HomeMy WebLinkAbout024-741-32-3301-LUP-2006-206 Application for Land Use Permit: (*Non-shoreland*) o o �, .
County of Savv��er N � `
�(� 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.
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL RE��UIRED PERMITS HAVE BEEN ISSUED. r
_ PRINT-USE BLACK INK OR PENCIL � �
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Owner Build��r c'
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Ma'lin Address Maili�ig Address O
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State, Zi City, State, Zip �
City, p
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Daytime Phone Daytime Phone �
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Additional Information: �Lone District: � � �
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Lot Dimensions: r
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Date lot was created: Acres: 3.5. o d o
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 one): �
O Alteration O Grading O Private Rd O 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 (�Storage Building O Enclosed �
( ) Frame built on site ( ) Screenhouse ( ) Living room �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen � �j
( ) Mobile/manufactured ( ) Other ( ) Bedroom
( ) Other primary structure ( ) ( ) Relocate/en�arge ' �
� � ( ) ( ) # of new .�'c �
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AdditionalInformation: W p
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Type of Construction: w
(•�j'Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete v, �
( ) Other ,�
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Construction Cost: Primary Structure $ � �
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Accessory Building: $ti�'C`�` `'�C Addition: $ �
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i�eed: voi Q � � r Cer�ified Soil Test# � �Z
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CSM: Vol Pg Lot# Sanitary Permit# a, �
Plat Envelope_ Or� N
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Condo Vol Pg Year Installed: c� �
Aff of ex septic Vol Pg Owner When Installed: '-'
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Previous office approvals/actions: "�
Variance: # LUP: # SP: ;� CUP: #
Inspection Report: # Change of Zone]�istrict: ���lo�
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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��fr.wide ft.wide ft.wide fr.wide
��fr.long ft.long ft.long ft.long
Floor azea. " "��sq.ft. sq.fr. sq.ft. sq.ft.
Hgk from gade�'l.l to peak�ft.hgt. fr.hgt. ft.hgt.
Stories stories stories stories
#of bedrooms
Rear Lot Line
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Fire Number and Name of Road // 70 3 GJ �t.. �ecL�
1. Enter lot dimensions and indicate north by arrow. Si nature of Own/erI�or A�fthorized Agent:
2. Indicate the location and size of the requested construction j r '�C�,� /-tcc�C�k
SignaNre
activities. I I� h�
PnntName:���Y\F'F 1 �F-i Z
3. Also,1ndlCate tlle lOCatlon and dlstance to t}le well, ihe above cerEfes that the listed information and intentions are
true and cortect.,that all work shall be performed in compliance
septic tank and drainfield,wetland areas,lot lines and to the with the requiremenis of ihe Savryer County Zoning Ordinance
and ihe laws and regulations of ihe Shate of Wiswnsin,and if
Centerllne of the T'oaQ. acting as owner(s)aoent,has the permission of ihe owner(s)to
pedorm ihe work requested on this appliration. The above
personsls hereby give�permission for access to Ne property for
`,� ansite inspec6on.
Permit fee:$ "1 �7-
T�n�e 20, 2vofo
Issue Date Signature of sui Agent
�uri�2 ZOr 2tJ0'� 50%Rule: Average Road Setback:
Expiration Date
Offiee Comments:
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SCALE : I INCH =400 FEE
DRAWN BY : D
COLON (:) INDICATES GO