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004-838-13-4101-LUP-2004-072 . � Application for Land Use Permit (*Non-shoreland*) o o �--- County of Sawyer � � ' PO Box 676 - Hayward 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 boundaries. �� CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. '� PRINT-USE BLACK INK OR PENCIL � � �� i����}�; re ls�;�-F��f 1�����cfs � Owner Builder c: 5. s ° � ��� �O 1��VIS/C� f � Mailing Address Mailing Address � I���"� �l ���, G� ;n�r� �.��t.s���,� S� 9� � City, State, Zip City, S te, Zip � 7��. 5 � - _3�.� C��s�) z��-�yi � � Da ime Ph�e � � Daytime Phone � Yt . �Additional Information; Fof' �je.�!'1�/��+�,v�r� Zone District: A ' � � �j('�'_ ���.�`1(7���iEt'_� � Lot Dimensions: � Date lot was created: Acres: 'S�0 e-� 80 0 Is there wetland near the proposed structure? If yes, how far � � Building Land Use Floodptain:-� j IFes �No � (�New ( ) Filling � O Addition O Dredging Driveway access off of a(Check one): � ( )Alteration ( ) Grading ( ) Private Rd � Town Rd. o ( ) Moving On ( ) ( ) County Hwy ( ) State Hwy �; � � ) � ) � � � r Primary Structure Accessory Building Addition � ° � Dwelling ( ) Garage-attached/detached � Deck W ( ) Year round ( ) # of car stalls ( ) Porch � ( ) Seasonal ( ) Storage Building ( ) Enclosed � ( ) Frame built on site ( ) Screenhouse ( ) Living room � f�Modular/manufactured ( ) Greenhouse ( ) Kitchen po ( ) Mobile/manufactured ( ) Other ( ) Bedroom ,t � ( ) Other primary structure ( ) ( ) Relocate/enlarge � � # of new ( ) ( ) �q ��,��c�te�� � �� Ad itional Inform tion: � � ' � ��. /-�����':��s �'�sc:���p/� � � "� l3 c�.s�mer�� �on��� c< w � � I`1v���e h�m�J �v��, o/� �► b�' r��o���r'-� ► � Type of Construction: C I � Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete O �. ( ) Other I�� . .ti � �, Construction Cost: Primary Structure $ � �� �-� 7 �?Q � Accessory Building: $ Additix�n: $ Q '(,� ��� � � (�,� ��t � Deed: Vol � �� Pg "2��7 Certified Soil Test# O� -a 3 / °4 z CSM: Vol Pg Lot# Sanitary Permit# Q 3 - 3 a8 � � Plat Envelope pr; N Condo Vol Pg Year Installed: � Aff of ex septic Vol Pg Owner When Installed: � � Previous office approvals/actions: ` C` Variance: # LUP: # �� '--S�� Sp; # CUP: # � Inspection Report: # Change of Zone District: �`�C � c r� � � N L� b� �i�I t�`1 \ \. Describe the construction using these columns. List the dimensions of each structure in a separate , � colu n. List each tory, each add' 'on each alteration in a sepa a���column. #1. � J' , 6�C i� #2. '� #3. #4. Size 2`� ft. wide 2f�_fr. wide Z D _ft. wide ft. wide 50 fr. long ��fr. long Z� ft. long ft. long Floor area � �/�� sq. f[. �sq• fr. yl�� sq• ft. sq' ft' Hgt.from gade L�5�n�to peak ft. hgt. ft. hgt. ft. hgt. Stories�_ stories stories stories # of bedroo�ns 3 Rear Lot Line I� /Ylr�E-' e �;el 15� �rom �, 5 P o l�ovse �n S��-Fh ���Pe ` �v` �� � � ���'s�,✓� 3arn � yfl'x6Y' lon� � �Ucfn �P9ror1os` So���h - �sf��� ��nv�y io�� �� � � o� Nor� �^h 0 Pro�'��-i/� �";���? ' � �a.SfSiGCe C�r l..�r/! �� ' o�l� o�t0o � [Sic�r �-�' (Neu�) ��e ZD n20 � l��us�' �kro4- 1`��� o�o�r C�ir� o� � �' � � �m�d<«Q Q � ��< �o��c Se�u�h Sic�e o� �-on�re Z0� ,i � � N 5� � , �r� y0' �r�m �� �1�U��FIo��s�= z� w�,d� �� � it����� l�o �� (�J'IVLU'�Gy � 50'/ca� � � Fr�mmP�o�y �Gi,il� ��o��.Cr�(1 )c,n k � G.�n� �P r�c�'u1�1' _ �,lo'�en N rth p������` f�ve �---- Q �r��'�lin� �1t�C�uc�er'c�V I�oac� tr�f'�) i,�zl I —� Q ;3n LR���'� See R77/ge�ieD �'��c;c�c� Fire Number and Name of Road D 0 j � �. � 1. Enter lot dimensions and indicate north by arrow. Si at ofQ�ner or Authorized Agent: 2. Indicate the location and size of the requested construction �� Q(�J� SignaNre activities. -��� _, ��,r�'�' PnnWame: � � 3. Also, 1ndiCatC the IoCatlon and dlstance to the Well, The above certifes mat the listed intormation and intemions are We and correct., Nat all work shall be perfortned in compliance septic tank and drainfield, wetland areas, lot lines and to the with the requirements of the Sawyer Counry Zoning Ordinance and the laws and regulations of the State o(Wisconsin, and if C0I1t0I'�1R0 Of Y}1C fOfld. acting as ownet(s)agent has the pertnission of the owner(s)�o pedortn ihe work requested on this application. The above personsls hereby give permission for access to the properry for onsite inspection. � n Permit fee: $ L �i L o �( J April 17 2004 - Issue Date Signature ofIss in ent April 17, 2005 50% Rule: Average Road Setback: Expiration Date Office Comments: � � No� Y��a� �/z°s � � �ly ���e ;�i?�n�Gr� � °n ���"r�'o��'� ---- ____.___ _ _���.���._._ __ __ , 2/��_� � C_G ���/-'{� *E--- '--� .� Exsf���'n G_ �,,. ��' ��? l05' d � �:;r n � , �p �f� ! ' -- - o �x�:.t;� 15' From Socr1-h ��f Coinei- N 5 � 's)el( l60' kou5� � � . �-�o, � �pe�k ao'X7n� � ov�/' ; ���� PU 2d�x2o� ' Ffol�� T nk. f�e -�, �PP��75�� °� -�l� Soufh W��Cr�//,t�" � � ; I \ � � � ' �� 2.� �.� \ \ \ `� - \ \ ''l \ � \ \ \ \ \ \ � \ \ 4.1 � 3. 1 �� � 5 1 14.1 13.1 15. 1 16. 1 :ALE: I INC�= 4� FEET FOR ASSESSMENT USE ONLY NC tAW�N 8Y: (� DATE : INTENDED TO SHOW CONCLUSI� �LON (:) INDIGATES GOVT. LOT EVIDENCE OF OWNERSHIP OR BOUN�ARY LOCATIONS