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006-439-06-3207-LUP-2004-297 � � i11�► � ._ �� r. � - . �- ' �� Application for Land Use 13"ermit�'`Nofi-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 , � �� 1l 'y sz _j 4 � 4%.�►,;',�d A 1' �, ~ i ; , � � ?;'� .`, � � � i • � Owner uilder _ _- �' _� �• �'����. ���0 �1 'I`1 J p.�� � � - �. Mailing Address � Mailing Address _ O � � • � `, , f � _ �' �_::,�"'i�'( � �'!t ►V .j '.:.j,_�;�w � � ',, � � ���� , '?i � �'v € � ,City, State, Zip City, tate, Zip ` i : _ . �S(�i jZi�1- b �,'�� or�Su7����'�? ' Daytime Phone ;� Daytime Phone � \. � f[►'AA�I..�-r� �%i � � � ,� � ...� •�h , ��`�� �\ Additional Information: ,• ' � Zone Distric ,�'� . � Lot Dimensions: - 1�d� �,�� � � Date lot was created: 't`��F� t Acres: � ,� , � o 0 Is there wetland near the proposed structure? If yes, how far��i' � S �-� �' Building Land Use Floodptain:� j I'es (�No � �. �New ( ) Filling � O Addition O Dredging Driveway access off of a(Check one): � � O Alteration O Grading O Private Rd (�'�Town Rd. o � ( ) Moving On ( ) ( ) County Hwy ( ) State Hwy N --` � � ) � ) o �. � 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 � ( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen _ ( ) Mobile/manufactured ( ) Other ( ) Bedroom `' .- O Other primary structure O O Relocate/enlarge A � � O O # ofnew � ' y � AdditionalInformation: p A 6� c„ � � c�� � Type of Construction: � ( ) Frame ( ) Log �Pole/metal ( ) Block ( ) Concrete - � ( ) Other ,� ,--i � I ,�. `U Construction Cost: Primary Structure $ �� �;; ���-�,'_.' � i� Accessory Building: $ - Addition: $ —" � �. . � � Deed: Vol ?5 3 Pg�_ Certified Soil Test# -- �Q z CSM: Vol Pg Lot# Sanitary Permit# ��/-/�o[� b, %� Plat Envelope Or� N 'v, Condo Vol Pg Year Installed: c� Aff of ex septic Vol Pg Owner When Installed: �-' � , , Previous office approvals/actions: Variance: # LUP: # SP: # CUP: # I� 1�u Inspection Report: # Change of Zone District: �� Cv�t� 3 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. �� a. �> #2. �Vc� #3. #4. Size �� ft. wide �ft. wide ft. wide ft. wide � (p� ft. long � ft. long ft. long ft. long � r� - i ,.f a. : , Floor area � �..'�'��� sq. ft. sq. ft. sq. ft. sq. ft. ` Hgt.from grade 2�� �,^ to peak ft. hgt. ft. hgt. ft. hgt. ' � Stories � stories stories stories �'• q # of bedrooms �_ h���`{-a-�o�'� C�e Y�e a- a� '��'� 'Rear Lot Line � � � � � P,� \ � ������ � ��,�. � � �. �__— Y('�0 `, a� ��� - � :;. � _ �-'�°� t->+ _ � ����, , \ _ , �y �: yo ,. � � ��� � �i �a � ,� 5 � ��;. � ,i �' � . / �� �\ � � , � 1 � ��`� � � �'� °J /__ :r� > .�. � .� �� �: � t �� t ` �� Fire Number and Name of Road � �� � `� �'� �l� Y'f-� � ,; ,� , • � `; ` �� l. Enter lot dimensions and indicate north by arrow. Signatur f w�er or horized Agent: 2. Indicate the location and size of the requested construction Signature activities. r• Print Nam : (� 1 S �1 Ytl' . P�l 3. Also, indicate the location and distance to the well, The above certifies that the listed information nd intentions are true and correct.,that ail work shall be performed 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 regulations of the State of Wisconsin, and if centerline of the road. a�t��s as ow�er�s�a9e�t,has the permission of the owner(s)to perform the work requested on this application. The above personsls hereby give permission for access to the property for onsite inspection. PeiI111�feP: � „C�� • � � June 2 4 2 0 0 4 G2/ ,��� ����s��� Issue Date Signature of Issuing Agent June 24, 2005 50% Rule: Average Road Setback: Expiration Date Office Comments: I �/ � ; ,' � � , . ; ; � = - - � 93� ' ;��;�. 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