HomeMy WebLinkAbout032-540-30-3111-LUP-2008-317 Application for Land Use Permit; (*Non-shoreland*) o o � . �� .,
� County of Saw�,�er � � �
J� PO Bux 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 ;�bove waterbodies located within ,
the property's bounda.ries. `
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CONSTRUCTION SHALL NOT BEGIN UNTIL ALL RE��UIRED PERMITS HAVE BEEN ISSUED. �
PRINT—USE BLACK INK OR PENCIL ` `
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Owner Bui►�'d��r �� �
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Mailing Address Mailing Address �
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City, Sta i City, State, Zip �
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Daytime Phone Daytime Phone
Additional Information: Zone District: R�-� �
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Lot Dimensions: �
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Date lot was created: ►2.- �l-$5 Acres: .5.Y8 o s
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Is there wetland near the proposed structure? If yes, how far � �
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Building Land Use Floodplain: ( ) Yes �C)No � �-
�New ( ) Filling � �
O Addition O Dredging Driveway access off of a(Check onf,): � �
O Alteration O Grading O Private Rd O Town Rd. 3 0
O Moving On O O County Hwy O State Hwy w N
( ) ( ) No �
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Primary Structure Accessory Building Addition o � °
Q�Dwelling O Garage-attached/cietached O Deck �, �
�) Year round O # of car stalls O Porch � �
Seasonal ( ) Storage Building ( ) Enclosed o �
( ) Frame built on site ( ) Screenhouse ( ) Living room ' �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen � Q T�'
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( ) Mobile/manufactured ( ) Other ( ) Bedroom � t�
( ) Other primary structure ( ) ( ) Relocate/enlarge o � A
� � ( ) ( ) # of new a -t `!'
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AdditionalInformation: o o �
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Type of Construction: �
�Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete Q,
( ) Other
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Construction Cost: Primary Structure $_ /�� D� r c, �-, . e� c7 � �
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Accessory Building: $ A��dition: $ � �
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Deed: Vol 35�Pg Certified Soil Test# �� �" z
CSM: Vol_�_Pg �3o Lot#� Sanitary Permit# U8-233 0, �
Plat Envelope �a3�9 Or: � `�l1c>cm�ao� �, (�
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Condo Vol I'g Year Installed: co
Aii,^,f 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: '
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363�
Describe the construction using these columns. List the dimensions of each structure in a separate
column. List each story, each addition, each alteration in a separate column.
#1. #2. � �,,.r� � #3. #4. .
Size� . wide �ft. wide 8. wide ft. wide
�3 y ft. long �_ft. long ft. long ft. long
Floor area �� sq. ft. �I sa sq. ft. sq. ft. sq. ft.
HgC.from grade to peak ft. hgt. ft. hgt. ft. hgt.
Stories� stories stories stories
# of bedrooms j��
�S� Rear Lot Line
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Fire Number and Name of Road ap�,�D f�oi-t GLf/�PN ��
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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 ��1 " yi f���.��x-«<-i �
SignaNre
activities.
PrintName:.�i fi�C- .3L� r/�/s�
3. Also, indlCate the IoCatiOn and diStanCe to the well, The above cedines that the listed intormation 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 w�cn me r���remeot5 or me sawyer co�ory zonin9 om��a�ce
antl the laws and regulations of lhe State of Wiscronsin, and i(
C0rit0lllri0 Of tI1B IO&d. acting as owner(s)agent, has the permission of lhe owner(s)to
perform the work requested on �his application. The above
personsls hereby give permission for access to lhe property for
onsite inspection.
Permit fee: $ � / ?f
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Issue D te Signatuxe ofIssu g A e t
25 � ZpU/" 50°/o Rule: Average Road Setback:
Expira ion Date
Office Comments:
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