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010-941-23-3210-LUP-2004-192 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 �, S, ' 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. r/AS P�� PRINT-USE BLACK INK OR PENCIL �` � � -: �;� W���� -- ��� t�,����s .�n > �f��� �� u�'� �D�C',���-,�� � � � � , �. �Owner � Builder �; � �, X� 4��' �5 5� � ;��.��. � l�r� o. / CJ S��__-��� � � � � �C Mailin Address �� � y�y� � Mailing Address •� � g � ��/W��- c�� �—�' � /�y3 �� ��.� � . City, State, Zip City, State, Zip � , � �„ �y- ssUz Da�yt mi e Phon�^ Daytime Phone S � '� _ � � Additional Information: Zone District: � � � Lot Dimensions: --� Date lot was created: Acres: � � ' � � � o Is there wetland near the proposed structure? If yes, how far � � � C Building Land Use Floadptain:-( j 1'es O No � � ,�New ( ) Filling � O Addition O Dredging Driveway access off of a(Check one): � � ( ) Alteration ( ) Grading ( ) Private Rd ( ) Town Rd. '� ( ) Moving On ( ) ( ) County Hwy ( ) State Hwy N �" � � ) � ) o � � r Primary Structure Accessory Building Addition � ° (�.Dwelling ( ) Garage-attached/detached ( ) Deck W (�Year round O # of car stalls O Porch � ( ) Seasonal ( ) Storage Building ( ) Enclosed � O Frame built on site O Screenhouse O Living room � ( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen a � ( ) Mobile/manufactured ( ) Other ( ) Bedroom -- ( ) Other primary structure ( ) ( ) Relocate/enlarge d � � � � � ( ) # of new !� �. AdditionalInformation: _ � � N � � W � � Type of Construction: u,, �, ( ) Frame �/:� Log ( ) Pole/metal ( ) Block ( ) Concrete \ �, ( ) Other ..d� � Construction Cost: Pri cture � � Accessory Building: $ y � �0� Addition: $ � r � � �;- <� � pg -i�- �:r. Certified Soil Test# �j �— O`�� �" z Deed: Vol , CSM: Vol � ;� Pg ,� �'7 Lot# �,,.. Sanitary Permit# U �--- (� �_ o� � Plat Envelope ����� Or: N �0 � Condo Vol Pg Year Installed: � � � Aff of ex septic Vol Pg Owner When Installed: " � Previous office approvals/actions: G Variance: # LUP: # SP: # CUP: # Inspection Report: # Change of Zone District: . I,3 Q� �I � �a581 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. ,_a�_, _ #3. �� ;. l� #4. Size Z ft. wide ft. wide �' fr. wide fr. wide 2 n ft. long ft. long � � ft. long ft. long Flo(ir�re�-� sq. ft. '- % sq. ft. I � sq. ft. sq. ft. Hgt.from giade � � to peak ft. hgt. fr. hgt. ft. hgt. Stories 2 stories stories stories # of bedrooms� tJ � � � � ' Rear Lot Line ipcJX I . ��t � �� �� O �' G G 5 � �� �Xiz �:,�/� � T i . Z 1 i _S� — N 1 /� Id l �5, � r � �� C J Fire Number and Name of Road �n���� ��7 �l`C 1. Enter lot dimensions and indicate nortq by arrow. $�re of Owngypr Au orized Agent: 2. Indicate the location and size of the re uested construction 0��� /</ f SignaNre / activities. Gr��S >zS H v`G� Pnnt Name: 3. Also, 1ndlCate the �oCation and diStanCe to the well, The above ceRifes that the listed information and intentions are true and coned.that all work shall be pedortned in compliance septic tank and drainfield, wetland areas, lot lines and to the w�m me �q��reme�� or me sawyer co�oh zo��o9 om��a�ce and the laws and regulalions of the State of Wisconsin, and if Centerline of the road. acting as owner(s)agent,has me permission ot the owner(s)to � perform the work requestetl on this application. The above S personsls hereby give pertnission for aceess to the property for �� � � �� onsiteinspection. Permit fee: $ - � � May 18 , 2004 - Issue Date Signature of Iss ng A nt May 18 , 2005 50% Rule: AverageRoadSetback: Expiration Date Office Comments: � � FZ LIMITED 5457 WARBLER CT LAVALLE WI 53911 $HEET � �F 2 SAWYER COUNTY CERTIFIED SURVEY MAP NO. LOCATED IN THE NW114-SW1I4,SECTION 23, T41N-R9W IN THE TOWN OF HAYWARD SAWYER COUNTY W13CONSIN, �✓o`53�3o'�t/ �ES8.i7 � ��'�Ys'r �� '_o-.�� o�� . / �p 999.60 30$.33' 23 79 ' E o��lm� � o �� �� a a7 � � o �O z -c� � o ��. ro � U � n ,i �� � � 30� N � ,� U � � (P ZN° - ' o . -� 2 ln � n /n m 3 c wA - � - � �,nz' � A �l y�m`� (71� ) mA�u, bq 2 N � Z ../ N � � `1 r N �� __ - - �� C�O yyN `WO W� N AZZ X: N v0 fXIS"T�N6 � ,n ,� � Z � r 7 m Gl � x p � {i� �- �q D °_ m O� 4�• � c m � fl In - -c. m o� . > - o � m — — — — 66 z � � m �A d � � Z __d .� � . �t� w � �.-{ r � P z pp 0 ;,S yl p� � � �a �� R � � a(�� �° O- � � � � G1 �Z � (� '� L -D E ��' • � � -�v�c a L �0 0 � 'O � � 0 d N @ ° �J���1'a!""'"'"*�',�yi 3. 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