HomeMy WebLinkAbout010-941-32-3102-LUP-2006-010 , �
A lication for Land Use Permit *Non-shoreland �
pp � � o 0
County of Sawyer � �
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PO Box 676 - Hayward WI 54843
715/634-8288 � �
*Property that is not located within 300' of a creek, river or stream or within 1000' of a S
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 ISSUEA -�,
PRINT-USE BLACK INK OR PENCIL S%-
�Ov'S,t�n�� �uC:,�L. �U�Q ��r S' cv�rJ. �c,.Lz�Z �►� � �
Owner Builder Q-:
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Mailing Address Mailing Address � �
1���1�..:;i:s ar'c� LvT' ,�fd'�3 �-�c� � � W—� S��'��' � G
City, State, Zip City, tate, Zip a �
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t7�5'-�� :�y 7� '7r�-�.��1- s�7 z � �
Daytime Phone Daytime Phone � '� �
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Additional Information: Zone District �r �' � �
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Lot Dimensions: s � �
o _. �
Date lot was created Acres y� �
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Is there wetland near the proposed structure? If yes, how far �
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Building Land Use
�New ( ) Filling Floodplain: ( ) Yes (�i)No # o �,
O Addition O Dredging Driveway access off of a(Check one): .� ,�
( ) Alteration ( ) Grading ( ) Private Rd ( ) Town Rd. � '
O Moving On O Commercial O County Hwy (� State Hwy �
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� ) � ) �
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Primary Structure Accessory Building Addition �
( ) Dwelling ( ) Garage-attached/detached ( ) Deck
( ) Year round ( ) # of car stalls ( ) Porch
( ) Seasonal ( ) Storage Building ( )Enclosed
( ) Frame built on site ( ) Screenhouse ( ) Living room N,
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen �
( ) Mobile/manufactured ( ) Other ( ) Bedroom
( ) Other primary structure (� o ��i��� � «;��,�c� ( ) Relocate/enlarge "
O Single family or multi-unit O �,� ) # of new ry/.'�
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Additional Information: A.
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Type of Construction � V.i
( ) Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete � � (�
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A �
(� Other /�1���,.� ,�
Construction Cost: Primary Structure $ .�l.s�C�,g�:' �
4 �
Accessory Building: $ •� Addition: $ �� N� ..C.
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93--l�i
Deed Certified Soii Test# �i �5--Z?�`i z
��. -/y�z_ �
CSM Vol Zy�, Pg ,��=� Lot# Sanitary Permit# y �- «t,
Plat Envelope Or: .�
Condo Vol Pg Year Installed
Aff of ex septic Vol Pg Owner When Installed: �
Previous office approvals/actions:
Variance: LUP: SP: CUP: �(;�
Inspection Report: Change of Zone District: � 'y,
�1� 1!.
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Describe the construction using these columns.List the dimensions of each strncture in a separate
column.List each story,each addition,each alteration in a separate column.
#1. #2. #3. #4.
Size �,�f fr.wide ft.wide ft.wide ft.wide
�/0 ft.long ft.long fr.long fr.long
Floor azea ����� sq.ft. sq.ft. sq.ft. sq.ft.
Hgt from gade 1 S to peak ft.hgt. ft.hgt. ft.hgt.
Stories � stories stories stories
#of bedrooms
(�SC.-�>
Rear Lot Line
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Fire Number and Name of Road �°W����� ��e � ���57� �� J� (-�w�� �3
L Fill in lot dimensions and indicate north by arrow. Signatu e o Ow� r or Authorized Agent:
2.Indicate location and size of existing and new structures. '� a
Signature
3.Indicate location of well,septic tank,drainfield. s
PtlntName:�'���--�� �- ��-��„�^"
4.IndlCate d1Sf3I1Ce to eXlsting StLl1ChIYes,lot I1neS,Se]�t1C System. The above ceRifes that tha listed iniormation and Intentbns are
� We and corred.,lhat all work shall be pedormed in compliance
5.Indicate distance to the ordinary high-water mark of any lake, w�m me req��remer�n or�,e sawyer co��ry zoomy ord�naoce
and the laws and regulations of the State of Wisconsin,and it
ond,river,Stream,creek,and nanle the body of w£lter. acting as owner'(s)agent,has the permission oi the owner(s)ro
p pedortn the work requested on this appliration. The above
6.Indicate ve etative buffer zone. personsls nereny give permission tor aceess ro tne property ror
g onsite inspedion.
7.Indicate size and location of all impervious surfaces.
8.Indicate any grading or clearing in excess of the construction site. Permit Fee: ��7 5
9.indicate distance to any wetland.
��rrt fi ua1Lu .ZSt �DU.6 L�� � �
Issue Date �' Signah�re of Issuing Agent
7 .Z5 �'7
Expiration Da
rnrr ��
/y . . ���� 4_� � J` �.�
Office Comments (1l;l(` , ���r °*•_ �� �'` � � � '
Total%impervious surface: Mitigation required:
Restrictions and other infoIInation:
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New Addition � �
64' x 40' Office -� � I /
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Aprox 94'- I " to Septic Tank and Field �
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