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018-837-28-5503-LUP-2003-601
Application for Land Use Permit o o }- County of Sawyer � / PO Box 676 -Hayward WI 54843 715/634-8288 � The undersigned hereby makes application for a Land Use Permit and agrees that all work shall be done in compliance with the requirements of the Sawyer County Zoning Ordinance and the laws and regulations of the State of Wisconsin. � NO CONSTRUCTION MAY BEGIN UNTIL ALL PERMITS HAVE BEEN ISSUED. �w�'� �V���C�/ �� PRINT-USE BLACK INK OR PENCIL � � � �nY�,�-� ��oOS-L�ti �%o�kh.w oo� ��r v Sk��� � Owner Builder °' � 393"z- lZ�`' ��,. Sa�.i lo�lb3 S�a���, �Z�' o� � Mailing Address Mailing Address � � \\ � ��nn:rt{�e,�l� ��N• ��0� R4yh%�v'� W�: S�gy� :; � City,State,Zip City,State,Zip � �;��. 6sl - Z:�l- OU6�- �t's —�,3�1 — S�ID� Daytime Phone Daytime Phone ' Additional Information: Zone District ��, r LotSize Z�-1�X 5���'X Z.7yx`�� Date lot was created Acres �j,Z�C� Is the property in a Shoreland District?(within 1000'of a lake or pond,within 300'of a river, creek or stream) If yes,how faz from the shoreline&water name: C(L ����fA�Ce , Is there wetland near the proposed structure?If yes,how far t��('� � Building Land Use � (Xi New ( )Filling Floodplain:( )Yes �No # � ( )Addition ( )Dredging � � ( )Alteration ( )Grading Chippewa Flowage: ( )Yes (�No 0 � ( )Moving On ( ) o ( � ( ) Driveway:( )State ( )County ( )Town Rd. i Primary Structure Accessory Building Addition � v I (�Dwelling ( )Garage-attached/detached ( )Deck ( )Year round ( )#of caz stalls ( )Porch � (�Seasonal ( )Storage Building ( )Enclosed , (�t Frame built on site ( )Screenhouse ( )Living room N � ( )Modular/manufactured ( )Greenhouse ( )Kitchen � ( )Mobile/manufactured ( )Other ( )Bedroom C ( )Other primary structure � ( ) ( )Relocate/enlazge � � ( ) ( )#of new > � � AdditionalInformation: � � C1os�n� SeP+. 2o,a�3 � I � Type of Conskuction � �Frame ( )Log ( )Pole/metal ( )Block ( )Concrete � � ( )Other " � � Conslruction Cust:Piimary-Structure$ �� � ��lJ I.-�.l Accessory Building:$ Addition:$ z �3 i55'�� �' Vol Pg of Deed Certified Soil Test# (��- �/_S � CSM Vol Pg Lot# Sanitary Permit# (5 � - �5 p Plat Envelope Or: � Condo Vol Pg Yeaz Installed Aff of ex septic Vol Pg Owner When Installed: Gard Gazebo Vol Pg Previous Variance: LUP: Inspection Date: y'�`��1^ 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. #l. #2. #3. #4. Size_z�ft.wide ft.wide ft.wide ft.wide �ft.long ft.long ft.long ft.long Floor area�sq.ft. sq.ft. sq.ft. sq.ft. Hgt.from gade�to peak ft.hgt. ft.hgt. ft.hgt. Stories_� stories stories stories #of bedrooms�_ � �- � '� Lot Line or Lake/River name: 6 � ��I � � �c�,3.c.,,��bL ._i �,�, 10 x L�� J s W • � � I � o 1`�c'? f } ��-�o�.. �� ha ___ � -- -----_.,..._ ����� �b,�,i.a..� �-�--i-�� �z.' _. �a�1�- �-,�v r �J +�--� � � � .. `� `.C��J.� �.z'z,�3 �y'`�,> � � � � � � Fire Number and Name of Road �- z"'1 y Z" 1.Fill in lot dimensions and indicate north by arrow. Signature of Owner or Authorized Agent: 2.Indicate location and size of existing and new structures. � � 3.Indicate location ofwell,septic tank,drainfield. ��^�-`t-�- � ti�' 4.Indicate distance to existing structures,lot lines,septic system. 5.Indicate distance to the ordinary high-water mark of any lake, pond,river,stream,creek,and name the body of water. P���Name: E�<'St `�r`°'s"r� The a6ove cerfifes that ihe listed informa6on and intentions are 6.Indicate any grading or clearing in excess of the construction site. �tie aod co��e�c rne abo�e Pe�oo5�5 nereny y��e Pe��sS�on tor access to the property for onsite inspection. 7.Indicate distance to any wetland. Permit Fee: �'7�� September 25, 2003 ' Issue Date Signature of Iss g ent September 25, 2004 Expiration Date Office Comments Inspection Date: 50%Rule Applies: Avg.Setback: Within Reservation boundaries: Restrictions and other information: C ,�.. .... ._ .. _�a..._...e.�...,.�..,.._.....�._ ...,... 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