HomeMy WebLinkAbout002-940-06-4302-LUP-2004-225 Application for Land Use Permit(*Non-shoreland*) o o `""""
County of Sawyer �, �
PO Box 676 -Hayward WI 54843 I
715/634-8288 r
*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 _ 1
the property's boundaries.
CONSTRUCT�ON SHALL NOT BEGiN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED.
M Q�� �a 1''� PRINT-USE BLACK INK OR PENCIL
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Owner Builder �'
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Mailing Address Mailing Address O
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City,St te,Zip City,State,Zip
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Daytime Phone Daytime Phone C �
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Additional Information: Zone District: I/��'� � �
Lot Dimensions: `��0� X 1(D � ��--�
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Date lot was created: Acres: /O, o (0
Is there wetland neaz the proposed structure?If yes,how faz �
Building Land Use Floodp}ain:( j Yes O No �
(�New ( )Filling �
O Addition O Dredging Driveway access off of a(Check one): �
O Alteration O Grading O Private Rd (�Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy �,"', �
( ) ( ) � S
0
Pri ary Structure Accessory Building Addition .�'o r
0
(�Dwelling ( )Garage-attached/detached ( )Deck "'
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( )Yeaz round ( )#of caz stalls ( )Porch �.
(i'jSeasonal ( )Storage Building ( )Enclosed �
O Frame built on site O Screenhouse O Living room
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen �
( )Mobile/manufactured ( )Other ( )Bedroom �„ `�
( )Other primary structure ( ) ( )Relocate/enlazge r �
( ) ( ) ( )#of new � :�
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AdditionalInformation: o p�
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Type of Construcrion: � �' �
( )Frame ( )Log ( )Pole/metal (✓�Block ( )Concrete �� � C�6
( )Other � �
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Construction Cost:Primary Structure$ Z� , a�� �
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Accessory Building:$ Addition:$ ,� �
D e e d:V o l 7aa P g �8 C e rt i f i e d S o i 1 T e s t# py-O S� tl4 z
CSM:Vol Pg Lot# Sanitary Permit# Dy-�!O � �
Plat Envelope Or: N �;�
Condo Vol Pg Yeaz Instailed: �
Aff of ex septic Vol Pg Owner When Installed: % �
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Previous o�ce approvals/actions: �' �^
Variance:# LUP:# SP:# CUP:# � �
Inspection Report:# Change of Zone District: / I6 y
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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 alteration in a separate column.
#1. �,i +� I,.ev�l #2. ,l.c���- #3. ,�- #4.
Size��fr. wide 2i: ft. wide ft. wide ft. wide
� � ft. long I � ft. long ft. long ft. long
Floor area�� 1- sq. ft. 7-�ZG sq. ft. sq. ft. sq. ft.
Hgt.from grade � It•� to peak�ft. hgt. ft. hgt. fr. hgt.
Stories -L I stories stories stories
# of bedrooms 1
� 0 Rear Lot Line
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�,� ` Fire erandName fRoad �jt>>�' � � �i �„i, N,�)
1. Enter lot dimensions and indicate north by arrow. Sig tu� of Ow r or ut oriz Agent:
2. Indicate the location and size of the requested construction .� ��^� � . �t�y�
&ChVlh05. _ gna `
Pont Name: � i� �1/1 L- � �l �C I
3. A150, 1ndiCate the loCatlon and CI1StanCe t0 the we�l, The above certifies that the listed intortnation and inten�ions are
hue and wnect., Mat all work shall be peRormed in compliance
septic tank and drainfield, wetland azeas, lot lines and to the with the requi2ments of the Savryer County Zoning ONinance
and fhe laws and regulalions of the State of Wiscronsin, and if
CCritC[IIriC Of t118 T02d. acting as ownet(s)agent,has ihe permission of the owner(s)to
perfortn Ne work requested on this application. The above
personsls hereby give permission for acceu to ihe propehy for
onsite inspec6on.
Permit fee: $�Od iSO a�
May 27 , 2004
Issue Date Signature of Issu g A nt
May 27 , 2005 50% Rule: AverageRoadSetback:
Expiration Date �
Office Comments:
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