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010-941-23-3205-LUP-2004-614 Application for Land Use Permit (*Non-shoreland*) o o _ -�! County of Sawy�r � � 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 SC4r� C4Y�` � -- �c����� '1��•..r�� Nc��v n� G°�ns�'c�c�%voe,� � a. Owner � Builder c: ^ �-�S �'C�- �� 1_�l.�-��� �-c�i i���t�1 Cs� . �.d�- ��'.� � � Mailing Address J � M�ing Address t O , � �6 ����C �'� `��'4� � City, State, Zip w '�{ C y State, Zip � ��s._ c����0 3�.� y����.�� 7��- ���- 3`�z 7 G Daytime Phone Daytime Phone Additional Information: Zone District: l�.-1 � � Lot Dimensions: � Date lot was created: �G� Acres: ��� o � Is there wetland near the proposed structure? If yes, how far ye.� ..�6ib��" '� � � Building Land Use Floodptain:� j Yes (xj No �° ( )New ( ) Filling � �+Addition ( ) Dredging Driveway access off of a(Check one): � ( ) Alteration ( ) Grading ( ) Private Rd fj� Town Rd. o ( ) Moving On ( ) ( ) County Hwy ( ) State Hwy N � � ) � ) o � � r Primary Structure Accessory Building Addition � ° ( ) Dwelling (�Garage-attached/detached (}�l Deck ,`; ( ) 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 � ( ) Other primary structure ( ) ( ) Relocate/enlarge wp � ( ) ( ) ( ) # ofnew � , AdditionalInformation: � „ C�o �' ��}"��S /b��L� �.�s�.�s•+Q�� � � I �'i+1.�- � � Type of Construction: � (� Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete �jj ( ) Other ��L� b y Construction Cost: Primary Structure $ �,5`�l7 � � � Accessory Building: $ Addition: $ � � 1 Deed: Vol C�t?� Pg �S" Certified Soil Test# q$-y,�7 °Q z CSM: Vol !�j Pg �/ Lot# � Sanitary Permit# 99' O!o(o � 7� Plat Envelope � 5`' '�' Or: � N Condo Vol Pg Year Installed: o20(�i � Aff of ex septic Vol Pg Owner When Installed: � � � �•�-�� Previous office approvals/actions: . Variance: # LUP: # q9'3� SP: # CUP: # Inspection Report: # Change of Zone District: ���,�'a o y Q I 25"7'1 Describe the construction using these columns. List the dimensions of each structure in a separate wlumn. List each story, each addition, each alteration in a separat column. � #1.�_ #2. ue _ #3. �__ #4. Size � � ft. wide � � • fr. wide _�__ft. wide fr. wide ��ft. long `� � ! ft. long �:Z ft. long ft. long Floor area /3��f sq. ft. i3 H�F sq. ft. ��sq. ft. sq. ft. Hgt.from grade a.'� � to peak ft. hgt. /D � ft. hgt. ft. hgt. Stories�_ stories �_ stories stories # of bedrooms�_ Reaf Lot Line D r f.t, N 5a' ' � q ' 1_2_� 5�� � Q ��z„ � G��r� _ . � r�i` `�� � ouS� � � r � � � ;� � i5� o< � � � Fire Number and Name of Road �0 J V/ 1. Enter lot dimensions and indicate north by arrow. Si tu wn or hofized Agent: 2. Indicate the location and size of the requested construction ���r ,�_ Signature activities. � D � ` PnntName: '�n.F� . Y� - �Si1� 3. Also, IndlCate the loCatlon and d15t3riCe to the well, The above ceNfes that the listed information and intentions are � ;i � ,/ true and conect., that all work shall be peRormed in compliance septic tank and drainfield, wetland areas, lot lines and to the with ihe requirements of the Sawyer Counry Zoning Ordinance r and the laws and regulations of the State of Wisconsin, and if COritCillriE Of thC i08d. acting as owneY(s)agent,has the permission of the owner(s)to perform the work 2quested on this application. The above personsls hereby give permission for access to ihe property for onsite inspecfion. Permit fee: $ October 2A, 2004 - � Issue Date Signature of Is i g Agent October 28, 2005 50%Rule: Average Road Setback: Expiration Date Office Comments: �.a,Q �,..:�v�,nQ �j up-b��•2�S C�.Lp��2(� w� C�O�-(-p�� oL -� �''PP�'ov � t�as�e�i or� o��c..e� s.�.�� or�.L�.� ' �io(a7�o� � � , SAWYER COUNTY CERTIFIED SURVEY MAP # LOCATED IN hiE NW1/4 OF THE SWI/4 OF SECTION 23, T41N, R9W, TOWN OF HAYWARD, SAWYER C0. N1. �AN➢S /� N0053'30'Y ffiSBIJ' 1 Y 13l6��' . . — . . 64),IY . . 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