HomeMy WebLinkAbout002-940-21-5307-LUP-2004-206 � G i L Us �' .
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Application for Land Use Permit (*Non-shoreland*) ' ��
r a
County of Sawyer N � . `'
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 � G
flowage, lake or pond or does not have any of the above waterbodies located within �
the property's boundaries. �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. �'
PRINT—USE BLACK INK OR PENCIL ,
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Mailing Address Mailing Address �
w,� �� S� �� f� � u/r S'��y3 �
City, tate, Zip Ci , State, Zip
17�s�) �q`� - 097/ CT�s� Z9� -3�32 �
Daytime Phone Daytime Phone
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Additional Information: Zone District: � '"'� �-)
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Lot Dimensions: �S'9�. �0 �X �3oc�9� ' �
Date lot was created: y����Z Acres: /l 2 7 0 �
Is there wetland near the proposed structure? If yes, how far � �
Buil ing Land Use Floodptain:( j Yes (�o °
(�New ( ) Filling �
O Addition O Dredging Driveway access off of a(Check one): �,
( ) Alteration ( ) Grading ( ) Private Rd ( ) Town Rd. o
( ) Moving On ( ) ( ) County Hwy ( tate Hwy N �
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Prim Structure Acce ory Buil ' Addition � °
(��King (��rag -attached/ etached ( ) Deck "'
�ar round (�'# of car stall�3) O Porch �
� Enclosed
( ) S �onal ( ) Storage Building ( ) �
( Frame built on site ( ) Screenhouse ( ) Living room �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen �
( ) Mobile/manufactured ( ) Other ( ) Bedroom � .-
( ) Other primary structure ( ) ( ) Relocate/enlarge '
,�
� � ( ) ( ) # of new '�'
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AdditionalInformation: � �
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Type of Construction: U �
(v�Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete �+
( ) Other ~-� ,�
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Construction Cost: Primary Structure $ `7C���� �
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Accessory Building: $ Addition: $ �
,-.
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Deed: Vol �� Pg 7�� Certified Soil Test# ��- � � � °4 z
CSM: Vol �� Pg�Lot#�_ Sanitary Permit# �)<%-/ LJL�' o, 7�
Plat Envelope � �5`'� Or: '-'
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Condo Vol Pg Year Installed: �
Aff of ex septic Vol Pg Owner When Installed: `-' �
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Previous office approvals/actions: LJ
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Variance: # LUP: # SP: # CUP: # �
Inspection Report: # Change of Zone District:
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Describe the construction using these columns. List the dimensions of each structure in a separate . •
column. List each story, each addition, each alteratio m a separate column. . �
#l . i�Y1� �:£�Ic � #2. a-- (�,��n�sJx,l� #3. ��_ #4.
Si �'x33 ft. wide � ft. wide �o _ ft. wide ft. wide
�ZO'`� ft. long \ �'�Z�' � ft. long 3� ft. long ft. long
Floor area / ) sq. ft. /�(3 sq. ft. �3�v sq. ft. sq. ft.
Hgt. from grade ?�6� to peak � ft. hgt. � ft. hgt. ft. hgt.
Stories Z � stories � stories �stories
# of bedrooms 3
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Rear Lot Line
�3 oB. 9 7 ` . _` , .- — - - ,
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Fire Number and Name of Road 8���✓ �O �d✓�a_�rr,�
1 . Enter lot dimensions and indicate north by arrow. S• or Authorized Agent:
2. Indicate the location and size of the requested construction �. . �
r ignature ,
1Ct1V1t10S. PnntName: � �7A IeWS��
3. Also, indicate the location and distance to the well, The above certifies that th sted 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�c��s as ow�er�s� a9e�c, has the permission of the owner(s) to
perform the work requested on this application. The above
persons/s hereby give permission for access to the property for
onsite inspection.
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Permit fee: $ c� �
May 24 , 2004 -
Issue Date S' nature of Issuing Agent
May 25 , 2005 0
50/o Rule: Average Road Setback: _
Expiration Date
Office Comments:
IT IS THE PROPERTY OWNER'S RESPONSIBILITY TO SUBMIT THIS FORM TO
THE TOWN BOARD FOR THEIR ACTION AND TO RETURN THE COMPLETED •
FORM TO THE ZONING DEPARTMENT
Town of hRS j L_R Kt
County of Sawyer
�j _ 1`�l _�,`�
Date
SUBJECT: Town Board Consideration of a Special Use Application for the Construction of a Year-
round or Seasonal Dwelling in the Forestry One (F-1) Zone District
TO: Sawyer Counry Zoning Administration
P. O. Box 676
Hayward, Wisconsin 54843-0676
Owner: -.joNtJ J �'�� Cv,C ��(�c'���A K C'(��C�1�
Address: `c3a35N S��i� 62� 0�1 Navw�ce�� w.i .� P<-I�
Approval is desired for the construction of the dwelling(s) indicated on the property owner's
Application for a Special Use Permit. (This application is to be pcesented to the Town Board for
review.)
By Action of the Town Board, use is: (�Approved O Denied O Tabled
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Comments:
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Chairman ;,.� �
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Supervisor
Supervisor
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SCALE : I INCH = 400 FEE
DRAWN BY : D
COLON ( : ) tNDIGATES GO