HomeMy WebLinkAbout032-438-07-4305-LUP-2008-026 .
Application for Land Use Permit: (*Non-shoreland*) o o� ' �
County of Saw�✓er � � —b
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. �i
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REi�UIRED PERMITS HAVE BEEN ISSUED. )6
PRINT-USE BLACK INK OR PENCIL '
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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 Daytime Phone �'
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Additional Information: Zone District: 11 � �
Lot Dimensions: � �
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Date lot was created: /��d Acres: �g . y _ n
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Is there wetland near the proposed structure? If yes, how far � �i
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Building Land Use Floodplain: ( ) Yes ( )No :�
( )New ( )Filling Cr� �
O Addition .� O Dredging Driveway access off of a(Check onf;): � �, �-
�Alteration ��'' ( ) Grading ( ) Pr•ivate Rd ( ) Town Rd. o �
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O Moving On��•�(s ) O C��unty Hwy O State Hwy N N
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Primary Structure Accessory Building Addition � � �
(�) Dwelling ( ) Garage-attached/�ietached ( ) Deck � �
(� Year round ( ) # of car stalls ( ) Porch � �. �
( ) Seasonal ( ) Storage Building ( ) Enclosed � �
( ) Frame built on site ( ) Screenhouse ( ) Living room � � �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen � � �
( ) Mobile/manufactured ( ) Other ( ) Bedroom �e �
( ) Other primary structure ( ) ( ) Relocate/enl''.arge � � i
( ) ( ) ( ) # ofnew � �
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Additional Information: 0 4 ��
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Type of Construction: c �'
�Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete �
( ) Other
Construction Cost: Primary Structure $ � �
Accessory Building: $ A��dition: $��00 � �
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Certified Soil Test# �
Deed: Vo13yJ�s� Pg � z
CSM: Vol Pg Lot# Sanitary Permit# � 7�
Plat Envelope Or: �, �
Condo Vol Pg Year Installed: !�o ,�n� �
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: �r
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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 . #2. #3 . #4.
Size 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 grade to peak ft. hgt. ft. hgt. ft. hgt.
Stories 2 stories stories stories
# of bedrooms �_
Rear Lot Line �
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Fire Number and Name of Road U" � (�`r� �o , �(wv, w
1 . Enter lot dimensions and indicate north by arrow. Signa re f C)wner or Authori ed Agent:
2. Indicate the location and size of the requested construction
ignature
activities.
PrintName: lU �eH4� �1S 1'Y1• SZl'4ba
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 reclulations of the State of Wisconsin, and if
centerline of the road. aot��9 as ow�er�s� a�,e�t, has the permission of the owner(s) to
perform the work requested on this application. The above
persons/s hereby give permission for access to the property for
Q onsite inspection.
Permit fee: $ [ s• �
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Issue Date Signature of Issuin Ag
l � � �� � 50% Rule: Average Road Setback:
Expiration ate
Office Comments:
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3. i 4.I
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8
� 14.1 13.2 13,1
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� 15.1
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SCALE: I INCH= 400 FEET FOR ASSESSMENT USE ONLY NOT
DRAWN BY: CK DATE: 6/10/81 INTENDED TO SHOW CONCLUSIVE
COLON (:) INDIGATES GOVT. LOT EVIDENCE OF OWNERSHIP OR
BOUNDARY LOCATIONS