HomeMy WebLinkAbout002-109-21-0200-LUP-2005-440 �
Application for Land Use Permit(*Non-shoreland) ,� � o 0
County of Sawyer • N �
J� PO Box 676 -Haywazd WI 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 boundazies. �NS�. � 1
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. �
PRINT-USE BLACK INK OR PENCIL �� �
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�wner Builder R �. �
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Mailing Address Mailing Address �N O
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City,S ate,Zip / City,State,Zip �-�
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Daytime Phone Daytime Phone �S
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Additional Information: .' Zone District -- ��- (Z 2-�
Lot Dimensions: ! /�
(� V \
Date lot was created ���,p'S Acres ��3 $ �
Is there wetland near the proposed structure?If yes,how far r�(� � �
Building Land Use � —
�New ( )Filling Floodplain:( )Yes (�No # o �
Addition O Dredging Driveway access off of a(Check one): �
( )Alterarion ( )Grading ( )Private Rd (�Town Rd. � �
( )Moving On ( )Commercial ( )County Hwy ( )State Hwy � �
� ) � ) l� �
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Pr ary Structure Accessory Building Addition �j ,°-r. v�
�Dwelling ( )Garage-attached/detached ( )Deck � �
�Year round ( )#of caz stalls ( )Porch � �
( )Seasonal ( )Storage Building ( )Enclosed Q �
Livin room �
O Frame built on site O Screenhouse O g � Q
( )Modular/manufactured ( )Greenhouse ( )Kitchen ��
( )Mobile/manufactured ( )Other ( )Bedroom �
( )Other piimary structure ( ) ( )Relocate/enlarge
O Single family or multi-unit O O#of new
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Additional Information: -� � >
� ���C b�`������ ��`�J/�' �� v�
h.M�F ��r�" tn� 1.vP os-�(!d� ((,l,� �
Type of Construction `� `° W
�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete o �
( )Other � .-�
Construction Cost:Primary Structure$ � 7 �''J;� �
Accessory Building:$ Addition:$ � �
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Deed .3�(,/Sy Certified Soil Test# `�'S- /3�� � z
CSM Vol Pg Lot# Sanitary Permit# C�'/�/9 �� �
Plat Enve]ope Or: �' �
Condo Vol Pg Year Installed � �
Aff of ex septic Vol Pg ' Owner When Installed:
Previous office approvals/actions:
Vaziance: LUP: SP: C�'
Inspection Report: Change of Zone District: nIO�
�,�
3q�So
Describe the construction using these columns.List the dimensions of each structure in a separate • +
column.List each story,each additiol�,each alteration in a separate column.
#1. #2.�� `'c--� #3. #4.
Size 'Z` ft.wide z�1 � ft.wide ft.wide ft.wide
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_�_ft.long �i`� ft.long ft.long ft.long
Floor area 9y� sq.ft. >,�' sq.ft. sq.ft. s4•�•
Hgt.from gade�to pealc ft.hgt. fr.hgt. ft.hgt.
Stories I stories stories stories
#of bedrooms G
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� 1��, Rear �ot Line
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Fire Number and Name of Road � �6� �� � "� 7 � /
1.Fill in lot dimensions and indicate north by azrow. Sig e of Owner or uthorize Ag
2.Indicate location and size of existing and new structures.
Signa re
3.Indicate location of well,septic tank,drainfield. � �� r,
PnntName: �aliYl �G�1 v_ �C�-. .-L:�
4.Indicdt0 dl5tance t0 OXlSting 5tLI1CtUICS,lOt I1riCS,50ptiC SyStEm. The above ceNfes Nat ihe listed in(orma on and intentions are
We and corted.,that all work shall be performed in compliance
5.Indicate distance to the ordinazy high-water mark of any lake, wiN ihe requirements of the Sawyer Counry Zoning Ordinance
and ihe laws and regulations of ihe Shate of Wisconsin,and if
pond,river,stream,creek,and name fl1e body oP water. acting as owner(s)agent,has Ne permission of the owner(s)ro
perform the work requested on Nis application. The above
6.Indicate ve 0t2t1VE bllff0t ZOriO. personsls hereby give permission(or access lo the property(or
g onsite inspection.
7.Indicate size and location of all impervious surfaces.
8.Indicate any grading or clearing in excess of the construction site. Permit Fee: /r/S��c�
9.Indicate distance to any wetland.
�� �,�s _
Issue Date Signature ofIss g nt
So � 2--0,
Expira ion Date `^�4
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Office Comments: ������� �tG c�� �`�1`l Y:�y (JC_t�l��cµ ��� ���'�� `'����
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Total%impervious surface: Mitigation required: J�
Restrictions and othec informatlon: �
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