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Home My WebLink About002-940-19-2102-LUP-2004-182 Application for Land Use Permit (*Non-shoreland*) o o � :--- County of Sawyer � � PO Box 676 - Hayward WI 54843 � 715/634-8288 *Property that is not located within 300' of a creek, river or stream or within 1000' of a v, flowage, lake or pond or does not have any of the above waterbodies located within J ""�� the property's boundaries. � � CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. PRINT-USE BLACK INK OR PENCIL � � , � � � � ' � � �� ► , � a � Owner Builder c: � �l`��U (��l!�i'(�+� �� Cr�t � �� Mailing Address Mailing Address � ,� Z � City,' tate, Zip City, State, Zip C�I'��q�z-1-�-�I��I �-� Da ime Phone r Daytime Phone Yt �� Additional Information: Zone District: �' � � 0 t�- Lot Dimensions: �' � n � Date lot was created: Acres: S o ,� Is there wetland near the proposed structure? If yes, how far � ro Building Land Use Floadptain:-( j IFes ( j No � —G ( )New ( ) Filling � O Addition O Dredging Driveway access off of a(Check one): �, ( ) Alteration ( ) Grading ( ) Private Rd ( ) Town Rd. o ( ) Moving On ( ) ( ) County Hwy ( ) State Hwy N � � ) � � o � � r Primary Structure Accessory Building Addition � ° ( ) Dwelling Garage-attached/detached ( ) Deck W � Porch �' ( ) Year round ) # of car stalls ( ) � O Seasonal O Storage Building O Enclosed � ( ) Frame built on site ( ) Screenhouse ( ) Living room � � ( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen Q � ( ) Mobile/manufactured ( ) Other ( ) Bedroom �� .- ( ) Other primary structure ( ) ( ) Relocate/enlarge � A � � O O # ofnew � � -fi� �_ AdditionalInformation: � A cn �C � Type of Construction: � ( ) Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete ��' �' O ( ) Other � ,� Construction Cost: Primary Structure $ � � U � �Accessory Building: $�,(�(�).� Addition: $ � C � Deed: Vol 7�t Pg �� Certified Soil Test# �'' � -�� `� z CSM: Vol Pg Lot# Sanitary Permit# C �� ' �3�> o, � Plat Envelope Or� N "�'` 'v, Condo Vol Pg Year Installed: � Aff of ex septic Vol Pg Owner When Installed: " � `J� Previous office approvals/actions: � Variance: # LUP: # �� o - � ; �-� SP: # CUP: # Inspection Report: # Change of Zone District: �''�o y 3�Io"1 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 . o+ C r t� �, �'- #2. �� : � ' �-- #3. ' ti� �cz� #4. Size t ` ft. wide �_� ft. wide _'j ft. wide ft. wide 3U ft. long � �! ft. long �_ ft. long ft. long Floor area 7 a C� sq. ft. �� sq. ft. sq. ft. sq. ft. Hgt. from grade I y b �(� ' to peak ft. hgt. ft. hgt. ft. hgt. Stories � stories stories stories # of bedrooms � Rear Lot Line ',��r � t;� � !ry 1 'P F C�. � � �_ ��.._. \� . . � .. . . . . Fire Number and Name of Road / �`� �i' �' `�� t�r t 1 . Enter lot dimensions and indicate north by arrow. Signature of Owner o�Authorized Agent: 2. Indicate the location and size of the requested construction ,� ;� �,�„��,�1 '� �-�^�J�'' � j ; , ign re i�� activities. � �- �� nntName: L�MMUbL �; 1 C� C" t- �- � 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 regulations of the State of Wisconsin, and if centerline of the road. a�t��s as ow�er�s> a9e�t, has the permission of the owner(s� to perform the work requested on this appliration. The above personsls hereby give permission for access to the property for onsite inspection. Permit fee: $ ( � � . D �� May 13 , 2004 — Issue Date Signature of u Agent May 13 , 2005 0 50/o Rule: Average Road Setback: Expiration Date Office Comments: � � . Iy�� k., �''-�''°f a��'¢> � � ��a� �� v! ``�, � �s —.. _... - r:._� � � � � /�` W i � � � � � � � F= \.� � � �i `� ,�, � � � ; ��'� � „� � , C� � � � �: � � � ��. ��t,� � � � �� : ��, � � o� � � � r � � � � � � �, X � � � � � � Q � � c � � � � � � � � TOWN OF BASS LAKE SEC. 19 TWP 40 N. R. 9 W. COLBROTH LAKE ROAD .5.2 6.2 .2.I .6.3 .6.1 .5.1 .I.I � .7.1 .8.1 .3.1 .4.1