008-937-30-1401-LUP-2004-379 Application for Land Use Permit I�lc�rl- o o c___
County of Sawyer � �
PO Box 676 -Ha ard WI 54 "','=�i"�� ``,, �
yw �t: ..,, „r �:ti_.i�i!�AENT:�
715/634-8288 R,
T he un dersigne d here by m a kes app li c a t i o n f o r a L a n d U s e P e r m i t a n d agr e e s t h a t a l l w o r k � �
shall be done in compliance with the requirements of the Sawyer County Zoning Ordinance �'
and the laws and regulations of the State of Wisconsin. ��
NO CONSTRUCTION MAY BEGIN UNTIL ALL PERMITS AAVE BEEN ISSUED. �, ,
PRINT-USE BLACK INK OR PENCIL ��.
ol ro
SO�'tti n� Kfl3 IL�SC1� C�2ar �K��� �� � � � �
Owner Builder G'' �
<�
7�(S'N.C.o.Ra. F �K 9 30�.�--o o:
Mailing Address Mailing Address � � �
�
g�.c�.,.��.,�1. ws S4��7 �/e,•,-,,, w z S 3 59 3 �
City,State,Zip City,State,Zip �
��� ��t 33�3 GUS -�'YJ-97uo N
Daytime Phone Daytime Phone
S
�
Additional Information: Zone District �-�� �
Lot Size
Date lot was created Acres L�b °1
r
Is the property in a Shoreland District?(within 1000'of a lake o pon�within 300'of a river, s
creek or stream) If yes,how far from the shoreline&water name: I� �s .tir n..+��
Is there wetland near the proposed structure?If yes,how far /oS c�r �
Building Land Use G
(�'New ( )Filling Floodplain:( )Yes ( )No # ;;
( )Addition ( )Dredging � G]
( )Alte.ation ( )Grading Chippewa Flo�vage: ( )Yes (/�No �
( )Moving On ( ) �' r"
( ) ( ) Driveway:( )State (�'County ( )Town Rd. � o
:'�
�, �
Primary Structure Accessory Building Addition
( )Dwelling ( )Gazage-attached/detached ( )Deck ��
( )Year round ( )#of car stalls ( )Porch " � �
( )Seasonal (�'Starage Building ( )Enclosed i � i'il
O Frame built on site O Screenhouse O Living room p�
( )Modular/manufactured ( )Greenhouse ( )Kitchen �
( )Mobile/manufactured ( )Other ( )Bedroom i _,� � ��
( )Other primary structure ( ) ( )Relocate/enlarge � � C
( ) ( ) ( )#of new o� ' A
�
�
Additional Information: "
m f1+
� O
�
Type of Construction �
( )Frame ( )Log (�'I'ole/metal ( )Block ( )Concrete �
( )Other �
Construction Cost:Primary Structure$ 3�88S°' `r
-�
Accessory Building:$ Addition:$ Z
� �
Vol 3 29 Pg (8`� of Deed Certified Soil Test# 9 I-/z y
CSMVoI Pg Lot# SanitaryPermit# 9/ '!3`/ "�
Plat Envelope Or: t,uf' 9 l '�8y �
Condo Vol Pg Year Installed
Aff of ex septic Vol Pg Owner When Installed:
Gard Gazebo Vol Pg
�0�
Previous Variance: LUP: Inspection Date: 1����
�oa-�I
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. #2. #3. #4.
Size�ft. wide ft. wide ft. wide ft. wide
�� ft. long ft. long ft. long ft. long
Floor area o3 7- sq. ft. sq. ft. sq. ft. s4• �•
Hgt.from grade�_to peak ft. hgt. ft. hgt. ft. hgt.
Stories stories stories stories
#of bedrooms
Lot Line or Lake/River name:
, � �o�
� � —
, > ,� �`
j � �
Y �j
� � 3�a,
v� '� ��"// C' �
� X \ �
� �U� °✓,.�`
oL� 1
1 ��o
Fire Number and Name of Road '7 y,s A1 Ce . �.� F
1. Fill in lot dimensions and indicate north by arrow. Signature of Owner or Authorized Agent:
2. Indicate location and size of existing and new structures. n n
� �1\
3. Indicate location of well, septic tank, drainfield.
4. Indicate distance to existing structures, lot lines, septic system.
5. Indicate distance to the ordinary high-water mazk of any lake, 1
pond, river, stream, creek, and name the body of water. P�nc Name:�J�n-� ��Kr'�'It�,�v�
The above cerfifes that the listed information and intentions are
6. Indicate any grading or clearing in excess of the construction site. we aod�oRea rne abo�e Perso�5i5 ne�eby 9i�e Pe�,�ss�o�ro�
aaess lo the property for onsite inspeclion.
7. Indicate distance to any wetland.
Permit Fee: �D G, O�
July 27 2004 -
Issue Date Signature of Agent
July 27, 2005
Expiration Date
Office Comments: �O'�`��� �'�'� �2 ��\��� �� U
Inspection Date: 50% Rule Applies: Avg. Setback: Within Reservation boundaries:
Restrictions and other information:
t
.2.� •
� 2.2 .2.3 .I.�
.I.3
.I .I
.8.3
1 .3.1 .4.1
�
.92 .14.1 .13.1 �.
V_ r
O 3
� :_
CREEK �
.15. .15. .16.1
H. 48
.15.4 � .15.3 �
SCALE: I INCH=400 FEET FOR ASSESSMENT USE OMLY NOT