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008-937-20-5217-LUP-2003-485 ` . Application for Land Use Permit o o County of Sawyer �, � � PO Box 676 -Haywazd WI 54843 715/634-8288 The undersigned hereby makes application for a Land Use Permit and agrees that all work A shall be done in compliance with the requirements of the Sawyer County Zoning Ordinance � and the laws and regulations of the State of Wisconsin. rO NO CONSTRUCTION MAY BEGIN UNTIL ALL PERMITS HAVE BEEN ISSUED. �, _ �ea� a.nd PRINT—USE BLACK INK OR PENCIL p ro �a�I :�, /�o z��'S S�i{- � S Owner J Builder °� <' Ioszs y9f`�,K.�v, o� � - Mailing Address Mailing Address I� O P� ,� ,�,,.� ss-�y� � mu�t' � � City, tate,Zip City,State,Zip R 763 -Ss9-Y�'31 � Daytime Phone Daytime Phone S AdnditionalInformation: ZoneDistrict R R�� y /C��Cr � l�ar�a�n�� �3� da� �� Ko,�n i s@ �,.�5� ,eom Lot Size ��/o/'X a�o'�ai3' � . � � � Date lot was created �`L J ' �� Acres S Is the property in a Shoreland District?(within 1000'of a lake or pond,within 300'of a river, ' creek or stream) If yes,how faz from the shoreline&water name: 1 dS' �ro.n d:�t��ta�� e Is there wetland near the proposed structure?If yes,how far � Building Land Use 'K (�New ( )Filling Floodplain:( )Yes ( )No # � ( )Addition ( )Dredging 'k o ( )Alteration ( )Grading Chippewa Flowage: ( )Yes ( )No IO � ( )Moving On ( ) Q o ( ) ( ) Driveway:( )State ( )County ( )Town Rd. � Primary Structure Accessory Building Addition , ( )Dwelling (�Garage-attached/ tach ( )Deck ( )Year round (2)#of car stalls ( )Porch � � )Seasoaal ( )Storage Building ( )Enclosed O Frame built on site O Screenhocse O Living room � ' ( )Modular/manufactured ( )Greenhouse ( )Kitchen � �A ( )Mobile/manufactured ( )Other ( )Bedroom v� O Other primary structure O O Relocate/enlazge r ( ) ( ) ( )#of new ,J > � rn Additional Information: " ro �m �, � � � Type of Construction x ('�Q Frame ' ( )Log ( )Pole/metal ( )Block ( )Concrete � � ( )Other W Construction Cost:Primary Structure��' v Accessory Building:$ `�� U o� Addition:$ z 7� Vol $NS Pg SS of Deed Certified Soil Test# /�a'3(e r1 CSM Vol��Pg�(�Lot#�_ Sanitary Permit# 4N ' c,�(� � Plat Envelope Or: � Condo Vol Pg Year Installed Aff of ex septic Vol Pg Owner When Installed: Gard Gazebo Vol Pg Previous Variance:Q 3—Oa—] LUP: Inspection Date: �1ao Describe the construction using these columns.List the dimensions of each structnre in a separate column.List each story,each addition,each alteration in a separate column. #1. #2. #3. #4. Size ��/ ft.wide ft.wide fr.wide ft.wide ��f ft.long ft.long ft.long ft.long Floor area S�� Sq•�• Sq•�� Sq��• sq.ft. Hgt.from grade I„2 to peak ft.hgt. ft.hgt. ft.hgt. Stories / stories stories stories #ofbedrooms o Lot Line or Lake/River name: 8� G b�e'�% �- $,'S Ci{'.e.f'e,a, L a k�- - - — - - ' � a �y,,,�,i` A32 ��y �—�'�✓ `��:r �� �:s;"5 � t�w Z� ��e^P e,-� � ti� .L�o♦ F-��3� �'s' D C� d�+s ��yw��r ��x;�+;�s ru.r.�el..ro.�y 'ha��. y��r.��:�u� i a�f x�-�t y�-��{ eK�/uR. S e a✓<-s' i �j//'��6 I loi.s_� ��53 e�.strn-��r Fire Number and Name of Road /z 3 S 6J��D��c+.� �p , 1.Fill in lot dimensions and indicate north by arrow. Signature of Owner or Authorized Agent: 2.Indicate location and size of existing and new structures. 3.Indicate location of well,septic tank,drainfield. ��/•� 4.Indicate distance to existing structures,lot lines,septic system. 5.Indicate distance to the ordinary high-water mark of any lake, pond,river,stream,creek,and name the body of water. P��t Name: �a ti( f K�"^'S The above certifes that the listetl information and intentions are 6.Indicate any grading or clearing in excess of the construction site. tNe a�a co��ecc rne abo�e Perso�s�s ne�eby 9��e Pe�m�55�o�ro� access to Ne pmperry foronsite inspection. ,�.I::al.^,."...0 uis!3.^.C�Y�:^�':`:8��2.^.3. Permit Fee: March 1, 2004 Issue Date Signature ofIssuing Agent August 12, 2004 Expiration Date Office Comments: Inspection Date: 50%Rule Applies: Avg.Setback: Within Reservation boundaries: Restrictions and other information: � . CeK4lF��9 SURV�1' MAP Park ok uiu�rwsu�k 60}2 tiw��on 1� �(3�rl K9 NI �ow�t o��d���a�k�v haWqcr� I�isu�thin �aa°ay { hy�,'Do.ia r7� � �'eun�lji4�o.�yeK(ip� V° �l/ ✓t �� �-� ��� ..� � � i,�. s 1�V e° N s# 6, 4�i —i�1-y._ "'-'N% D.49 4..! `�+ . � �'� n.W4 K{t 8. 6. 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