HomeMy WebLinkAbout010-941-23-1313-LUP-2005-443 Application for Land Use�Pern�it (*Non-shoreland) r
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. I �
PRINT—USE BLACK INK OR PENCIL
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Own Builder a�.
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Mailing Address Mailing Address � p
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City, tate, Zip City, State, Zip `'
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Daytime Phone Daytime Phone
Additional Information: Zone District � �
Lot Dimensions:
Date lot was created Acres , ��
Is there wetland near the proposed structure? If yes, how far�,l Q
Building Land Use �
( )New ( ) Filling Floodplain: ( ) Yes (�No # o �
O Addition O Dredging Driveway access off of a(Check one): .�
( ) Alteration ( ) Grading ( ) Private Rd (�(� Town Rd. � � '
( ) Moving On ( ) Commercial ( ) County Hwy ( ) State Hwy �
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Primary Structure Accessory Building Addition �
( ) Dwelling (�j Garage-attached/detached ( ) Deek
( ) Year round (3) #of car stalls ( ) Porch
( ) Seasonal ( ) Storage Building ( ) Enclosed
O Frame built on site O Screenhouse O Living room �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen �
( ) Mobile/manufactured ( ) Other ( ) Bedroom
( ) Other primary structure ( ) ( ) Relocate/enlarge '
( ) Single family or multi-unit ( ) ( ) # of new Z
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Additional Information: A
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Type of Construction � �
(� Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete � �
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( ) Other �
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Construction Cost: Primary Structure $ � �
Accessory Building: $_��Q.��O Addition: $ �
Deed o?g 53 .5 7 Certified Soil Test# ''j 9 - �!88 � �
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CSM Vol — Pg "" Lot# Sanitary Permit# 78 ' Z5�7 � �
Plat Envelope Or: � �
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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: SP: CUP: . a �
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Inspection Report: Change of Zone District: .
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Dcscribe 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 ft. wide ft. wide
�_ft. long ft. long ft. long ft. long
Floor area I ��Q sq. ft. sq. ft. sq. ft. sq. ft. �
Hgt.from gade .r�j'�j„ to peak ft. hgt. ft. hgt. ft. hgt.
Stories� stories stories stories
# of bedrooms�
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/�° Rear Lot Line � �""��
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Fire Number and Name of Road ./�,f R�
1. Fill in lot dimensions and indicate north by arrow. Signat of or Au ized Agent:
2. Indicate location and size of existing and new structures.
SignaNre ,
3. Indicate location of well, septic tank, drainfield.
Pnnt Name:����n..C.G Y10�2 I
4. Irid1C2tC dlStdriCO YO eXlStlrig S1Sl1Ch1I'CS, IOt I1riC5, SCpY1C 5}'SteIII. The above certifes that ihe listed nformaEon and intenlans are
We and wnecL,Nat all work shall be pedormed in compliance
5. IndlCate diStaT10E to tlle ordin3T'y hlgh-Water maTlc of any lalce, wim me requirements of ine Sawyer Counry Zoning Ordinance
and Ne Wws and regulations of Ihe Sfate of Wisconsin, and if
pond, rlver, Stream, creek, and nante the body oF water. acting as ownel(s)agent,has the permission of the owner(s)ro
pedorm ihe work requested on this appliration. The above
6. IridiC3tC V0 0t311VC IIUffC2 ZOriO. personsls here6y give permission for aceess to the property for
$ 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: �p 1 oO -Dd
9. Indicate distance to any wetland.
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Issue ate Signature ofIss g ent
t,�,,,l�or d,. Z DoL�
Expir tion Date
Office Comments:
Total % impervious surface: Mitigation required:
Restrictions and other inFormation:
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NOTE� SURVEYS MI7HIN SECTI�N 23 HAVE USED OIFFERENT SECTION "�' `" "z
CORNER POSITIpNS ❑VER THE YEARS• THIS HAS CAUSED A GENERAL
LACK pF FIT BETWEEN DIFFERENT SURVEY MAPS AND THE OEEOS THAT � � � � �
MERE BASEO UPON THESE SURVEYS, THIS PROBLEM MAY NOT EXIST -
'HQSP�TAL RO' [N THE F[ELD DUE TO THE USE OF COMMON FpUND MONUMENTS, ��
SHOIMN AS 66' M70TH POR THE GIS LAYER MAS POSITIONEO BY THE BEST FIT ME7HpD FpR � .
MAPPING PURPOSES. MAPPING PURPOSES ONLY. �
_ AOOITIONAL RESEARCH AND/OR SURVEY WORK MAY BE REOUIRED. �
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