HomeMy WebLinkAbout016-637-20-3401-LUP-2008-121 Application for Land Use Permit: (*Non-shoreland*) r y �
County of Saw�,�er � � °`—�'�
PO Box 676 - Hayward �VI 54843 `�
715/634-8288 �
*Property that is not located within 300' of a creek, river or stream or within 1000' of a
flowage, lake or pond or does not have any of the �bove waterbodies located within � ��
the property's boundaries.
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL RE��UIRED PERMITS HAVE BEEN ISSUED. �, �
PRINT-USE BLACK INK OR PENCIL �
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Owner Build��x. �•
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9��0 �c.� .D R u it.�E �'[� � y `��3s o�o r��.� �� �-'�J���Il'��.
Mailing Address Maili�ig Address ` p �
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City, State, Zip City, S`�ate, Zip �`
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Daytime Phone Dayti�ne Phone
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Additional Information: Zone District: � -�
Lot Dimensions:
Date lot was created: Acres: A� y p o Z
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Is there wetland near the proposed structure? If yes, how far .� �
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Bu ing L.and TJse Flood�lain: ( 1 Yes (' No �
( New ( ) Filling �
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O Addition O Dredging Driveway access off o�a(Check one): U` CD
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( )Alteration (y�Grading ( ) Private Rd (�Town Rd. , o
O Moving On O O County Hwy O State Hwy s N �
( ) ( ) � o �
Primary Structure Accessory Building Addition w � o
( ) Dwelling ( ) Garage-attached/cietached ( ) Deck � W
( ) Year round (Jj# of car stalls ( ) Porch o� �
( ),Seasonal (� Storage Building ( ) Enclosed � �
(�Frame built on site ( ) Screenhouse ( ) Living room r, �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen �' � �[
( ) Mobile/manufactured ( ) Other ( ) Bedroom
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( ) Other primary structure ( ) ( ) Relocate/enflarge � "
( ) ( ) ( ) # ofnew .� � U
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AdditionalInformation: s �o�r ��,a.�-►� Q A
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T of Construction: �
r,u�- 8 " �
( y Frame ( ) Log ( t) Pole/metal ( ) Block ( ) Concrete .�
( ) Other c I I
�d �Construction Cost: Primary Structure $ � /����J t �
Accessory Building: $ Addition: $ � �
35 Z�7� �
TJ�ed: ��ol�_Pg� Certif ed Soil '?'�st# �" Z
CSM: Vol Pg Lot# Sanitary Permit# o, �
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Plat Envelope �r� N
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Condo Vol Pg Year Installed: c�
Aff of ex septic Vol Pg Owner When Installed: " �
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Previous office approvals/actions: �
Variance: # LUP: # SP: � CUP: #
Inspection Report: # Change of Zone l�istrict: b0
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Describe the construction using these columns. Lisi:the dimensions of each structure in a separate
column. List each story, each addition, each alteration in a separate column.
#1. #2. #3. #4.
Size _�� ft. wide ft. wide ft. wide ft. wide
�ft. long ft. long ft. long ft. long
Floor area js.3�, sq. ft. sq. ft. sq. ft. sq. ft.
Hgt from grade ��;2` to peak ft. hgt. ft. hgt. ft. hgt.
Stories stories stories stories
# of bedrooms
Rear Lot Line
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Fire Number and Name of Road ;�%7 y LCI �,�t�U��;r� ���
1. Enter lot dimensions and indicate north by arrow. Signature of C)wn r or Authorized Agent:
2. Indicate the location and size of the requested construction '' �"' -
� ignature
activities. ,�
PrintName:��9'/�/�,,�j���J,�- rl.j���5
3. Also, indicate the location and distance to the well, The above certifies that the listed information and intentions are
true and correct.,that all work shall be performed in compliance
septic tank and drainfield, wetland areas, lot lines and to the with the requirements of the Sawyer County Zoning Ordinance
and the laws and regulations of the State of Wisconsin, and if
�e:lt�:ll:.� Of tr,e TO�d. acting as owner'(s)a�ent, has the permission of the owner(s)to
perform the work requested on this application. The above
personsls hereby give�permission for access to the property for
onsite inspection.
Permit fee: $ ��CaU�
`��i�.� ��� 2 �� `�
Issue Da et Signature of Issu g g t
� �Q� 50%Rule: Average Road Setback:
Expiration Da e
Office Comments:
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