014-941-02-1302-LUP-2004-461 • Application for Land Use Permit(*Non-shoreland*) o o i�
County of Sawyer �, � �
PO Box 676 -Hayward WI 54843
715/634-8288 �---
*Properiy 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 boundazies. �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. �
PRINT-USE BLACK INK OR PENCIL �. �
�T.��ie� L. C�I-�c��s�n c���r�F t� �
oWner 9 � ��`
�.�������� �,����_���1� CLR�f'�� Buildec ��'1"1 �_ �
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ailing Address ( Mailing Address O �„�
(cUf Y�-t�rC� �c.�_T ,71�C/�/� �Cf�'Y1 �
�City tate Zi City,State,Zip �'
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Daytime Phone Daytime Phone �
Additional Information: Zone District:
I�R � �
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Lot Dimensions: ��I� �k'��l.� `ys�'
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(� (+�� l
Date lot was created: � (��C% Acres: ���j o �
Is there wetland near the proposed structure?If yes,how faz �Ci � �
Building Land Use Floodptain:� j Yes �No `;
( )New ( )Filling �
Dred m Drivewa access off of a Check one CD
( ) g� g Y � )� dc
Alteration O Grading O Private Rd (�Town Rd. o
O Moving On ,QQ C�/J E O County Hwy O State Hwy N �
�?�J Nuw:P.oc�s+W�o���J( ) � �
FlocrF���s���llow'� � o
Primary Structure Accessory Building Addition -,(� �. a �'�` N
�Dwelling (f.)Gazage-attache etached (�Deck �4_ )�
()C)Year round ('�)#of caz stalls�W"�•� yY:) �JQ Porch"- .-
O Seasonal O Storage Building O Enclosed �
QQ Frame built on site O Screenhouse O Living room �-- �
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen �% j
( )Mobile/manufactured ( )Other ( )Bedroom _
( )Other primary structure ( ) ( )Relocate/enlarge '� '
� � ( ) ( )#of new �
F�r.i.��j,v.� cts-� Moa.t�1 �`oc� ��-� a cnl Nza)�oc� TNcI � �
AdditionalInformation: `� (�� � > >
�r�lS5e5i �.�aP2tgz�dBX`�8'Fe be.O.eti'�o=���u��ef�..��� �i v�
�e�1�s�t�'�r�c���; �e,c�o�ie�xiz�w�A �oz 3[ t-d ��e pi �
Ty e of Construction: f��'�� �`� "-�`�t�` ���� �
�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �' �
�
( )Other ro ,�
Construction Cost:Primary Structure$ ;9���'�'CC� �o��� � �
t�.�ks f�ar�4.F�� `?
Accessory Building:$ '�C�r� (_��E� Addition:$ s s�ron� I�.k�� x ,
T— � ---
Deed:Vol 5rf 7 Pg� Certified Soil Test# �� - ���c . z
CSM:Vol Pg Lot# Sanitary Permit# � 7— ��I C' � %n
Plat Envelope Or: i;, �
Condo Vol Pg Year Installed�g�-1`��i� U
� �
Aff of ex septic Vol Pg Owner When Installed: "
I�vr�L. �._���c��zso� �
Previous office approvals/actions: �
Variance:# LUP:# 43' '158 SP:# CUP:#
Inspection Report:# Change of Zone District: ^
g'�Q/��'�/
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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. I+� �2 ; �J #2. �.dY2;�,_ #3. #4.
Size , � ft. wide ��_fr.�wide fr. wide fr. wide
!-, ,
p L ft. long g ft. long fr. long ft. long
Floor azea �CC sq. ft. / 3�� sq. ft. sq. ft. sq. ft.
Hgt.from grade 1� to pealc /� ft. hgt. fr. hgt. ft. hgt.
Stories�__ � stories stories stories
# of bedrooms�
Rear Lot Line
�GC � �
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Fire Number and Name of Road �C� � ( S,��c� 1� �����ti �—°'�'� ��
1. Enter lot dimensions and indicate north by arrow. Si� ure of 0� f �A tized Agent:
2. Indicate the location and size of the requested construction � � � '`��C�
g re
activities.
Print Name: �P� �n
3. Also, inCllCate tlle loCatlon and Q15Y3S1Ce to th0 we��, The above certifies that the listed informat n antl InteNlons are
We and correcL,that ali work shall be pedormed in crompliance
Sept1C t3llIC and dLalnf eld, wetl3Tld 2ieas, �ot 11nes and to tlle with ihe requiremenis oi the Sawyer County Zoning ordinance
and the laws and regutations of the State of Wisconsin, antl if
CCC1teLllriO Of�IC I'O&C�. ading as ownef(s)agent, has the permission of the owner(s)to
pedorm the work requested on this application. The above
personsls hereby give permission for access to the pmperty for
onsiteinspection.
1--� �L
Permit fee: $ (� �
September 1 , 2004 -
Issue Date Signature ofIs uin gent
September 1, 2005 50%Rule: AverageRoadSetback:
Expiration Date
Office Comments:
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