024-641-14-2305-LUP-2004-420 �
Application for Land Use Permit(*Non-shoreland*) o o � .
County of Sawyer � ,�, �
PO Box 676 -Haywazd 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 A �
LJCi�'P f SCr�C'� � �P«s i.1�9.�r 7C�i f C C k �cn5 fri�C'f�rn Zhc�. � \ �
Owner � � Builder �: 1�
�
P �• �(3ail `1R� �S1..7��i 2„d �.k. Scl,00l �'�1�� �
Mailing Address Mailing Address O
Cahle L1�1 .SyR�I a � r �, �
City,State,Zip City, tate,Zip
'715 ' 7�R �`�3�/4� 7LS- L�3�-1- o��Cr
Daytime Phone Daytime Phone
Additional Information: Zone District: ��'�
Lot Dimensions:
Date lot was created: Acres: rj. 5 G c����v o
Is there wetland neaz the proposed structure?If yes,how far � �
Building Land Use FloodpYain:� )Yes (� )No � Z
�
(y)'New ( )Filling �
O Addition O Dredging Driveway access off of a(Check one): a,
( )Alteration ( )Grading ( )Private Rd ( )Town Rd. o
O Moving On O (Jf County Hwy O State Hwy i,"', �
O O o S
r
Primary Structure Accessary B Addition �
(a�Dwelling �)Garag attache /detached ( )Deck W
(vYYear round O#o c a s O Porch �
O Seasonal O Storage Building O Enclosed �
O Frame built on site O Screenhouse O Living room
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen �
( )Mobile/manufactured ( )Other ( )Bedroom A
( )Other primazy structure ( ) ( )Relocate/enlarge
� � ( � ( )#of new �
s
Additional Information: A
Z �
�
�
Type of Construction: �
(�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete vj 1
( )Other ,�
b �
Construction Cost:Primary Structure$��"� I'�n(l.OL� �
Accessory Building:$ Addition:$ � �
�
�
Deed:Vol CgyU pg y3y CertifiedSoilTest# �3-33I tl4 z
CSM:Vol Pg Lot# Sanitary Permit# �)�- �� o, �
Plat Envelope �r� N .�
�
Condo Vol Pg Yeaz Installed: �
o �
Aff of ex septic Vol Pg Owner When Installed:
�
Previous office approvals/actions:
Vaziance:# LUP:# SP:# CUP:# �
Inspection Report:# Change of Zone District: ��r��{
l/1"�
��It�i3
Describe the construction using these columns.List the dimensions of each structure in a separate
column.List each story,each addition,earch alteration in a se arate colum�-?n. �y�
#1. �45FMPn� #2. /11G��n }�00: #3. � � 1,Y�1nU #4.
Size��ft.wide ;� ft.wide ��ft.wide ft.wide
� _ft.long �ft.long -3� ft.long fr.long
Floor area I 3��c sq.ft. Cr o sq.fr. �sq.ft. sq.ft.
Hgt.from grade � _to peak�_fr.hgt. fr.hgt. fr.hgt.
Stories�_ _�_stories stories stories
#of bedrooms 2
j�\ a 48� Rear Lot Line
°Z` E---�"3 0` �
� m
�
L e1`- ' j��.,,��,�id
� �3 1�' ---� �
'� J�_
N�uS� � r�K
� r I�"-
N�
��`�� / C�5�P �
.� P15k° �� C
G �'
s �v Q
I ` o,
�� v�
M �
�f-°�.
� �
v �
� �
Fire Number and Name of Road l I/a//V �r��•i'�� �����✓ S
1. Enter lot dimensions and indicate north by arrow. Si a"ture��f,�}�,er or Authorized Agent:
2. Indicate the location and size of the requested construction �iW�cr�I �mr�e ��
activities. /Ja�.e� T !v�uswGhq�Cr
PnnlName:
3. Also,IndlC3te tlle IOC&tlOn and d1StanCe to the wel�, The above ceNfies that the listed intormation and in tions are
We and coned.,that all work shall be pedormed in compliance
se tic tank and drainfield,wetland areas,lot lines and to the with ihe requiremenLs of the Sawyer Counry Zoning ONinance
P and Ne laws and regulations of the State of Wisconsin,and if
centerllne of the road. acting as ownel(s)agent,has tne pertnission ot the owner(s)to
perform the work requestetl on this application. The above
personsls hereby give permission for access to the property for
onsite inspecUon.
�f
Permit fee:$ ��
A�i,d,tr_ t1, �nn4 l'1�, o .� Y�,2u —"�c�� 7�--
Issue Date Signature of ui Agent 6
August 11, 2005 50%Rule: Average Road Setback:
Expiration Date
Office Comments:
1�OWN OF R OU N D L
! SEC. I4 TWP � �
� •
�� � 2
� s
� .
.6. 1 \ �' S.3 5.J. 5. b
O O
; � 5, 2
� �
� �
�� �
�
.5�.7
5.4
1 (�. 2 5. 5
1 �
�
l
7. 2 � � �
. r
, J
• 3 $.2 8• 1
7. 3 � � I O
�
1
�� 7. ► • �
� 1 O �
? 4 '�- `
.
o �.
� 1 ������y
- .� � � � . �' CHiP�PEW� RIVI
� )
� �-- -�
7. 5 �� Q�� ./' ���-�'1.L- -_-�_
r (� � � � / � ��/ ^
' � J � � r � `y � � _5 �� 4 � �
� � , / ,�� /./ . _ ._. . . _
�� �-- --� tp . I � : t���� 14. I
� . �4.2
� � V � �
�0.2 l
� / �_ `l � .
,� / 4
�
14.4
� s � � �
� � � � �1
10•3 � �
i � O
/ 9.lo q. 2 q . 5
� � O O O
�� � /
/�
� / � / �R . �
„ J / /
: '� f � j �p.5 ,,
' / I1
� � � ` ,
`5 14.12
i O � � �
.� ,0.4 f� ,��. � , q.3 � l�.�i
�
� �, � � ` —� I I .I
1
+a
�� �
: ��1 . 2 Il .j � . �
� � � / .15.2.
✓
F' � � �
� ` I� ,/ % r �
�� � 2. I
� � o
Y �
� � �
� l ��.. 4
� � o .
� � , ��