012-740-02-1111-LUP-1999-700 ��j5�`' -
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Application for Land Use Permit r y �
County of Sawyer � �
PO Box 668 - Hayward WI 54843 �
715/634-8288
The undersigned hereby makes application for a Land Use Permit and agrees that all work
shall be done in compliance with the requirements of the Sawyer County Zoning Ordinance -
and the laws and regulations of the State of Wisconsin.CONSTRUCTION MAY NOT �• �
BEGIN UNTIL THE PERMIT IS ISSUED.
PRINT-USE BLACK INK OR PENCIL � �
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G 1��2<<-- T2��/� �c.�ZF �:
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Owner Builder � o
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Mailing Address Mailing Address
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City, Sta e, Zip City, State, Zip
(�� � � 3� �� -�7��) �Z- 3� �� �
Daytime Phone Daytime Phone
Building Land Use
( ) New ( ) Filling Zone District � F�- � _
( ) Addition ( ) Dredging
O Alteration O Grading Lot Size o
( ) Moving On ( ) ,�
( � ( ) Acres �, (D �;
.,
Primary Structure Accessory Building � �
Additi � (� °
�Dwelling ( ) Garage-attached/detached ( ) Deck o
Year round O # of car stalls O Porch � ��'
( ) Seasonal ( ) Storage Building �j Enclosed I
O Frame built on site O Screenhouse O Living room !
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen ' �
( ) Mobile/manufactured ( ) Other ( ) Bedroom � �
( ) Other primary structure ( ) ( ) Relocate/enlarge � A
� � ( ) ( ) # of new �, �
� �
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Type of Construction � A
�.Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete �
( ) Other �
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C011StT'L1Ct1011 COSt $ C1 (rj�(� �
Vol (�s9 Pg � 3� of Deed Certified Soil Test #�'`) --�3��
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CSM Vol Pg Sanitary Permit # �/ ^ Dy� , z
Plat Envelope pr: �v�" Qa -��'y � '�'
Condo Vol Pg Year Installed �� �
Aff of ex septic V P Owner When Installed: �
rila�l�
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� Application for Land Use Permit — Page 2 �
Describe Construction: List dimensions of each structure, story, addition, or alteration. -
# 1 . #2. #3 . #4.
Size� ft. wide ft. wide ft. wide ft. wide
� ft. long ft. long ft. long ft. long
Floor area 3� sq. ft. sq. ft. sq. ft. sq. ft.
Hgt. from grade �-� to peak ft. hgt. ft. hgt. ft. hgt.
Stories / stories stories stories
# of bedrooms -�-
rear lot line or waterline of lake/river
In the box sketch in: �
y� , . ZE
Location and size of all \ �
existing and proposed structures. ��, � � , \ /73 �
\C1< <5 �'��
Location of septic system. � �� �5 ��
��.
Indicate distance to: 5� �
Waterline/Wetlands
Road /�.ppi rioa —
Lot lines j � ti�'�
Septic system/privy �' �' �-N« o5�
Well � � � � . ';b . ��-- �---Y�
Distance between structures. � � ZL � /,,� �, 2��,^ e O��
Indicate North. �
qa. ` �� �6 �` i �
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Fire Number: ,�
� - 9
�G3v � %2EL�n� RD � �� � , _ _ _ . .
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Signatur of O�vner � �,/
oj.
The above cerrifies that the listed � Co� � Q,�.
information and intentions are true and � 2��
correct. The above person/s/ hereby
give permission for access to the
property for onsite inspection. ------- centerline of road-------
IssueDate November 30 , 1999 ExpireDate november 30 , 2000
Office Comments: � �
Signature of Zoning Administrator
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