HomeMy WebLinkAbout026-148-00-0800-LUP-2006-306 . �
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Application for Land Use Permit(*Shoreland*) o o .
County of Saw}�er � �� �
PO Box 676 -Hayward WI 54843
715/634-8288 �
*Property that is located within 300'of a creek,river or stream or within 1000'of a o ,�
flowage,lake or pond or has any of the above waterbodies located within � 1 �
the property's boundaries.
CONSTRUCTION SHALL NOT BEGiN UNTIL ALL REQUIRED PERMI'CS HAVE BEEN ISSUED.
PRINT-USE BLACK INK OR PENCIL
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Own r Builder p-
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Iv�ailing Address Mailipg Address � �
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City,State,Zip City tate,Zip
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Daytime Phone Daytime h�one �i
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Additional Information: Zone District: �12_�_ � �
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Lot Dimensions: -S h �� ,�S n
Date lot was created: Acres: .!9y . �56 k./7 I
Is there wetland near the proposed structure?If yes,ho�v far o �
Building Land Use Floodplain:O Yes �No � �
( )New ( )Filling Chippewa Flowage:( )Yes �lY, No � �
O Addition O Dredging Driveway access off of a(Check one): x�
( )Alteration ( )Grading ( )Pxivate Rd ( )Town Rd � �
( )Moving On ( ) ( )CounTy Hwy j�STate T�wy �' �
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Prim y Structure Accessory Building Addition� �y� /� o
O Dwelling O Garage-attached/detached f�Q Decici'�J UGP�n>���
( )Yeaz round ( ),�,-of caz stalls ( )Porch �
( )Seasonal ��Storage Building ( )Enclosed
O Frame built on site , O Screenhouse O Living room �o
( )Modular/manufaCtured ( )Greenhouse ( )Kitchen �
( )Mobile/matiufactured ( )Other ( )Bedroom � �
( )Other primary structure ( ) ( )Relocate/enlarge �
� � ( ) ( )#of new I
Additional Information: t�C; �r2��- ���z�-�-���"�``�- �'O�c����/ "' p
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Type of Construction: i I'�
�j Frame ( )Log ( )Pole/metal ( )Block ( )Concrete ��
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( )Other �
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Construction Cost Primary Structure$ �oo�o, i
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Accessory Building:$ � �«�"`'"�— w
Addition:$ ��at- � �
Deed:Vol 83b Pg 315 Certified Soil Test# �
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CSM:Vol Pg Lot# Sanitary Permit# OI-3�2", ' � �
Plat Envelope Or: o� �
Condo Vol Pg Yeaz Installed: n� �
"Loads and Flows": Vol Pg Owner When Installed: �
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Previous office approvals/actions: � f`'
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Variance:# `�g-00 rp LUP:# SP:� CUP:# I O�
Inspection Report:# Change of Zone District: � \,�\b�
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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.
#I. �p�1L #2. nt,l� #3. #4.
Size Co ft. wide ID ft. wide ft. wide ft. wide
/(o ft. long �4��y ft. long fr. long ft. long
Floor area��sq. ft. l� sq. ft. _sq. ft. sq. ft.
Hgt from grdde to peak ft. hgt. ft. hgt. ft. hgt.
Stories stories stories stories
# of bedrooms Zq�
Lake/Pond/Flowa�e/River/Stream ame
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Fire Number and Name of Road /lc/ 7 3 �v � '��'�✓ ���
1. Enter lot dimensions and indicate north by arrow. Sigl�a�,Se of Qwner or Authorized Agent:
2. Indicate the location and size of the requested construction � J-PJa.k(/ E'Q>���—�„-,
•% Signature
activities.
Pnnt Name:
3. AISo, 1nd1C3te �le IoCatlon and d15tanCe to T.Ile Well, The ahove cerGfes ihat�he listed intormation and intentions are
We and cortec4,that ali work shall be performed in compliance
Sept1C tank and dralnfleld, wetland areas, lot lines, with the requirements ot the Sawyer County Zoning oNinance
and 1he laws and regulations of the SFate of Wisconsin, and if
centerline of the road and waterbodies. aa�o9 as ow�er�s�a�e�t na5 me Pe��sS�o� or me owner�s>io
pedonn the work requestetl on this application. The above
personsls hereby give permission for axess to the property for
onsite inspedion.
Permit fee: $
Total land azea within 300' of the waterbody: (A) 3 03� 7
Total impervious surface area [including this project] (B) �9(�
(B) / (A) x 100 = % Used z.Q% (Shall not exceed 15%[or 25% with a conditional use permit].)
Shoreline Vegetation Protection Area: Mitigation Required? Yes ( )No
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Issue te ignature of Issuing Agent
A ua �s f 9 , o10f)� 50% Rule: Average Road Setback:
Expira ion Date
Office Comments:
. I V • • � � V� VI •� �a,r ��• N .�
� M. C. BOYLAN SU��,
PART Gr GOVT �OT I �
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