018-837-09-2302-LUP-1999-102 ��r~�
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Application for Land Use Permit �Q-" -
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County of Sawyer v � ,
PO Box 668 - Haywazd `JVI 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 0 '�
and the laws and regulations of the State of Wisconsin. I � �
���� `��('-� '�"'��� PRINT—USE BLAC�j INK OR PENCIL �
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Sf�U e � Q c�i�� SO�( �(�V� locv� 1a�c l� f1��---- - _ a �
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Owner �-� � � � �•
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Mailing Address Mai ing Address ���,� 5 °
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City, State, Zip City, State, Zip s
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Daytime Phone Daytime Phone �'
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Building Land Use
(}�New O Filling Zone District f{- 1
( ) Addition ( ) Dredging -�-�,
( ) Alteration ( ) Grading Lot Size �°
( ) Moving On ( ) � c
( ) ( ) Acres /� _ �
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Primary Structure Accessory Building Addition � �
(� D�velling ( ) Garage-attached/detached ( ) Deck '� �
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O Year round O # of car stalls O Porch �' o
Seasonal Storage Buildin � �
� ) ( ) � ( ) Enclosed c,�
( ) Frame built on site ( ) Screenhouse ( ) Living room I I
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen � �
O Mobile/manufactured O Other O Bedroom �'� V�
O Other primary structure (� � ��i.� O Relocate/enlar�e N �
� � O O # ofnew � � ��
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Type of Construction � �
Q� Frame O Log O Pole/metal O Block O Concrete w a
( ) Other
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- Construction Cost $ �p , (�D O � �
Vol <o a 7 pg �S of Deed �
Certified Soil Test # 99'O(o O =
CSM Vol Pg Sanitary Permit # 99- Q$8 ,v
Plat Envelope Or: �z
Condo Vol Pg Year Installed /�j�'-/9 �i , ; , , ~
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Aff of ex septic V P Owner When Installed: I
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Application for Land Use Permit— Page 2 -
Describe Construction: List dimensions of each structwe, story, addition, or alteration. .
#L C(��; #2. �;n;�, #3. ��'-'^�� #4.
Size ��l fr. wide I 2 ft. wide � ft. wide ft. wide
3� fr. long � fr. long � fr. long ft. lon
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Floor area� sq. fr. �9 z sq. fr. �� sq. ft. sq. ft.
Hgt from grade /1 � to peak I Z- 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
existing and proposed structures. �
Location of septic system. � h '
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Indicate distance to: 7 S <�
Waterline �� � ��`�
Road
Lot lines 7 S � � �—�
Septic system � ��� �
Distance between structures.
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Indicate North. ' --
ISU --.. __ �I/ �,
Fire Number. i � I Ya%'
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Signat r of9wf►er �u r� i�o-�
The above certifies that the fisted �
information and intentions are true and
correct. The above person/s/hereby
�ive permission for access to the
properry for onsite inspection. ------- centerline Of ��^Cp ( ioad-------
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Issue Date April 14 1999 E�pire Date April 14, 2000
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Office Comments: — �
Signature o oning Administrator
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SEC. 9 TWP. 37 N . -
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