024-741-32-2202-LUP-2004-296 .
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A lication for Land Use Permit *Non-shoreland*) r � .
PP � o 0
County of Sawyer � �
PO Bo� 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. � �
CONS'i'RUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED.
PRINT-USE BLACK INK OR PENCIL
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Owner Builder � �:
l��Z a� ��+ �o B /s�3� x ��
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Mailing Address Mailing Address �
� w�,�o, Gvl- s�dH3 �w� Lv,� �.s`��y �
City, State, ' City, State, Zip
� �-�a 63 a3�� �
Daytime Phone Daytime Phone c�
Additional Information: Zone District: ��� �
Lot Dimensions: ���� ���6
Date lot was created: ��/��wf Acres: �� n
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Is there wetland near the proposed structure? If yes, how far /l/'� �
Building Land Use Floadptain:� j �es (�)No ° �
�New ( ) Filling � �
Addition O Dredging Driveway access off of a(Check one): �` �
( ) Alteration ( ) Grading ( ) Private Rd � Town Rd.,�,�LS� o f�
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy ,B/Z�� N
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Primary Structure Accessory Building Addition � °
(�Dwelling (� Garage-attached/ tac O Deck W
( Year round (�.�#of car stalls ) Porch � �
Seasonal Storage Building �c) Enclosed'�1� �
(�} � )
( ) Frame built on site ( ) Screenhouse ( ) Living room �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen
( �OMobile/manufactured ( ) Other ( ) Bedroom � .-
ther primary structure ( ) ( ) Relocate/enlarge ' �
� � ( � ( ) # ofnew L
AdditionalInformation: � �
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Type of Construction: I �
(�,► Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete � �
( ) Other � �
Construction Cost: Prin:ary Structure $ �Q �O� � �
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Accessory Building: $ �r��� Addition: $ _ � ���
,-.
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Deed: Vol�7`I Pg �6� Certified Soil Test# U�/� /yd � z
CSM: Vol Pg Lot# Sanitary Permit# ��—/�0 0 0, �
Plat Envelope Or: N �
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Condo Vol _Pg Year Installed: � �
�
Aff of ex septic Vol Pg Owner When Installed: "
�
Previous office approvals/actions: �. .
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Variance: # LUP: # SP: # CUP: #
Inspection Report: # Change of Zone District: ��
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Describe the construction using these columns. List the dimensions of each structure in a separate
column. List each story, each addi�ion, each alteration in a separate column.
#1 . �i � ,E #2. C,79�'l�-�� #3. #4.
Size �`- ft. wide 3c' ft. wide '� ft. wide . ft. wide
`��� � ' ��6 ��ft. long `�C ft. long `s:�` ft. long ft. long
Floor area � sq. ft. �L� � sq. ft. ` �� sq. ft. sq. ft.
Hgt. from grade 1_5 ' to peak is ' ft. hgt. P�� ft. hgt. ft. hgt.
Stories _�_ � stories stories stories
# of bedrooms _�
Rear Lot Line
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ire Numbe d Name of Road ���/� �Q
1 . Enter lot dimensions and indicate north by arrow. Signat�re of 0�e�r r A�i rized Agen :
2. Indicate the location and size of the requested construction `� .-�y ,. � �t;�%�!-��i�'�
� Signature
activities. �H
Print Name: ��t � �� � %�-'� t�� •�
3. Also, indicate the location and distance to the well, The above certifies that the listed information and intentions are
true and correct., that all work shall be performed in compliance
septic tank and drainfield, wetland areas, lot lines and to the with the requirements of the Sawyer County Zoning Ordinance
and the laws and regulations of the State of Wisconsin, and if
centerline of the road. a�t��s as ow�er�s> a9e�t, 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 prope�Ry for
onsite inspection.
Permit fee: $
June 23 , 2004
Issue Date Sig ature of Issuing Agent
June 23 , 2005 50% Rule: Average Road Setback: _
Expiration Date
Office Comments:
IT IS THE PROPERTY OWNER'S RESPONSIBILITY TO SUBMIT THIS FORM TO
THE T'OWN BOARD FOR THEIR ACTION AND TO RETURN THE COMPLETED
FORM TO THE ZONING DEPARTMENT
Town of Q ���
County of Sawyer
�/2]��
Date
SUBJECT: Town Board Consideration of a Special Use Application for the Construction of a Year-
round or Seasonal Dwelling in the Forestry One(F-1)Zone District
TO: Sawyer County Zoning Administration
P. O. Box 676
Hayward,Wisconsin 54843-0676
Owner: .J�"G/T 9� Y�ON/l��- ����
Address: ���/yZ � ) c�, � � �Y/1A�i1�w, �il� S'�j'y
Approval is desired for the construction of the dwelling(s)indicated on the property owner's
Application for a Special Use Permit. (This application is to be presented to the Town Board for
review.)
By Action of the Town Board,use is: ( �pproved O Denied O Tabled
Comments:
ha� ��--��--�
�;` .r:�n� �,,�
Supervisor g� ��', , ,
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Super',��e�-�-�---�v-=�.\� J U N 1 F_. 200�9
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�'TFu�t�J';
TOWN OF ROUN
SEC. 32 TWP. 41 N . R .
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