HomeMy WebLinkAbout032-539-22-1101-LUP-2008-029 Application for Land Use Permit; (*Non-shoreland*) o o �
County of Saw`Jer � �
PO Box 676 - Hayward �%VI 54843
715/634-8288
*Property that is not located within 300' of a creek, river ar stream ar within 1000' of a �
flowage, lake or pond or does not have any of the above waterbodies located witriin � �
the property's bounda.ries. � �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL RE��UIRED PERMITS HAVE BEEN ISSUED.
��d NGI� �rl.SerpRINT-USE BLACK INK OR PENCIL �
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Owner Builder � �
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ti� G � 7 S Sf I� 70 �� �
Mailing Address Mailing Address �
t 4� � N'�"�Y ���.• , .5�8�q - c�
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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: ��lc��� -�'� /I� -1
Lot Dimensions: 2U�'�e• ---
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Date lot was created: Acres: �q,g Z� /�-� fi'�' �' "` o �7
Is there wetland near the proposed structure? If yes, how far � ' �a
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Building Land Use Floodplain: ( ) Yes �No � �
(�New ( ) Filling ,-, �
O Addition O Dredging Driveway access off of a(Check onf;): �
( ) Alteration ( ) Grading ( ) Pi•ivate Rd ( ) Town.Rd. �
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( ) Moving On ( ) ( ) County Hwy � State Hwy � �,
( ) ( ) �b,,, � �
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Primary Structure Accessory Building Addition � � �
( ) Dwelling ( ) Garage-attached/detached ( ) Deck , W -
( ) Year round ( ) # of car stalls ( ) Porch ���
( ) Seasonal (�Storage Building ( ) Enclosed o � �
O Frame built on site O Screenhouse O Living room tn�,�
O Modular/manufactured O Greenhouse O Kitchen r, R`
O Mobile/manufactured O Other O Bedroom N w
( ) Other primary structure ( ) ( ) Relocate/enflarge � N '
( ) ( ) ( ) # of new p �`
Additional Information: Q� �
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Type of Construction: g � N
�Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete �, ,:� �
( ) Other �
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Construction Cost: Primary Structure $ /� /� - � ,�
Accessory Building: $ A�3dition: $ � �E,
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Deed: Vol Z 1(o Pg L Z.p Certified Soil Test# °'Q
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CSM: Vol Pg Lot# Sanitary Permit# � 7�
Plat Envelope Or: �, �
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Condo Vol Pg Year Installed: � `
Aff of ex septic Vol Pg Owner When Installed: � �
.
Previous office approvals/actions:
Variance: # LUP: # SP: ;� CUP: # ' '�
Inspection Report: # Change of Zone District: : ��
a``�
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Describe the construction using these columns.Lis1: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 l 2 ft.wide ft.wide ft.wide ft.wide
_�_fr.long ft.long ft.long ft.long
Floor area% 97_ sq.fr. sq.ft. sq.ft. sq.ft.
Hgt from grade�to peak /o-4 ft.hgt. ft.hgt. ft.hgt.
Stories / stories stories stories
#of bedrooms
Rear Lot Line
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Fire Number and Name of Road /Lf.�L" r�� .�4� ��cd 70
1. Enter lot dimensions and indicate north by arrow. Signature of C)wner or Authorized Agent:
2. Indicate the location and size of the requested construction d�.w( �o�'u,�i
Signature
activities. ��e�`1 JC .����
Print Name�
3. Also,1ndiCate the locatlon and d1SY3nCe to t}le well, The above cedifies that the listed intormatlon and intentions are
We and covect.,lhat all work shall be performetl in compliance
septic tank and drainfield,wetland areas,lot lines and to the witn me requiremen�or tne sawyer counry zonin9 ominance
and the laws and reguia�ions of ihe State of Wisconsiq and if
CCrit011lriO Of 211e T'02d. acting as ownef(s)aqent,has the permission of the owner(s)to
pedorm the work requested on this application. The above
personsls hereby give permission for access to the pmpedy for
onsiteinspection.
Permit fee:$ ��°%
'1 l�Z00�
Issue Date Signatuce ofIss ng ent
��rtti 1 I . 2L^O9 50%Rule: Average Rozid Setback:
Expiration Date
Office Comments:
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