HomeMy WebLinkAbout032-540-21-1401-LUP-2008-123 f . ...
Application for Land Use Permit; (*Non-shoreland*)
County of Saw��er � � x .� '
PO Box 676 - Hayward �VI 54843
715/634-8288 S�
*Property that is not located within 300' of a creek, river or stream or within 1000' of a 1-�
flowage, lake or pond or does not have any of the above waterbodies located within z
the property's bounda.ries. � �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REi�UIRED PERMITS HAVE BEEN ISSUED. 7b
PRINT-USE BLACK INK OR PENCIL
/ � �C.. YNTH//{ /�'1. �LK .fi'F1E'yL �_i.�'�ST'EN S1�.J _ �✓,+CK �it�c���l,�S �
A�v iE� A . �.,
Owner Build��r c' �
/2 3�I �IAR/!ET /"�ACE S`�7�c� �tAK[.F� ,L N �.
Mailing Address Maili�ig Address � O �
I- / �
WAu.k'£.SNA Yt/1. s?i8`�J /�flS��, wl. SS��SG hl �
City, State, Zip City, State, Zip � �
►�1 -`�
2 G�. - S��-a,s'�� 7is- '7G 3-3�/y� � Z
Daytime Phone Dayti�ne Phone � �
N h
Additional Information: Zone District: R�-1 � �
t
r
Lot Dimensions: /32 a X /3z� c CJ
Z
Date lot was created: Acres: �
D o :�a
�
Is there wetland near the proposed structure? If yes, how far No � a
Building Land Use Floodplain: ( ) Yes (X)No � �
Q�New ( ) Filling � a�
O Addition O Dredging Driveway access off of a(Check onf,):
r
O Alteration O Grading O Private Rd � Town Rd. J o �
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy � N
� ) � ) N o �
� r
Primary Structure Accessory Building Addition �' � °
O Dwelling O Garage-attached/cietached O Deck Q �
( ) Year round ( ) # of car stalls ( ) Porch �
O Seasonal (� Storage Building O Enclosed d `�
( ) Frame built on site ( ) Screenhouse ( ) Living room � % �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen �' � �'1
( ) Mobile/manufactured ( ) Other ( ) Bedroom � N
( ) Other primary structure ( ) ( ) Relocate/enl�arge '� '
( � ( ) ( ) # ofnew p � �
�C �h
AdditionalInformation: p N .�
C� �
CZ i cU'u
� � �
Type of Construction:
( ) Frame ( ) Log dC) Pole/metal ( ) Block ( ) Concrete Q � �
O
( ) Other �
O � �
Construction Cost: Primary Structure $ � �
�
Accessory Building: $ 3S� 00 0, o A�3dition: $ � �
�
Deed: Vcl SD7 P� vb Certified Soil Test# q �- U 3/ UQ
z
CSM: Vol -�' Pg — Lot# -- Sanitary Permit# 9�" 4 y 7 � 7�
Plat Envelope Or: �, t,1
Condo Vol Pg Year Installed: �
Aff of ex septic Vol Pg Owner When Installed: �-' �
=C
Previous office approvals/actions: `
Variance: # LUP: # y7 -085 SP: � CUP: #
Inspection Report: # Change of Zone ]�istrict: ��
5��°�-
,3�02�
f
Application for Land Use Permit: (*Non-shoreland*)
County of Saw�,�er � � x '
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 M
flowage, lake or pond or does not have any of the ��bove waterbodies located within z
the property's bounda.ries. �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL RE��UIRED PERMITS HAVE BEEN ISSUED. R� _
PRINT—USE BLACK INK OR PENCIL
r, ��7 1 � �
Aiv iE� A �YN TH i,q M. �c K .�,�AE'Yt ���'«TEN Ja �J - ;/'✓.��'K ,�c��.���1�S �
Owner
� Builder ¢'
/2 3�/ �AR/!ET /"�ACE �``/7�i'� �tAJ«F� ,�� o�
�
Mailing Address Maili�ig Address � O
G{lAu.++�'£SHA °�1. S?�a'9 /�f1Sa�. WZ. S`��'SG N �
City, State, Zip City, State, Zip � � ��
�G't. - �'S//"'`DS�c :. 7�.t� '7�3-.3�y11 v �
Daytime Phone Dayti�ne Phone N �
r
Additional Information: Zone District: R�'2 � �
�
r
Lot Dimensions: /32Q X i3za �' (�
�
Z
Date lot was created: Acres: �D o �
Is there wetland near the proposed structure? If yes, how far /vb � �
Building Land Use Floodplain: ( ) Yes (7() No � ��,,
Q�New O Filling � � a 1
O Addition O Dredging Driveway access off of a(Check onf,):
O Alteration O Grading O Private Rd � Town Rd. J o �
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy � N
� ) � ) N o �
� r
Primary Structure Accessory Building Addition �' � °
( ) Dwelling ( ) Garage-attached/cietached ( ) Deck „� W
Porch � '�
( ) Year round ( ) # of car stalls ( ) �
O Seasonal (� Storage Building O Enclosed � �
( ) Frame built on site ( ) Screenhouse ( ) Living room � � `,�
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen (j T1
( ) Mobile/manufactured ( ) Other ( ) Bedroom � �N �
( ) Other primary structure ( ) ( ) Relocate/enl,arge '� A
� � ( � ( ) # ofnew p � �
�
AdditionalInformation: o nl �
Q �
{ �
� � �
Type of Construction:
( ) Frame ( ) Log dC) Pole/metal ( ) Block ( ) Concrete p � �
4
( ) Other � ,..d ,�
Construction Cost: Primary Structure $ � �
� �
�
Accessory Building: $ 3� 00 0. o a A��dition: $ � �
c�
Deed: �Jel �O 7 Pg U6 Certified Soil Test# q �- U 3� �' z
CSM: Vol �' Pg — Lot# — Sanitary Permit# 97-' 4 y 7 0, �
Plat Envelope �r� N �
�,
Condo Vol Pg Year Installed: c�
� �
Aff of ex septic Vol Pg Owner When Installed: ;-'
:L,
Previous office approvals/actions: `
Variance: # LUP: # �7 -d85 SP� `� CUP: #
Inspection Report: # Change of Zone ]�istrict: ��
5��°�-
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