HomeMy WebLinkAbout026-938-02-3303-LUP-2008-024 Application for Land Use Permit; (*Non-shoreland*) '�
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County of Saw��er � �
PO Box 676 - Hayward `VI 54843
t
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 bounda.ries. �-
CONSTRUCTION SAALL NOT BEGIN UNTIL ALL REi�UIRED PERMITS HAVE BEEN ISSUED.
PRINT-USE BLACK INK OR PENCIL � N
�at�C� AN� �..�r� �n'����� �'�.."t�' �
Owner Builder �'
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Mailing Address Maili�ig Address O
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City, State, Zip City, State, Zip �
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Daytime Phone Daytime Phone �
Additional Information: Zone District: � - � y;
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LotDimensions: �4�a(�, �f` t�''taC3
Date lot was created: ��„i��%`�:' Acres: /0 n �
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Is there wetland near the proposed structure? If yes, how far 1�:.,:�:: � ;��?
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Building Land Use Floodplain: O Yes O No � ` 5�
( )New ( ) Filling G, �
�Addition O Dredging Driveway access off of a(Check onf,): � �
O Alteration O Grading O Pr•ivate Rd j�j Town Rd. � o
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy � N �
� ) '��t � ) 1�' o �
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Primary Structure Accessory Building Addition � `� �
( ) Dwelling ( ) Garage-attached/cietached J��eck "'
( ) Year round ( ) # of car stalls ( ) Porch .�a �
( ) Seasonal ( ) Storage Building ( ) Enclosed � �
( ) Frame built on site ( ) Screenhouse ( ) Living room � �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen (,�, � �
( ) Mobile/manufactured ( ) Other ( ) Bedroom ,
O Other primary structure O O Relocate/enl�arge U, A
( � ( ) ( ) # of new � p �
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Additional Information: �
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Ty e of Construction: �W
�Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete �j }�
( ) Other
Construction Cost: Primary Structure $ � �
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Accessory Building: $ �i��diiior�: $ �z z 00°�•�y l.a�hs�,.3 �� �
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Deed: Vol 11 _Pg 2,7 Certified Soil Test# 9�-OqS aQ
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CSM: Vol Pg Lot# Sanitary Permit# (�O._�,� � �
Plat Envelope Or: N �
Condo Vol Pg Year Installed: ��,:`,;j� �
Aff of ex septic Vol Pg Owner When Installed: � �
u�.ti�,-.,�'�a �� 1�u r R �c����— �
Previous office approvals/actions: W
Variance: # LUP: # ��-/p�� SP: ;� CUP: #
Inspection Report: # Change of Zone District: ,oa
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Describe the construction using these columns. Lis1:the dimensions of each struc:ture in a separate
column. List each story, each addition, each alteration in a separate column.
#1. �z�K #2. #3. #4.
Size ZO ft. wide ft. wide ft. wide ft. wide
Zc� t�`�`�ft. long ft. long ft. long ft. long
Floor area �,� 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
Rear Lot Line �..¢�i�I
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Fire Number and Name of Road �S'.� '/(t Lv fj�au�er ��
1. Enter lot dimensions and indicate north by arrow. Si nature of C�wr�Pr or Authorized Agent:
2. Indicate the location and size of the requested construction � ��a�:'�•
Signature
activities. �'
Print Name:�_�t?S �, t`f���E'�
3. Also, indicate the location and distance to the well, The above certifies that the listed information and intentions are
true and correct.,that all work shall be performed in compliance
septic tank and drainfield, wetland areas, lot lines and to the with the requirements of the Sawyer County Zoning Ordinance
and the laws and regulations of the State of Wisconsin, and if
centerline of the road. aot��9 as oW�er�s�ane�t,has the permission of the owner(s)to
perform the work requested on this application. The above
personsls hereby give� permission for access to the property for
onsite inspection.
Permit fee: $�_°�
�.a,c.c� ��, .zcr� � ` -
Issue Date Signature of Is in gent
���� / 3, ,�6D� 50% Rule: Average Road Setback:
Expiration Date
Office Comments: ,
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S�U�'�I PA RT SEC. 2 1���'- ;
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SCALE: I INCH=��O FEE1
DRAWN BY: RH � ��
co�oN (:) INDICATES GO�