HomeMy WebLinkAbout018-837-10-2301-LUP-2008-382 Application for Land Use Permit: (*Non-shoreland*) o 0
County of Saw�Jer � � � �
PO Box 676 - Hayward �%VI 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 bounda.ries. �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. j
A n n y�, PRINT-USE BLACK INK OR PENCIL ,
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Owner Build��r �
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Mailing Address Mailing Address O
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City, State, Zip City, State, Zip
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Daytime Phone Dayti�ne Phone
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Additional Information: Zone District:
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Lot Dimensions: ``
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Date lot was created: �`� � 3 Acres: � � 3S o �
Is there wetland near the proposed structure? If yes, how far �� � �
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Building Land Use Floodplain: O Yes (� No �°
( )Ne ( ) Filling �
( Addition O Dredging Driveway access off of a (Check onf,): �,
O Alteration O Grading O Pr•ivate Rd O Town Rd. o
( ) Moving On ( ) ("�County Hwy ( ) State Hwy (r N �
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Primary Structure Accessory Building Addition � � �
( ) Dwelling ( ) Garage-attached/�ietached ( ) Deck , �
O Year round O # of car stalls O Porch N �
( ) Seasonal ( ) Storage Building ( ) Enclosed ' �
( ) Frame built on site ( ) Screenhouse ( ) Living room �"' � `,
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( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen � � �
( ) Mobile/manufactured (X) Other ( ) Bedroom , �
( ) Other primary structure (�'���f �, 4���=� I������^ ( ) Relocate/enl'.arge � G, '
( ) ( ) ( ) # of new � 1 �
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AdditionalInformation: ' � A
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Type of Construction: o �
( ) Frame ( ) Log (�ole/metal ( ) Block ( ) Concrete W �
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( ) Other °
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Construction Cost: Primary Structure $ � � �
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Accessory Building: $ � A��dition: $� (�v� o � �
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Deed: Vol S73 Pg 3`�/ Certified Soil Test# � �Q z
CSM: Vol Pg Lot# Sanitary Permit# G � 7�
Plat Envelope Or: �; �;
Condo Vol Pg Year Installed: �
Aff of ex septic Vol Pg Owner When Installed: � �
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Previous office approvals/actions:
Variance: # LUP: # SP: ;� CUP: #
Inspection Report: # Change of Zone District: n,.�0�
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Describe the construction using these columns. List: the dimensions of each struc:ture in a separate
column. List each story, each addition, each alteration in a separate column. �
#1 . #2. �o� q��`- #3. #4.
Size ft. wide ,' 4� 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 grade to peak ft. hgt. ft. hgt. ft. hgt.
Stories stories stories stories
# of bedrooms
Rear Lot Line
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Fire Number and Name of Roac�� /�ts"� �� �-�Lt ��f:� C
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l . Enter lot dimensions and indicate north by arrow. Signa ure of C)wner or Authorized Agent:
2. Indicate the location and size of the requested construction �,,,���
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Signature
activities. ,
Print Name: �� �`'""'� �orzr•• ,�,,;w
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 rec;ulations of the State of Wisconsin, and if
centerline of the road. a�t��s as ow�er�s> a��e�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: $ 5�
J1�oc�.r�.r 13 . Z Uo � -
Issue Date Signature of Iss i Agent
/UC�(�-Q �►L,�9.�,' � 3 , 2[�� �j 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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