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024-741-19-5303-LUP-2004-489 . � ' � Application for Land Use Permit(*Non-shoreland*) o o. - County of Sawyer � PO Box 676 -Haywazd WI 54843s�� f ji=^�;;;;;; .�;::jp;;°�F'�,�(-� � 715/634-8288 f *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. � 1 PRINT-USE BLACK INK OR PENCIL n � � �IC.�iae,I `q- j�oGL,j' SN�� M�G�t��� Nl�����F� a � Owner / Builder '<' ��0?3 VA��eS� �i�r�/'v�h ���? �/erl�� Cc,rvi �a-p �' � Mailing Address Mailing Address � M�do� ���y�.� �n�.ssr�A /"1-e�ldofi�t �c��hts,�'l,v.ssl/� :; � City,State,Zip City,State,Zip � �12� �41r4-- �oa� l rJ_ 8��_ aoaf r Daytime Phone Daytime Phone a Additional Information: Zone District:!���� � Lot Dimensions 2rrT �i}q/ Date lot was created: (`��� Acres: - Sd ��-- � � Is there wetland near the proposed structure?If yes,how faz N U � � Building Land Use Floodptain:( j Yes (�No � ( )New ( )Filling �, O Addition O Dredging Driveway access off of a(Check one): � O Alteration O Grading O Private Rd Q�Town Rd. o O Moving On O O County Hwy O State Hwy i G� �j G� ( ) g � r Primary Structure Accessory Building Addition � ° ( )Dwelling (�Gazage-attached/detached ( )Deck w ��J O Year round (3)#of car stalls O Porch � ( )Seasonal ( )Storage Building ( )Enclosed � O Frame built on site O Screenhouse O Living room o ( )Modulaz/manufactured ( )Greenhouse ( )Kitchen � ( )Mobile/manufactured ( )Other ( )Bedroom -C � ( )Other primary structure � ) ( )#of new�enlazge � O � � � AdditionalInformation: ►� A � � ov � Type of Construction: �� � 4Cj Frame ( )Log ( )Pole/metal ( )Block ( )Concrete ( )Other .b .� Construction Cost:Primary Structure$� � � � � Accessory Building:$ 3o�oa Addition:$ � � r� azySo7 `° Deed:Vol Pg Certified Soil Test# 75-3!9 a' z CSM:VoI � Pg/���rcyLot# �- SanitaryPermit# 'J5-20lo b� � Plat Envelope �3�� Or: N `�l Condo Vol Pg Year Installed: � I� Aff of ex septic Vol Pg Owner When Installed: � Previous office approvals/actions: � Vaziance:# LUP:# Ol-�40 SP:# CUP:# Inspection Report:# Change of Zone District: �,�.� $���a,� ;�553� Describc 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. #L ��q.r�c o c- #2. #3. #4. Size�ft. wide ft. wide ft. wide ft. wide 'drC.� � r � 0 ft. long ft. long ft. long ft. long Floor area�'sq. ft. sq. ft. sq. ft. sq. fr. Hgt.from giade �S' to peak ft. hgt. ft. hgt. ft. hgt. Stories � sYories stories stories # of bedrooms U Rear Lot Line S�� K7t�iC-Lt!(� �Yawlh� Fire Number and Name of Road /0 9& 3 �/ l�E`�/l1 G L� %�[)/�-D 1. Enter lot dimensions and indicate north by arrow. Sign Y o,f10w a r�r� ed Agent: 2. Indicate the location and size of the requested construction � .l� _ Signature activities. Pnnt Name: 3. f�iSO, 1rid1C8Y0 t110 IOCaYIOri 211C�d1St1I1C8 t0 t110 W011, The above certifies that Ihe listed information and Intentions are irue and covect,that all work shall be performetl in compliance Sept1C t3T11C 3T1C�dTalnfteld, wetland 2leas, lot lines anC�to tl'le with the requiremenfs ot the Sawyer Counry Zoning Ordinance and the laws and regulations of the St21e of Wisconsin, and if Centelllne of�le Io2d. acting as owneV(s)ageN, has the permisslon o(the ownar(s)to pedortn the work reques�ed on this applicalion. The above personsls hereby give permission for aceess to the property for onsite inspection. Permit fee: $ lUv September 8, 2004 1�,������ ~ 6��?�� Issue Date Signature of Issuing Agent September 8, 2005 a 50/o Rule: Average Road Setback: _ Expiration Date Of�ce Comments ��� �`�� � 11.h . ��JLf�PNil��c�,�„ (��ji/ 1.,. f.��r..�,,r�.�' ��.� �i. ��� � - .,�`.�a-�- �. ..�,�-�.Q�-� � (�-�-El, -��;.�� �° / :2.1 °1.7 . y :1.8 1.2 �1.6 1.5 / ..- -� i � 2.2 2.5 � I.1 /� l :2.8 � �� \ :2.6 i � � � \. � t2.3 �� �� ��� `='= - -- �2.7 :1.9_ . . . . . ,�q�_'�_�'i.-� � � 3 � � :2.14 2 �2.15 � :1.12 �2.1 I 4 �2.17 ;2.12 ., 3 :2.1 � 2.9 � �I.I I . 2 V, :2.10 � 3�� �. •.3�2 ' � ..3�3 :3.1 ,3.5 `- 1 - 2 '' / v .g�� /� � � i 4 � �+ :3�5 � 5 " ✓. s•.3�6 3.4 / \�.3)? 3.1.8 i \ / 3 2 � 1 531 3 4 :3,9 3.7 3.1 I :3.12 ,, z � 3g ^ :5. 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