016-637-09-3101-LUP-2004-657 Application for Land Use Permit(*Non-shoreland*) o o/�
County of Sawyer �,•. a X�`�S.°° = N '� �'
PO Box 6 7 6 -Hayv✓az d W I 5 4 8 4 3 �`��, �
715/634-8288
*Property that is not located within 300'of a cree k,river or s tream or wi t hin 1 0 0 0'o f a � �
flowage,lake or pond or does not have any of the above waterbodies located within p -
the property's boundazies. � �
CONSTRUC i ICN SFiALL NQT FrrIN LINTIL AI.L REQUIRED PERMITS HAVE BEEN ISSUED. 6
pRINT-USE BLACK INK OR PE�.CIL c
��`f`�QJJ W1LcSr• �C.J C Q �
�� T
�1�`o/�y J SC+� a
Owner Builder �.
���-4� I� ���1' -�'`�°l 1J �5s� �.
Mailin Address �
Mailing`�ddress g �
� r I�aM�e��-c��-S�a/� �'������a�cc;�e�e 14�� �a3�� �
City,State,Zip Ci State,Zip r
�,�l.l �-�j''-��—�J�v�Z ��`�'�57�-5"l l � i (�
Daytime Phone Daytime Phone �
A
Additional Information:�Wn p�S; Zone District: F'�( �-
L.Q.4nd Mar�hu TacKSo�+ '/3 i^a� � / �`
�vory and .Cfs4 7'rCf«Son i/$�nf. �
LotDimensions: 13a� n �3ao S
,�qr�y and �O.ane ✓arnt/! �/3 +��
Date lot was created:
Acres: y�•�� o �
�
Is there wetland near the proposed structure?If yes,how faz /�/C� �
Building Land Use Floodpkain:-( j Yes (�)No �
( )New ( i F-��iro
�
(�Addition O Dredging Driveway access off of a(Check one): �
O Alteration O Urading O Private Rd (�f Town Rd. o
O Moving On O O County Hwy O State Hwy i."'i G�
� ) � � � . o �
r
Primary Structure Accessory Building Addition � °
O Dwelling O Gazage-attached/detached O Deck w �
)Year round O#of car stalls �Porch � m
(�Seasonal O Storage Building O Enclosed g -;
I,ivin room Y
O Frame built on site O Screenhouse O S " �Z
O Modulaz/manufactured O Greenhouse O Kitchen 0 m
( )Mobile/manufactured ( )Other ( )Bedroom p
( )Other primary structure ( ) Relocate/enlarge �
� � � � �#of new W �
0
�
AddirionalInformation: '0 A
� �
w �,
o "
Type of Construction: �
Frame ( )Log ( )Pole/metal ( )Block ( )Concrete
( )Other b y
Construction Cost:Primary Stn.�cture$ ��C'0 � �
Accessory Building:$ Addition:$ � J
rn
Deed:Vol Y9� Pg z'7� Certified Soil Test# tlQ z
CSM:Vol Pg Lot# Sanitary Permit# O1-0)b� o, �
Plat Envelope Or: N �
Condo Vol Pg Year Installed: � �
�
Aff of ex septic Vol Pg Owner When Installed:
�D
Previous office approvals/actions: �y
Variance:# LUP:# o i-3 og SP:# O 1-308 CUP:#
Inspection Report:# Change of Zone District: �
g�lq��
�Go3o
Describe the construction using these columns.List the dimensions of each structure in a separnte �
column.List each story,each additioa,each alteration in a separate column.
#1. xis{ina ca1�n #2• 4�. #3. #4.
Siz�7 ft.wide 2� ft.wide ft.wide fr.wide
16 ft.long � ft.long fr.long fr.long -
Floor area a56 sq.ft. 54•ft• Sq'ft' Sq'��
Hgt from gade to pealc ft.hgt. ft.hgt. ft.hgt.
Stories
stories stories stories
#of bedrooms ^'�, �( 1
�'�: ,
Rear Lot Line �
i W
, .` ; �� ��
�
n (
\ I\ -_ -��—�
�, i
`' \`�-�-- _ / I� �;�, �ti
S J �
`� ,ac�C��� �'o� ,,�
f � � �r �
:: � — -� � .�_�.__ �
,, � � � --- --
�f �
(r] p'�"`�
Fire Number and Name of Road �g793 W 5""�'�� Rd
1. Enter lot dimensions and indicate north by anoyy�� :: :,:.��natC�re'of Owner r t orized Agent:
2. Indicate the location and size of the requested R�:�ucti,�'• i. �
�W : .•, sr � �/ �
activities. �_ '�'� .� ��xfi�'s"5o;✓
•, .Pflnt Name:
3. Also,indicate the location and distance to the well, - - � ' ' ' � � ��s a dVcrortectethataalltworktshall b Petn�mea i�tcomPrenee
septic tank and drainfield,wetland azeas,lot lines and to the w�lh Ne iequl2ments of Ne Saxyer Counry Zoning Ordinance
and the laws and regulatlons of Ne Shate of Wiscronsin,znd if
CCritCi11R0 Of YZ1C SOad. ading as ovmer(s)agent,has the permission of Ne ownens)to
pedortn the woAc requasted on this application. The above
persons/s heraby gNe parmission for access to the properry for
onsite InepacUon.
Permit fee:$ �s�,°o I �
November 15, 2004 "
Issue Date Signature of Issui A t
November 15, 2005 50%Rule: Average Road Setback:
Expiration Date
Office Comments:
1
���t� /��V�� ' ' �,
-�'.�,._ �
v�.«+p� � .
��
,
3 �
37 37��' �� �� �
(p,' 'o� a�
• � ,
• � � �',5.� ��� '
.
�
�
L_
-[
3"�, ;
a�' 6� ��;i
• � � �::�.
. �f�
� �7, 37� ,�
a� ' s cn t�
c
�, 1 �$,2
37��
�
' '0�
� 7. 2/
C:� t- G�
8 �' -
��.
� ^�
`/OrI
37,
���'��, a� �
t�,/4,1 � '�.
;�37,
(m' �'�
,
�
\ /p�;
37 37
o � ' ' 't�
, ,�, m
, ��• 1 , ��,�
�
�
�,j � � .. �:, � �b I 6
�'' ��� a J sc�,�� .
• / � / r �I� �. t�'��"�`•:-` f tx� � D ,� (�f� ~ S � / ��,/