026-938-11-3301-LUP-1998-410 r
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Application for Land Use Permit r � � ���
County of Sawyer � �
PO Box 668 - Hayward WI 54843
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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. �
R�,Q,� (J, Pe,derso.'� PRINT—USE BLACK INK OR PENCIL
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O Builder �'
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M �ling Address Mailing Address �
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City, State, Zip City, State, Zip �
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Daytime Phone Daytime Phone
Building Land Use �
( )New ( ) Filling Zone District � - �
( ) Addition ( ) Dredging '
( ) Alteration ( ) Grading Lot Size
( ) Moving On ( ) � �-
( ) ( ) Acres ,�
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Primary Structure Accessory Building Addition �
( ) Dwelling ( ) Garage-attached/detached ( ) Deck �
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( ) Year round (�# of car stalls ( ) Porch , o
( ) Seasonal ( ) Storage Building ( ) Enclosed '"
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( ) Frame built on site ( ) Screenhouse ( ) Living room
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen
( ) Mobile/manufactured ( ) Other ( ) Bedroom � �
( ) Other primary structure ( ) ( ) Relocate/enlarge
( ) ( ) ( ) # of new � A
Type of Construction 1� �
( ) Frame ( ) Log �Pole/metal ( ) Block ( ) Concrete >
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( ) Other �
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Construction Cost $ � ��� �� °
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Vol �_�,J �► ,� Pg •��`f �
of Deed Certified Soil Test# �
CSM Vol Pg Sanitary Permit# �--- �. �
Plat Envelope Or: ��-'�' �5 ���� z
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Condo Vol Pg Year Installed �,��,. -�-�� � �j �e �� ,�
Aff of ex septic V P Owner When Installed:
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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
y fr. long ft. long ft. long fr. long
Floor area 1 yyo sq. ft. sq. ft. sq. fr. sq. ft.
Hgt from gade�to peak fr. hgt. ft. hgt. fr. hgt.
Stories � stories stories stories
# of bedrooms �
reaz lot line or waterline of lake/river
In the box sketch in: �
Location and size of all .�llL �
existing and proposed structures. 55 f��C
Location of septic system. '' p�� �//,r�/`
G�\S� �' iV. V
Indicate distance to: � /�.'�
Waterline ��"- '""�'��
Road — (�� �•Y
Lot lines �`�
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Septic system �j �—�
Distance between structures. ��R�� l
Indicate North. � t � ��� 1
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Fire Number: �
'1` 1 � � i�'J �
3�, �� 50�, .
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Sign�f Owner F �b��3�' ��r!
The above certifies that the listed �
information and intentions are true and �
correct. The above person/s/hereby �
give permission for access to the /
property for onsite inspection. ------- centeiline of l 4 ( f'!-y'=� road-------
IssueDate August 7 , 1998 ExpireDate August 7 , 1999
Office Comments: `�,��„�( [�_ii�?
Signature of Zoning Administrator
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SCALE: I INC =400 FEE"
DRAWN BY: RH D/
COLON (:) INDICATES GO�