HomeMy WebLinkAbout024-741-18-1101-LUP-2006-203 . �
Application for Land Use Permit: (*Non-shoreland*) r ,� y�,:
��' County of Saw�Jer � � �
�� /� 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 bounda.ries.
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL RE��UIRED PERMITS HAVE BEEN ISSUED.
�a�rq�.e a Q� PRINT-USE BLACK INK OR PENCIL �
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Owner Builder �'
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Mailing Address Maili�ig Address O
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City, State, Zip ity, tate, Zip �
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Daytime Phone Dayti�ne Phone
Additional Information: Zone District: � �(
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Lot lllimensions: �
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Date lot was created: Acres��•K� �, � n
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� �Is there wetland near the proposed structure? If yes, how far (�Opcb�C . �� �
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Building Land Use Floodplain: ( ) Yes �No :�
�New ( ) Filling �
O Addition O Dredging Driveway access off of a(Check onf,): �,,
O Alteration O Grading O Pr�ivate Rd �Q Town Rd. o
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy �, �
� ) � ) o �
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Primary Structure Accessory Building Addition � �
O Dwelling � Garage-attache cietach O Deck W
( ) Year round (;� # of car stalls ( ) Porch �
( ) Seasonal ( ) Storage Building ( ) Enclosed �
( ) Frame built on site ( ) Screenhouse ( ) Living room �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen �,
( ) Mobile/manufactured ( ) Other ( ) Bedroom
( ) Other primary structure ( ) ( ) Relocate/en�arge � A
� ) ( ) ( ) # of new � ?
� ��
AdditionalInformation: � A
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Type of Construction:
�Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete
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( ) Other ,� ,.�
Construction Cost: Primary Structure $ � �
c�
Accessory Building: $ 3,�,CC�d A�3dition: $ � �
,-.
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Deed: Vol Pg Certified Soil Test# 9(0 -,3�'] � z
CSM: Vol Pg Lot# Sanitary Permit# y!� • Zy8 o,
Plat Envelope �r� N
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Condo Vol Pg Year Installed: �;
Aff of ex septic Vol Pg Owner When Installed: `�' �
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Previous office approvals/actions: �
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Variance: # LUP: # 9b- `i� SP: � CUP: #
Inspection Report: # Change of Zone l3istrict: ��`
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Describe the construction using these columns.List 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 fr.wide ft.wide
�ft.long ft.long ft.long ft.long
Floor area__���sq.ft. sq.ft. sq.ft. sq.ft.
i
Hgt.from gade l� to peak ft.hgt. ft.hgt. fr.hgt.
Stories_�__ stories stories stories
#of bedrooms
Rear Lot Line
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Fire Number and Name of Road l.) �S � � G�i� �-Ee.��S
1. Enter lot dimensions and indicate north by anow. -
Si of0 Aut ori..-,r,>;gent:
2. Indicate the location and size of the requested construction —!�����
Signa
activities. i
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Print Na� ���F n� -��C K��
3. Also,1ndlCaYe tlle location 2Ald dlstance to the Well, The above certifles ihat the listed iniormation and intentions are
_ . tn:e 2rd ccrrect.,that 2!I wnrk shall be pedormetl in comoliance
septic tank and drainfield,wetland areas,lot lines and to the with the requirements of the Sawyer County Zoning Ordinance
antl the laws and regulations of the Sta�e of Wisconsin,and if
C0rit0lllri0 Of tlle 103d. acting as ownef(s)apent,has the permission of ihe owner(s)to
peAorm the work requested on �his application. The above
persons/s hereby give permission for aaess to the property for
��;�� onsiteinspection.
Permit fee:$ J�l�
c7c�na 2D. ZOio6 �-
Issue Date Signature of Issu g nt
7u r� Z U� zdo'7 50%Rule: Average Road Setback:
Expiration Date
Office Comments:
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