016-637-09-1101-LUP-1999-701 _ '�X
Application for Land Use Permit r �,.� -
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 UNTI�L THE PERMIT IS ISSUED. � �
� ,atn� - PRINT-USE BLACK INK OR PENCIL � �
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' Owner Builder � o �
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Mailing Address Mailing Address � ')
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City, State, Zip City, State, Zip �•
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Daytime Phone 9��3-�3a Daytime Phone
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Building Land Use
(�New ( ) Filling Zone District �� �
( ) Addition ( ) Dredging �
( ) Alteration ( ) Grading Lot Size o
( ) Moving On ( ) �
� ) O , �
Acres ��;'6 ``✓� �
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Primary Structure Accessory Building Addition °
( ) Dwelling ( ) Gara�e-attached/detached ( ) Deck � o
# of car stalls ( ) Porch � �`
( ) Year round ( ) ,
( ) Seasonal �Stora�e Building �( ) Enclosed �
,,� �-.
O Frame built on site O Screenhouse O Livin�room ,�
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen
( ) Mobile/manufactured ( ) Other ( ) Bedroom ��,
( ) Other primary structure ( ) ( ) Relocate/enlarge :�. A
� � O O # ofnew �
� �i
Type of Construction -�, A
( ) Frame ( ) Log �Pole/metal ( ) Block ( ) Concrete �
( ) Other �
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Construction Cost $ ���' '�
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Vol ��� Pg <'�5," of Deed Certified Soil Test# � �'
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CSM Vol Pg Sanitary Permit # `-""� ° z
Plat Envelope Or: �'
Condo Vol Pg Year Installed `�- �
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 (Cv ft. wide ft. wide ft. wide ft. wide
LZ ft. long ft. long ft. long ft. long
Floor area ��L sq. ft. sq. ft. sq. ft. sq. ft.
Hgt.from g�ade � to peak � ft. hgt. ft. hgt. ft. hgt.
Stories i� 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.
Location of septic system.
Indicate distance to: �
Waterline/Wetlands
Road
.�',.
Lot lines v
Septic system/privy `�`
Well \ ��
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Distance between structures. - '`�
� - - -_-- L LC ��
Indicate North. �� d
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Fire Number: �.
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Signature of Own
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. ------- centerline Of QL,,(7 % TOad-------
Issue Date November 30 1999 Expire Date november 30 , 2000
Office Comments:
L[%2%C���drir� �� •
Signature of Zoning Administrator
MEADOWBROOK :
WP. 37 N . R . 6 W. _.
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