HomeMy WebLinkAbout020-639-23-3205-LUP-2008-272 �
Application for Land Use Permit: (*Non_shoreland*) o o ,�,
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 above waterbodies located within
the property's boundaries.
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. � ,
PRWT—USE BLACK INK OR PENCIL ��
s�dy � �
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Owner Builder ��
�i�'!��,�'� �4l'...E,C���, \`t.�L v\ ��
Mailing Address Maili�lg Address O �
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City, State, Zip City, State, Zip U�
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Dayti e Phone Dayti�ne Phone
�is- � � �- �'lll - �
Add tional Information: Zone District: � �-
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���'(� � -� CcZ,� i c �'u , Lot Dimensions:
�.v� rn�� !!�c� et � � �
Date lot was create�: y Acres: .5 ��� n _
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Is there wetland near the proposed structure? If yes, how far � �
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Building Land Use Floodplain: ( ) Yes ( )No � ��
.;('�New ( ) Filling ,�
O Addition O Dredging Driveway access off of a(Check onf,): � �
( ) Alteration ( ) Grading ( ) Piivate Rd ( ) Town Rd. � o
O Moving On O O County Hwy O State H�vy � N �
O O � o �
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Primary Structure Accessory Building Addition N � o
( ) Dwelling (� Garage-attached/cietached ( ) Deck ' "'
( ) Year round ( ) # of car stalls ( ) Porch � '-'
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O Seasonal �,l Storage Building O Enclosed � �
( ) Frame built on site ( ) Screenhouse ( ) Living room � � �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen N � �
( ) Mobile/manufactured ( ) Other ( ) Bedroom W O .-
( ) Other primary structure ( ) ( ) Relocate/enl�;arge � �- A
( ) ( ) ( ) # of new `� U,
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AdditionalInformation: 1" '� �
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Type of Construction: ' %�
( ) Frame ( ) Log �S Pole/metal ( ) Block ( ) Concrete °� �I �
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( ) Other �
Construction Cost: Primary Structure $ � � �
Accessory Building: $ �,(�(� C)(� A��dition: $ � ;�;
;3 f`� 3(0��- � �.�
Deed: Vol Pg N3 0� Certified Soil Test# °Q z
CSM: Vol a ?� Pg ''� Lot# � Sanitary Permit# p� 02 8 ��also � -3zo�� � 7�
Plat Envelope ��� Or: �`A`r'�a S`.Is��e`'^ H,T. �,
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Condo Vol Pg Year Installed: �
Aff of ex septic Vol Pg Owner When Installed: � �
0
Previous office approvals/actions:
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Variance: # LUP: # SP: ,� CUP: #
Inspection Report: # Change of Zone District:
c�����'
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Describe the construction using these columns. Lis1: the dimerisions of each structure in a separate
column. List eac , each addition, each alteration in a separate column. �
#1 . �� CC' � �� �' , #2. #3. #4. � �
Size ,�, (G ft. wida� ft. wide ft. wide ft. wide �
_� ft. long ft. long ft. long ft. long
Floor area 7 d � sq. ft. sq. ft. sq. ft. sq. ft.
Hgt. from grade 1 3 to peak ft. hgt. ft. hgt. ft. hgt.
Stories �_ stories stories stories �
,
# of bedrooms �_ �
Rear Lot Line
/ 1► . .
c.� � � C.�,� '� C� l�- C� GI `� L�I ��1,'�.! � .
Ul� 4
Fire Number and Name of Road �53 �_S" fl.% � �, , � ;�
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1 . Enter lot dimensions and indicate north by arrow. $ig ture of C)wn�r or Authorized Agent:
2. Indicate the location and size of the requested construction ._��---,.�_ __,J�.:,ti,_.��.
Signature t
activities.
Print Name: C? � �9 i1 � C � (,lJ �f b� �
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 reciulations of the State of Wisconsin, and if
centerline of the road. a�t��9 as ow�er�s> a�,e�t, has the permission of the owner(s) to
perfortn the work requested on this application. The above
persons/s hereby give� permission for access to the property for
onsite inspection.
Permit fee: $ ( D O . C�C�
���a �s �- 27 , Zvvb _ z
Issue Date Signature of Is in A ent
a � vS� 2 7 . Zoo 9 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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