026-105-00-1006-LUP-2004-312 Application for Land Use Permit(*Non-shoreland*) o o� /�
County of Sawyer - - . _ N � -
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PO Box 676 -Hayward WI 54843 � � �
715/634-8288 � z
*Property that is not located within 300'of a creek,river or stream or within 1000'of a P...
flowage,lake or pond or does not have any of the above waterbodies located within U �
the property's boundaries.
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. r� ' --
PRINT-USE BLACK INK OR PENCIL
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Owner Builder ��
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Mailing Address Mailing Address, �� O
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Cit,StaYe,Zip . City,State,Zip � ��,
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Daytime Phone Daytime Phone � �
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Additional Information: Zone District: � C--/
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{�.PPMx: (C
LotDimensions: IOD����o'� 12U"�/yo' '
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Date lot was created: ka Acres: �.�I 0� o �
Is there wetland neaz the proposed structure?If yes,how faz .t/.y� � �^r,
Building Land Use Floodptain:f j Yes (�)No =; b
( )New ( )Filling � ,(�
O Addition O Dredging Driveway access off of a(Check one): �
O Alteration O Grading O Private Rd (�"Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy N �
(�C)`L7ao F ( ) g S
�P�-�4cew�eur r� o
Pnmary Structure Accessory Building Addition �o
O Dwellin� O Garage-attached/detached O Deck W i�
( )Yeaz round ( )#of caz stalls ( )no:ch =
O Seasonal O Storage Building O Enclosed �
O Frame built on site O Screenhouse O Living room
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen N
( )Mobile/manufactured ( )Other ( )Bedroom �
( )Other primary structure ( ) ( )Relocate/enlazge �
O O O#ofnew �
AdditionalInformation: � >
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Type of Construction: � �
(�'Frame ( )Log ( )Pole/metal ( )Block ( )Concrete -
( )Other
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Construction Cost:Primary Structure$ _ '�1 ���� � �
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Accessory Building:$ h�/} Addition:$ i(!i9 x `'�
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Deed:Vol�,4Z __Pg 9Z Certified Soil Test# it/�t � z
CSM:Vol Pg Lot# Sanitary Permit# /v� � �
Plat Envelope Or: �, �
Condo Vol Pg Yeaz Installed: �
Aff of ex septic Vol Pg Owner When Installed:
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Previous office approvals/actions: �
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 eac story,each addition,each alteration in a separate column.
# #2. 'feo�' # #4.
Siz .wide �'�fr.wide ft. ide ft ide
ft.long ���`ft.long .long .long
Floor ar sq.ft. tSL'0 sq.ft. q.ft� sq�fr•
Hgt.fro e to peak _� ? � ft.hgt. fr. gt. .hgt.
Stori �_stories stones s ries
#o edrooms
Rear Lot Line
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GO hrcr�f: � .�.,,��;.__�_�_..�.�_M�____.._.
Fire Number and Name of Road�(��!sJ�! //r cTa�cs ��cali�l l i�t cL�
-1. Enter lot dimensions and indicate north by arrow. Sig ure of-9wn r�Aut rized Agent:
�Z. Indicate the location and size of the requested construction �_�,'
Signa ure
activities. i
PrinWame:X��� � n ��-;t i.:.=K
�i3. Also,1ndiC3te t}le IoCatlOn and d15tanCe to the well, The above ceRifes that the listed information and intentiuns are
true antl corred.,that all work shall be peAormed in compliance
septic tank and drainfield,wetland areas,lot lines and to the with the requirement5 of the Sawyer County Zoning OrCinance
antl�he laws and regulations of the State of Wiscronsin,antl i(
CBriteT'11riC Of tI1C I'O&d. acting as owner(s)agent,has the pertnission of the owner(s)to
pedortn Ne work requested on ihis application. The a6ove
persons/s hereby give pemiission for access to the property for
onsite inspec6on.
Permit fee:$ /S�o0
.Tune 28, 2004 /�'�%' /�!/ / —
Issue Date Signature of Issuing Agent
June 28, 2005
50%Rule: f Average Road Setback: /VdJ
Expiration Date
Office Comments: C t'�FY►tV: � �/S(�DD; Sa�lo Ct'�/1tU:'��,�s�
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� SCALE: i INCH= 20o FEET FOR ASSESSMENT USE ONLY NO
(RE- DRAWN BY: ��o DATE : Q/�z/eo INTENDE� TO SHOW GONCLUSIV
COLON (:) INDIGATES GOVT. LOT EVIDENCE OF OWNERSHIP OR
80UNDARY LOCATIONS