024-641-14-4105-LUP-1999-617 . � � �. �.M �N .� � � N j�
Application for Land Use Permit r �
County of Sa`vyer ;� r `
PO Box 668 - Hay�vard WI 54843
715/63=�-8288 G
The undersi jned hereby makes application for a Land Use Permit and agrees that all work �
shall be done in compliance �vith the requirements of the Sawyer County Zoning Ordinance
and the laws and regulations of the State of Wisconsin.CONSTRUCTION NIAY NOT �
BFCI� UNTIL THE PERI`IIT IS ISSUED. �
PRINT - USE BLACK INK OR PENCIL �'
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�k�,«,� L ,e S �� �c,�� � � S o:
Owner Builder o ,�
,/� ��/ll �Y"�l/Z S G-/4/�'(//�l� /� G7 �-�i
Mailing Address � �lailing Address �
1� A �c�;�,�c� !,!�� �'
City, tate, Zip City, State, Zip S
��S- 5��'� - � �i7 5��5��
Daytime Phone Daytime Phone I�
Building Land Use �
i�'e��� Filling �-� �C
(�Q ( ) Zone District � �
( ) Addition ( ) Dredging �
( ) Alteration ( ) Grading Lot Size `i C�`G� �� � �-� „ �
( ) Mo��ing On ( ) °.
( ) ( ) Acres � � � '
� i
_ „
Primary Stnicture Accessory Buildin� Addition I� ��
O D���ellin� ( j Gara�e-attached/detached O Deck j9, ,-
( ) �"ear round ( ) � of car stalls ( ) Porch !,S j�
O Seasonal (j� Storage Buildin� O Enclosed ► i
O Frame built on site O Screenhouse O Livino roon� � !
( ) ��Iodular.�manufactured ( ) Greenhouse ( ) Kitchen !
�
( ) i�tobile/mailufactured ( ) Other ( ) Bedroom i^ ; �)
( ) Ot11er primary structure ( ) ( ) Relocate/enlarge � y
( ) ( ) ( ) # of ne��� � v,
o ���
T��pe of Construction � s
� Frame ( ) Lo� ( ) Pole/metal ( ) B(ock ( ) Concrete i � ��
( ) Other � ��
� = ��
Construction Cost S �� /'�d � r�
�
; �
Vol (��(� Pg I �3 of Deed CertiFied Soil Test � qci -��$ i— �
�
CS�1 �'ol Pg Sanitary Pernlit tt g�I - 3d �o i 'z
Plat En�elope Or: ��1 ,~
Condo �'ol Py �'ear Installed ; �
i ��
�Ff of ez septic �� P O��ner ��'ilen Installed: �
Application for Land Use Permit — Page 2
Describe Construction: List dimensions of each structure, story, addition, or alteration.
# 1 . #2 . �3 . #4. ,
Size G� ft. wide ft. �vide ft. wide ft. wide
�� ft. long ft. long ft. long ft. long
Floor area ,-� �5q. ft. sq. ft. sq. ft. sq. ft.
H�. 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: � � �aos � L � F �` '^
Location and size of all � �`.�
existing and proposed stnlctures. � � �
Location of septic system. � � ��
Indicate distance to : ` C' ` f� '�'�, L
�Vaterline/�Vetlands � `� /
Road �
Lot lines �
Septic system/privy -�'
�
`�'ell �� �}
Distance between structures. � v
�
Indicate �'orth. ` �
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ap ^^' l
�s .
Fire �umber: � �—_ � ` ° �" , �•
J � r
1 iv 7h � z S'1�o � � 5 � � � .
(� o � i f � � 2 �, � � � � � ,�' , AR /�� '" �� 111p �� t'`
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Signature of O�vner �
"Che abo� e certities that the li�ted --- —___ �-------- — . -.-
inturmation and intentions are true and �. � � `�
correct. The abo��e persoii's% hereby ' ' - � " — _ " - __ _ - / c �� �. S `/;�/�� G
L
<<ive permission for access to the
propern,� tor onsice inspeccion. ------- centerline of road-------
�a�,�,� /3, �e0
Issue Date May 23 , 2000 Expire Date ,
. .
Officc Com ���ents :
Si ;natur� ot Zonin �, Administrator