HomeMy WebLinkAbout024-741-12-2302-LUP-2006-116 Application for Land Use Permit: (*Non-shoreland*) o o -
County of Saw�Jer � � ,
�,�/�"` PO Box 676 - Hayward �%VI 54843 � �'
/ 'rt_ 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 bounda.ries. �
CONSTRL7CTION SHALL NOT BEGIN UNTIL ALL RE��UIRED PERMITS HAVE BEEN ISSUED. �
PRINT—USE BLACK INK OR PENCIL
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Mailing Address Maili�lg Address O
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City, S ate, Zip City, State, Zip
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Daytime Phone Dayti�ne Phone
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Additional Information: Zone District: —� r
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Lot Dimensions:
Date lot was created: Acres: J`. L o V�
Is there wetland near the proposed structure? If yes, how far � G`
Building Land Use Floodplain: O Yes O No � r
(�ew ( )Filling � �*�>
O Addition O Dredging Driveway access off of a(Check one): � �N`
( ) Alteration (�rading ( ) Private Rd ( ) Town Rd. o
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy N �
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Primary Structure Accessory Building Addition � °
( ) Dwelling ( ) Garage-attached/cietached ( ) Deck W
( ) Year round ( ) # of car stalls ( ) Porch �
O Seasonal ( �arage Building ( j Enclosed �
O Frame built on site O Screenhouse O Living room � �
( ) Modular/manufactured ( ) Greenhouse ( ) KitchetY -� �
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( ) Mobile!:::anufactured ( ) Other ( ) Bedroom �
( ) Other primary structure � j ( ) Relocate/en�arge .� "
( � ( ) ( ) # of new �� �
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Additional Information: � ``� �
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Type of Construction:
( ) Frame ( ) Log (r?'�ole/metal ( ) Block ( ) Concrete
( ) Other ,�
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Construction Cost: Primary Structure $ � �
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Accessory Building: $ •.:,�ti.• `��� A��dition: $ � �
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Deed: Vol '� `�'� ',; Pg C, �- Certified Soil Test# � z
CSM: Vol Pg Lot# Sanitary Permit# __ � �
Plat Envelope pr; N �
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Condo Vol Pg Year Installed: c�
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Aff of ex septic Vol Pg Owner When I��stalled: : ,� - `-'
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Previous office approvals/actions: 1''" � �
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Variance: # LUP: # SP: � ` CUP: #� • �=
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Inspection Report: # Change of Zone District: -� �j��
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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.
Size � ft. wide ft. wide ft. wide ft. wide
�j � �,�„�� ft. lang�, !, G2� ft. long ft. long ft. long
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Floor area" ' � �;� :' sq. ft. sq. ft. sq. ft.
Hgt. from grade �$�_�t 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 �� S 1� �€,°� c�v �'� �
1. Enter lot dimensions and indicate north by arrow. Si�qrfa re of C) qer o �4 horized Agent:
2. Indicate the location and size of the requested construction
i nature
activities. � �l � ,r�
Print Name: �� �!�f�L K G�—I�CK�'
3. Also, indicate the location and distance to the well, The above certifies that the li es d info�ion and intentions are
true an d correct., t hat a l l wor k s ha l l be pe rforme d in comp liance
septic tank and drainfield, wetland areas, lot lines and to the with the requirements of the Sawyer County Zoning Ordinance
and the laws and repulations of the State of Wisconsin, and if
centerline of the road. a�t��9 as ow�er�5� a�ie�t, has the permission of the owner(s) to
perform the work requested on ttiis application. The above
persons;s hereby give� permission for access to the property for
onsite inspection.
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Permit fee: $ � ��} "�"` C�{�t�' � � �>
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Issue Date Signature of Issui ent
� 50% Rule: l-�verage Ro�d Setback:
Expir tio D te
Office Comments: � � � � � ��G�� ��j��—
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