022-738-14-5211-LUP-2004-362 . �r' . .
- Application for Land Use Permit(*Non-shareland*) o 0
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
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
�
f/F7Rn�D E �vNNA C'��kk vc�N�� a �
Owner Builder �' �
��AjI /L/ �NDi CaTT � D S��-� �:
�
Mailing Address Mailing Address O
l�Avisso.✓ � �i� SyH� 1 � �
City,State,Zip City,State,Zip
1/.S� `�`1�• �/S�� �� �
Daytime Phone Daytime Phone
Additional Information: Zone District:
�-� �.
Lot Dimensions: �
�
c
Date lot was created: Acres: o n
Is there wetland near the proposed structure?If yes,how far G G
��
Building Land Use Floodptain:� j Yes O No ✓ =R
(�(j New ( )Filling � �
O Addition O Dredging Driveway access off of a(Check one): � Z
( )Alteration ( )Grading ( )Private Rd (J�Town Rd. o �
O Moving On O E�c I SIiNi 6-/'AUP O County Hwy O State Hwy i,"', �
� ) � ) o �
t�
Primary Structure Accessory Building ,�_�� Addition � °
O Dwelling ({�Garage-attached detached 7 (}Q Deck W �
O Yeaz round (2J#of caz stalls O Porch =
( )Seasonal ( )Storage Building ( )Enclosed �
O Frame built on site O Screenhouse O Living room �
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen Q '"
( )Mobile/manufactured ( )Other ( )Bedroom ti �
Relocate/enlar e N '~
( )Other primary structure ( ) � ) g � ��
� � ( ) ( )#of new �
W
AdditionalInformation: � P
� �
�
�
c,,,
Type of Construction: N� �
(yQFrame ( )Log ( )Pole/metal ( )Block ( )Concrete �
( )Other
b �
Construction Cost:Primary Structure$ $�q Gc;��,G'G (MoI�E �'� L6s S �
:? �Accessory Building:$ Addition:$ �
Deed:Vol 2.7 3 Pg 5 24 Certified Soil Test# OG- Z I/ 04
z
CSM:Vol Pg Lot# Sanitary Permit# G b - Z SQ o� �
Plat Envelope �r� N �
�
Condo Vol Pg Yeaz Installed: �
Aff of ex septic Vol Pg Owner When Installed:
� �
N
Previous office approvals/actions: �
Vaziance:# LUP:# (� -3`� SP:# CUP:#
Inspection Report:# Change of Zone District pC��U G�'
�i��
��N�ll
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. _ZFC.dL #3. #4.
Size ft. wide 1 ft. wide ft. wide ft. wide
3(rft. long �?,q_ ft. long ft. long , ft. long
Floor area sq. ft. _ & sq. ft. sq. ft. sq. ft.
Hgt. from grade
Stories
# of bedrooms
• r ,
------- centerline of EN Di eo 7T- RE) road-------
Fire Number and Name of Road 3
1. Enter lot dimensions and indicate north by arrow.
2. Indicate the location and size of the requested construction
activities.
3. Also, indicate the location and distance to the well,
septic tank and drainfield, wetland areas, lot lines and to the
centerline of the road.
re of Owner or Authorized Agent:
Signature
Print Name:
The above certifies that the listed information and intentions are
true and correct., that all work shall be performed in compliance
with the requirements of the Sawyer County Zoning Ordinance
and the laws and regulations of the State of Wisconsin, and if
acting as owner'(s) agent, has the permission of the owner(s) to
perform the work requested on this application. The above
personsls hereby give permission for access to the property for
onsite inspection.
Permit fee: $
�
2.1 I.I 1.2
.1.3 �
KING �
0
3.I � 4.
, CREEK
32 3.3 4.3 4.5
.4.I
.3.4
� 4.4
�.T
.14.
�I.I ,�f
� . 6
\
O
� .�5
Gr' ,\Z, �/
9.i .14.1 M1'`
�
�� � �1.4
a ��
�v �I.3
2.i :2.1
z.�a 8 :2.5 '2.10
i 2.a ,
2.13
� �2.8 c
\ /6r
/
��
i23 � 2.7 � J
:z.z 29 �
� �2. �
. � s.oz z � • :z.n
s.z� � i
� z.ie�
:2.6 ':a�9
:2.z1 :222 � �.J N .
�12. z.zo 3.1
:2.iz
°2.3 '
\LE: I INCH=400 FEET FOR ASSESSMENT USE ONLY NOT
�WN BY: DATE:7/26/84 INTENDED TO S'HOW GONCWSIVE
_ON (�) INDIGATES GOVT. LOT gOIUNDARY LOGAT ONS IP OR