HomeMy WebLinkAbout016-637-19-3301-LUP-2008-252 � '
Application for Land Use Permit (*Non-shoreland*)
County of Saw��er ° � '�
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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 bounda.ries. c
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. � '
PRINT-USE BLACK INK OR PENCIL
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Daytime Phone Dayti�ne Phone �
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Additional Information: Zone District: Aq �
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Lot Dimensions: �
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91 0 �
Date lot was created: Acres: � , �
Is there wetland near the proposed structure? If yes, how far /�/Q � �
Building Land Use Floodplain: ( ) Yes (�Q No � �
( )New ( ) Filling �
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O Addition O Dredging Driveway access off of a(Check onf,): �
(� Alteration ( ) Grading ( ) Pi�ivate Rd ( ) Town Rd. � � �
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( ) Moving On ( ) (Xj Cuunty Hwy ( ) State Hwy J �; �
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Primary Structure Accessory Building Addition (`� � o
( ) Dwelling ( ) Garage-attached/cietached ( ) Deck , �
( ) Year round ( ) # of car stalls ( ) Porch ,�' �
( ) Seasonal J� Storage Building ( ) Enclosed o CD
O Frame built on site O Screenhouse O Living room � % x�i
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen � � �
( ) Mobile/manufactured ( ) Other ( ) Bedroom �" � \
( ) Other primary structure ( ) ( ) Relocate/en�arge (,,, �'
( ) ( ) ( ) # of new t��-''•
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Additional Information: � ,,: , . ' _; ' , ; C � � - O � �
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Type of Construction: 0 1 �
( ) Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete o �
� Other �V�� �'�� �li =� � �� C�� Q1C� 0 K 'Vu �� °
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Construction Cost: Primary Structure $ � �
Accessory Building: $�,:��t Addition: $ � �.�.'
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Deed: Vol�Pg `i18� Certified Soil Test# Qz. -OZa �"
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CSM: Vol Pg Lot# Sanitary Permit# 6 z -a78 � 7�
Plat Envelope Or: �; �,
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Condo Vol Pg Year Installed: �
Aff of ex septic Vol Pg Owner When Installed: � �
Previous office approvals/actions:
Variance: # LUP: # Oz 3y9 SP: � CUP: #
Inspection Report: # Change of Zone llistrict: $�'I l�
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Describe the construction using these columns. Lis1:the dimensions of each structure in a separate � �
column. List each story, each addition, each alteration in a separate column.
#1. #2. #3. #4. "
Siz ��ft. wide ft. wide ft. wide ft. wide � �
�ft. long ft. long ft. long ft. long ..
Floor area -��C."" sq. ft. sq. ft. sq. ft. sq. ft. y
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Hgt.from grade ,�- 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 ��O�G,1 ��`��[�,�_
1. Enter lot dimensions and indicate north by arrow. t re of r or Author�ze Agent:
2. Indicate the location and size of the requested construction ��;����:_.J
Signature
activities. —�( �
Print Name: �a�u-�`�'�'1 l�G��2'=2�c'I
3. Also, indicate the location and distance to the well, The above ceRifies 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 reJulations of the State of Wisconsin, and if
centerline of the road. a�t��9 as oW�er�s�aGe�t, 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 propeRy for
onsite inspection.
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Permit fee: $�j(��
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Issue Da'te � Signature of Issu' g Ag n
1yG,f� fj''� Zpo9' S0% Rule: Average Roz�d Setback:
Expirati n Date
Office Comments:
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