HomeMy WebLinkAbout022-638-21-1102-LUP-2008-205 /: ` -
Application for Land Use Permit (*Non-shoreland*) o o x
County of Sawyer � �
PO Box 676 -Hayward�VI 54843 O
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 boundazies. '
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. N
PRINT-USE BLACK INK OR PENCIL O ,
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%iMef�,y r,.�C /c�tESif'A R�Sc� ��/°R�f � `' �
pwner� Builder a`
8s95w oJ� f/yu.• �o cvwNTY 1L�• SS �:
Mailing Address Mailing Address O O
• G, c✓i. S L �Lc LA�%E cs►". ;
Cit ,State,Zip City,State,Zip �
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Daytime Phone Daytime Phone �
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Additional Information: Zone District: ��/
Lot Dimensions: �
Date lot was created: ��� �� s Acres: S5 L o �
Is there wetland near the proposed structure?If yes,how far �
Building ' Land Use Floodplain:O Yes (f.)No :°
�)New I^� ae�( )Filling �
)Addition O Dredging Driveway aecess off of a(Check one): `D
�c
c
O Alteration O Grading O Private Rd (�l Town Rd. � o
( )Moving On ( ) ( )County Hwy ( )State Hwy � N �
� ) � ) �:' o �
N t-'
Primary Structure Accessory Building Addition w � °
O Dwelling �Garage-attached/detached O Deck p�W
O Year round (3)#of car stalls O Porch R �
Enclosed CD
O Seasonal O Storage Building O N �
O Frame built on site O Screenhouse O Living room ��-
( )Modular/manufactured ( )Greenhouse ( )Kitchen � 0 ^�
O Mobile/manufactured O Other O Bedroom o N
( )Other primazy structure ( ) ( )Relocate/en➢azge ' � '
� � ( ) ( )#of new � W �,�
a0
AdditionalInformation: g �, y
N � (/1
6 ' m
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Type of Construction: � 2�
( )Frame ( )Log �j Pole/metal ( )Block ( )Concrete �'
( )Other ,�
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Construction Cost:Primary Structure$ �
Accessory Building:$��r0�''O Addition:$ � �
�
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Deed:Vol 3$3Pg3 g Certified Soil Test# °Q z
CSM:Vol Pg Lot# Sanitary Permit# o� �
Plat Envelope �r� N �
Condo Vol Pg Year Installed: o
� �
Aff of ex septic Vol Pg Owner When Installed:
Previous office approvals/actions: N
Variance:# LUP:# SP: # CUP:# \\/\�
Inspection Report:# Change of Zone District: �
7
R/�Y
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.
#I . #2. GGtNQp +� #3. #4.
Size fr. wide 3�-ft wide fr. wide ft. wide
ft. long � ft. long ft. long ft. long
Floar area sq. fr. !D g0 sq. ft. sq. ft. sq. fr. .
Hgt. from gade to peak� ft. hgt. ft. hgt. ft. hgt. �
Stories ( stories stories stories
# of bedrooms � t
k
Rear Lot Line
��d Jrj,
Y � f.J� ft.
� -Lq � � � �_._— �
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� SE�t �
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Fire Number and Name oFRoad �b.�Si.J �(o� �'�'�b
l. Enter lot dimensions and indicate north by arrow. Si n�re of Owner or thori d Agent:
2. Indicate the location and size of the requested construction
SignaNre
activities.
Print Name:
3. Also, 1nalCate the �oCatlon and dista[1Ce to the well, The above cedifes that the listed intortnation and intentions are
true and wnect., that all work shall be peAormetl in compliance
septic tank and drainfield, wetland areas, lot lines and to the with Ne requiremenGs of the Sawyer County Zoning Ordinance
and the laws and reculations of the State of Wisconsin, and if
CeIltBLI1riC Of tI1C I'02d. acting as owner(s) agent, has the permission of the owner(s) to
peAortn Ihe work requested on this application. The above
personsls here6y give permission for aceess to �he property for
onsite inspeclion.
Permit fee: $ � 6 b _ D�
a..9.�. �4 �zU�� -
Issue Date ��� Signature ofIss in gent
a ,9.. \� . Z.00°I 50% Rule: Averlge Road Setback:
Expirat noi Da et —�c
Office Comments:
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