004-838-30-3201-LUP-2000-420 ,� M E N�M ��/ r .
Application for Land Use Permit r y �
County of Sawyer � �
PO Box 676 -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 NIAY NOT �,
BEGIN UNTIL THE PERMIT IS ISSUED.
PRINT-USE BLACK INK OR PENCIL � �
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a
�G�S �!. G4i'.;C:.LE � <
Owner Builder � o
3o�S� N. uoer►�ruD FL� � �
Mailing Address Mailing Address
LIRclitc��`�'D Wt�G� ;�{�I;' ��
City,State,Zip City,State,Zip �
;�- :_f;<:� c�
;.-. �
Daytime Phone Daytime Phone �
Building Land Use �—
�New O Fillin� Zone District R��' �
( )Addition ( )Dredging ctS
O Alteration O Grading Lot Size o
( )Moving On ( ) s
( ) ( ) Acres J� O % �
� �
Primary Structure Accessory Building Addition � �
O Dwelling O Garage-attached/detached O Deck c o
( )Year round ( )#of car stalls ( )Porch �. "
( )Seasonal �Storage Building ( )Enclosed �
( )Frame built on site ( )Screenhouse ( )Living room 'v�
( )Modular/manufactured ( )Greenhouse ( )Kitchen °C �
( )Mobile/manufactured ( )Other ( )Bedroom o �
( )Other primary structure ( ) ( )Relocate/enlarge �
� ) ( ) ( )#of new � �
0
Type of Construction � o
�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �
( )Other � �
� �
i� �
Construction Cost$_ � ,'��"�C?GC �4 �
Vol (D� Pg /�of Deed Certified Soil Test# B6 — �7� '�
CSMVoI Pg SanitaryPermit# n� 3�/ G �z
Plat Envelope Or: �'
Condo Vol Pg Year Installed ��'
Aff of ex septic V P Owner When Installed: � �
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Siu�
Application for Land Use Permit — Page 2
Describe Construction: List dimensions of each structure, story, addition, or alteration.
#1. #2. 5 ti c c� #3. #4.
Size ft. wide IZ- ft. wide ft. wide ft. wide
ft. long � ft. long ft. long ft. long
Floor area sq. ft. a�� sq. 8. sq. ft. sq. ft.
Hgt. from gade 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:
Location and size of all
existing and proposed structures.
,�._� � �4 .'�.-1741��.C� � �il":.� '
Location of septic system. r
,�,} � T�Tf Ub-S
Indicate distance ta � -( �X, ��.��'k" .
Waterline/Wetlands
Road
Lot lines
Septic system/privy
Well
Distance between structures.
Indicate North. � �. ��S" '' ��J�G�
Fire Number: `
S��
,� D � '-f /U�r'� k �h�° �.� lZ� 2`�
, �:
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Signature of Owner —�� �
C C 1`E{�Ei� ��
The above certifies that the listed �
informa[ion and intentions are hue and f"' c [ n�" � �
coaect. The above person/s/hereby �
give permission for access [o [he
properry for onsice inspeccion. ------- centerline of i0ad-------
Issue Date August 3 , 2001 Expire Date AUgust 3 , 2002
Office Comments: '
�� ure o onin� Administrator