HomeMy WebLinkAbout002-940-09-3201-LUP-2004-011 Application for Land Use Permit(*Non-shoreland*) r .� �--
County of Sawyer � �
PO Box 676 -Haywazd WI 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 r �
the property's boundaries. �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. �
, � n n Q �a t PRINT-USE BLACK INK OR PENCIL
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Owner Builder a O
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Mailing Address Mailing Address � O
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City,Stat Zip City,State,Zip _
]l � (,-��{ 75�?
Daytime Phone Daytime Phone �_
Additional Information: Zone District: ��-�_ �
Lot Dimensions: �
a
Date lot was created: Acres: �� 1� � S�7� �
Is there wetland neaz the proposed structure?If yes,how far /lr � �\'
Building Land Use Floodplain:O Yes (�'�To � �
(�Gew C�,�'ui4�, ( )Filling � �
O Addition O Dredging Driveway access off of a(Check one): �
( )Alteration ( )Grading (�rivate Rd ( )Town Rd. �,
( )Moving On ( ) ( )County Hv✓y (,��State Hwy u �
O O S
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Primary Structure Accessory Building '� Addition °
( )Dwelling (�Gazage-attache detache ' ( )Deck '
O Year round (�#of caz stalls O Porch �
O Seasonal O Storage Building O Enclosed O
( )Frame built on site ( )Screenhouse ( )Living room �
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen �� �
( )Mobile/manufactured ( )Other ( )Bedroom �
( )Othe prima�y structure, ( ) ( )Relocate/enlazge A^
� ) �,� I j�-'-��,."w� ( ) ( )#of new
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Additional Information: >
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Type of Construction: �
( )Frame ( )Log (�Q Pole/metal ( )Block ( )Concrete � �
( )Other ��� ���c't- � -�
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Construction Cost:Primary Structure$ `��(.(�
Accessory Building:$ Addition:$
Deed:Vol�i}'�) Pg�"'�� Certified Soil Test# q o1- 3 01 Ob-oZGI ;" z
CSM:Vol��Lot# Sanitary Permit# 4a"�y� Od'ag'7 � 7�
Plat Envelope Or: �
Condo Vol Pg Year Installed: �
Aff of ex septic Vol Pg Owner When Installed:
Previous o�ce approvals/actions:
Vaziance:# LUP:# Q a'398 SP:# CUP:# q����3
Inspection Report:# Change of Zone District: �I9/��
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�031
Describe the construction using t6ese columns. List 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 '� J ft. wide ft. wide ft. wide fr. wide ,
7 Z- ft, long ft. long ft. long ft. long �, ..
Floor area `� (r.v sq. fr. sq. ft. sq. fr. sq. ft. �
Hgt from to peak ft. hgt. ft. hgt. fr. hgt.
Stories stories stories stories
#of bedroo
♦
ear Lot Line
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Fire Number and Name of Road �C.� /U �(•(�y � �
1. Enter lot dimensions and indicate north by arrow. Sign3tt f'e of qwner or Authorized Agent:
2. Indicate the location and size of the requested construction 6"L ��i
�gnaNre
activities.
PrintName � 1 �� �� l�-��r�
3. Alsq indicate the location and distance to the well, The above certifies ihat me listed intormation and intentions are
true and correct.,that all work shall be pedortned in compliance
septic tank and drainfield, wetland azeas, lot lines and to the W�U me 2quirements of the Sawyer Counry 2oning Ordinance
and the laws and regulations of the State of Wisconsin, and if
centerline of tlle road. aciing as ownet(s)agent has the permission ot the owner(s)to
peAortn the work requested on this application. The above
personsls hereby give pertnission for access to the property for
onsite inspection.
Permit fee: � /��L' i�
January 16 2004 '�
Issue Date Signahue of Iss 'ng ent
January 16 2005 3°0% Rule: Average Road Setback:
Expiration Date
Office Comments:
TOWN OF BA :
SEC. 9 TWP 40
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