HomeMy WebLinkAbout002-840-31-5315-LUP-2004-637 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
flowage, lake or pond or does not have any of the above waterbodies located within V,
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 Maili g Address O �
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City, State, Zip City, State, Zip �
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Daytime Phone Daytime Phone �
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Additional Information: Zone District: �R.-► �
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Lot Dimensions:/lc�l`i6'X l�e g,���x ��.cs x Gsv.b °.
Date lot was created: Acres: �� 3� o �
Is there wetland near the proposed structure? If yes, how far /1/�1 � �
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Building Land Use Floadptairi: ( j �es (�('f No � �
(�{1 New ( ) Filling � �
O Addition O Dredging Driveway access off of a(Check one): �
( ) Alteration ( ) Grading ( ) Private Rd (7Q Town Rd. o
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy �; �
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Primary Structure Accessory Building Addition � �
(� Dwelling ( ) Garage-attached/detached ( ) Deck W
Q�(Year round ( ) # of car stalls �( �Porch �
( ) Seasonal ( ) Storage Building � j Enclosed �
( ) Frame built on site ( ) Screenhouse ( ) Living room �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen �
J�jMobile/manufactured ( ) Other ( ) Bedroom c� A
( ) Other primary structure ( ) ( ) Relocate/enlarge �
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AdditionalInformation: ' „ '
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Type of Construction: w
� Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete - �
( ) Other
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Construction Cost: Primary Structure $ � �`T� �C)��. �� � �
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Accessor Building: $ -� Addition: $ -6- �
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Deed: Vol �zS Pg 7�'Z Certified Soil Test# p 3 3� °° z
CSM: Vol Pg Lot# Sanitary Permit# p y_ y y y � :�
Plat Envelope Or: N v
Condo Vol Pg Year Installed: �'
Aff of 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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