HomeMy WebLinkAbout236-941-22-4408-LUP-2005-016 Application for Land Use Permit (*Non-shoreland*) o o � .
County of Sawyer � � �
PO Box 676 - Hayward 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 boundaries.
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. � '
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Mailing Address Mailing Address �
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City,� tate, Zip City, State, Zip
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Daytime Phone Daytime Phone �
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Additional Information: Zone District: C� " �
Lot Dimensions:
Date lot was created: Acres: . �{ o ti
Is there wetland near the proposed structure? If yes, how far � `
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Building Land Use Floadptain:� j �es ( j No `�
( )New ( ) Filling �
(i�jAddition 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/detached ( ) Deck W
( ) Year round ( ) # of car stalls ( ) Porch �
O Seasonal O Storage Building O Enclosed �
( ) Frame built on site ( ) Screenhouse ( ) Living room � �
( ) Modular/manufactured ( ) Greenhouse ( )Kitchen (;
( ) Mobile/manufactured ( ) Other � Bedroom
Relocate/enlar e �
( ) Other primary structure ( ) � ) g � �
� � ( ) ( ) # of new � �a,.,�
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AdditionalInformation: i A
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Type of Construction: � �
(� Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete � �
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( ) Other „� y
Construction Cost: Primary Structure $ � �
Accessory Building: $ Addition: $j �'���' -���} � -�
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Deed: Vol (�,�;� Pg� Certified Soil Test# $,5'— 1 y 7 .. z
CSM: Vol Pg Lot# Sanitary Permit# �.� — �3`� a, �
Plat Envelope pr; � a G-�.Q�i'-�� �������'+� �, -�
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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: N
Variance: # LUP: # SP: # CUP: # /
C,
Inspection Report: # Change of Zone District: ��
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38`l(08
Describe the construction using these columns. List the dimensions of each structure in a separate '
columa List each story, each addition, each alteration in a separate column.
#1. �� #2. #3. #4.
Size�fr. wide ft. wide ft. wide ft. wide
ft. long ft. long ft. long ft. long
Floor area 4 `1lP sq. ft. sq. ft. sq. ft. sq. ft.
Hgt.from grade to peak ft. hgt. ft. hgt. ft. hgt.
Stories stories stories stories
# of bedrooms___�___�p-�cz (
Rear Lot Line
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Fire Number and Name of Road � 5 5 9�/ Ct� S u v�n« 5/ c/r � �� � '� �u '-�
1. Enter lot dimensions and indicate north by arrow. Signature o Owner or Authorized Agent:
2. Indicate the location and size of the requested construction �6j--
C Signature
activiries. � F�
PnnWame: ��� 5 � n �S� �
3. AlsO, 1nCIlCate �'le loCfltlon and d15t2riCe to the Well, The above cer6Tthat the listetl Information and in�entions are
true antl corred.,that all work shall be pedormed in compliance
septic tank and drainfield, wetland areas, lot lines and to the w�m me �����me�t5 or me sav,ye� co��ry zo���y om�nance
antl ihe laws and regulations of the Sqte of Wisconsin, and if
Cente711rie Of tlle ToaC�. acting as owner(s)agent, has the permisslon of the owner(s)to
pedorm Me work requestetl on this application. The above
persons/s hereby give permission for access to the property for
onsiteinspection.
Permit fee: $ �s`�'`
Februarp 7 , 2005 ' - Zy4-
Issue Date Signature of I in gent
Pebruary 7 , 2006 50% Rule: AverageRoadSetback:
Expiration Date
Office Comments:
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0 o n Mq pP��GA 66
NOTE: THERE IS AN PROBLEM INTH TA I.D. NUMBERS �F� � g SUbC�IVI�
AND h1E DEEDS REFERENCED BY 7HE IN hIE SW
POR110N Of THE SE-SE. p y
EDW. E. G08L£R PERFOF2MED A DIVI OF 10 LpiS IN � o�,���' Survey
JANUARY OF 1961, BUT SINCE hiE SURVEY DEEDS 6PQ�
AND TAX INFORMATION HAVE AC RED A - DfdWlfl
ONSIDERABLE QUANITY OF ERR AND OMISSIONS. 4, PyQJ g
MORE RESEARCH ANO/OR SUR K IS HfCHLY � �?V
RECOMMENOED. r '5.2��QQ D ra f te r
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GtiTy � o* Drawing
IC SCALE o� Drawin
TAX ASSESSMENT PURPOSES ONLY Disk: C
aoo i6oa Information contained on this map is
� advisory. Map accuracy is limited by the Tax Rol
quality of the public records from which it Current
was prepared. It is not intended as a Sheet �
FEET ) substitute for an accurate field survey.
= 400 ft.
Plotting