Storage Building ( ) Enclosed ,�
O Frame built on site O Screenhouse O Living room .C�
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen �` �
( ) Mobile/manufactured ( ) Other ( ) Bedroom � �
O Other primary structure O O Relocate/enlarge C A
( ) ( ) ( ) # of new � I(J�
� ��
Type of Construction � p
( )Frame (�Log ( ) Pole/metal ( ) Block ( ) Concrete � �
�
( ) Other - ��
�
.� �.� � G
r.; �
Construction Cost $ ���� �
�
Vol �11 Pg ��of Deed Certified Soil Test # �� - �/� '
� �
CSM Vol Pg Sanitary Permit# d'y�D�/ C/� z
�
Plat Envelope Or: ,�'
Condo Vol Pg Year Installed `'� >
Aff of ex septic V P Owner When Installed: � 1� �
,�\ �
3y3 8
Application for Land Use Permit — Page 2 ' �
Describe Construction: List dimensions of each structure, story, addition, or alteration. �
#l . #2. #3. �✓�cl Sl�,.'� #4.
Size G� ft. wide ��`` ft. wide �_ ft. wide ft. wide �
��_ ft. long � ` � ft. long _j�_ ft. long ft. long
Floor area !` 4 �'
� -� � sq. ft. s- �,> sq. ft. ��L sq. ft. sq, ft. `' ,
Hgt. from grad��=f� to peak % .S ft. hgt. ft. hgt. ft. hgt.
Stories � / stories stories stories
� �,- � ��- , t
# of bedrooms �
,_. .., , rear lot line or waterline of lake/river
lG/cc l z�� aZ��J�C
�
In the box sketch in:
f
Location and size of all � =
�
existing and proposed structures. �, ' � � �
7`! ' ���' 6d �
Location of septic system. zs' i
Z`' u"�^4�`- c".9 '
p�/„� /fvvs-t Z�' .
Indicate distance to: - � > . � �
Waterline/Wetlands �r+ � ' — -- - - -�
- - —
. � ��� � ��� , � �, - -- �oo ,�.� r„rt �.
Road ; �<rd` � � �,/ �
o �l� '� O�� _ G�` c'� _ �
Lot lines `��� �� '
J � / S /
1 _— "
Septic systemlprivy � % � '��
,� �,.,�-
Well �_ �
Distance between structures. � \ �
.� � o .�-. �, _
e � � --
Indicate North. ��� ��� � �, -� � :�, , � =
� .�� �
5
\� �l
Fire Number: �
���_� �'f�/� I W \ 'Jl .
/1GcJ _I
�,� �
! �f,. � �
i��/ � � _
�
i �,-
%:' �' . , � _ ,
�`' �pOG ��� �. _( `v
„ ,` ' Z4u
Signature of O�vner �— � 1��
G
� 'i-
The above certifies that the listed ' � � syr�;.
information and intentions are true and 1���� �
correct. The above person/s/ hereby ` ��d/ •��=. -
give permission for access to the � , `
property for onsite inspection. � �" ' �------- centerline of � '� S road-------
r
Issue Date February 23 , 2004 Expire Date February 23 , 2005
vr(
Office Comments: ��; C �(�
, � nature of Zoning Administrator
`�
2J I. I
•4.2
) 3.I 4. I 4.3
) 14.I 13. I
�I5.1 16.I
SGALE: IINCH=400 FEET FOR ASSESSMENT USE ONLY NOl
DRAWN BY: DATE: INTENDED TO SHOW CONCLUSIVE
COLON (:) INDIGATES GOVT. LOT EVIDENCE Of OWNERSHIP OR
BOUNDARY LOGATIONS