002-940-24-5204-LUP-1997-273 �
Application for Land Use Permit y
County of Sawyer � � �_�
PO Box 668 -Haywazd WI 54843
715/634-8288 �
The undersigned hereby makes application for a Land Use Pemvt 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. �'
ti
����� PRINT—USE BLACI{.INK OR PENCIL
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Owner Builder y
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Mailing Address Mailing Address � �
l-I/4vr�� 1rJ ,C� �' � I���vtf�-�, `�/-'1- �S'S�� y�
City,State,Zip City,�S te,Zip
/- 7/S" - C3y- �3763 /- ��S- G3N -� �-�/ z �
Daytime Phone Daytime Phone �
Building Land Use , , ��
�New O Filling Zone District � ;� 1 i c��
( )Addition ( )Dredging ��
O Alteration O Grading Lot Size r�� X 5��-3 �
( )Moving On ( ) � o
� � (-) Acres /.D� b Z
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Primary Structure Accessory Building Addition � �
( )Dwelling ( )Gazage-attached/detached ( )Deck �
( )Year round ( )#of caz stalls ( )Porch N »
( )Seasonal �Storage Building ( )Enclosed ,
( )Frame built on site ( )Screenhouse ( )Living room
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen o
( )Mobile/manufactured ( )Other ( )Bedroom �
( )Other primary structure ( ) ( )Relocate/enlazge N
� � ( ) ( )#of new �c =
Type of Construction N
�YFrame ( )Log ( )Pole/metal ( )Block ( )Concrete 0 >
( )Other � ^
ro �
G�� n �
Construction Cost$�� C�C=c,^. �
Vol 5'Sq Pg 2 3 9 of Deed � Certified Soil Test# 8�' �J 3 y v {�
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CSM Vol � Pg 2 ( 7 l��r 2-� Sanitary Permit# Q;�j - �S� , "' Ip
Plat Envelope Or: N z
Condo Vol Pg Year Installed D 5— J�N c -/9 4� �
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Aff of ex septic V P Owner When Installed:
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Application for Land Use Permit — Page 2
Describe Construc6on: List dimensions of each structure, story, addition, or alteration. .
#1. #2. #3. #4.
Size�ft. wide ft. wide fr. wide ft. wide
3� ft. long ft. long ft. long ft. long
Floor azea l�sq. ft. sq. ft. sq. ft. __ sq. ft.
Hgt from g�ade�to peak _ft. hgt. ft. hgt. ft. hgt.
Stories / stories stories stories
# of bedrooms
r lot line or waterline of �/;Y J 1%t �`f lake/river
In the box sketch in: �-_ ,
Location and size of all ' /3G %
F / nl'J
existing and proposed structures. '�?�Nt \�
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Location of septic system. �,,� �� =
�. � �\
Indicate distance to: S�f1� � �-
Waterline � �OJSE �zyF-�. _.___ _-
Road � �z �
Lot lines , �
Septic system 7 �� 5 i �I�
Distance between structures. �/ � �
�` 26, — �' c"�
Indicate North. �� ,���d — �
3g ��5c � -�S —�� t
Fire Number: V ' ��j,�w � j �
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Sig�ature of�ueer-�j,`� , p� �
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`i q�ft' ��'('_ �=
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------- centerline of �s ; • , '.% road-�__e__
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Issue Date 14 July, 1997 Expire Date 14 July, 1998
Office Comments: -��t.�
TOWN OF BAS�
SEC. 24 TWP 4 0 N .
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