HomeMy WebLinkAbout002-106-11-1100-LUP-2004-345 �
Application for Land Use Permit(*Non-shoreland*) o o L____;
County of Sawyer �
PO Box 676 -Haywazd WI 54843 w_„
715/634-8288 � ,,� `,>
*Property that is not located within 300'of a creek,river or stream or within 1000'of a w N� ,
flowage,lake or pond or does not have any of the above waterbodies located within i � �
the property's boundazies. � ,r
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. u �
PRINT-USE BLACK I1VK OR PENCIL '
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Owner Builder � �
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Mailing Address Mailing Address � p �
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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: 1`�-Z �-
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Lot Dimensions: °
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Date lot was created: /9.2Q:5 Acres: , z�7� �c� �
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Is there wetland neaz the proposed structure?If yes,how faz 3 b
Building Land Use Floodptain:f J YEs (�)No �:; —
(�New ( )Filling
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(�i�Addition O Dredging Driveway access off of a(Check one): �
O Alteration O Grading O Private Rd Town Rd. o
(�}Moving On O O County Hwy (�State Hwy �,w,
O O � S
0
Primary Structure Accessory Building Addition �
0
( )Dwelling (�Gazage-attached/detached (,�Deck W
( )Yeaz round ( )#of caz stalls ( )Porch �.
O Seasonai (X)Storage Building O Enclosed �
O Frame built on site (�Screenhouse O Living room
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen �
( )Mobile/manufachued ( )Other ( )Bedroom
( )Other primary structure (��7 c�`����C�/��", E ( )Relocate/enlarge ' �
( ) ( ) �j E 4 N IS�� � �#of new �
AdditionalInformation: ` a
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Type of Construction: p, I�
(�j Frame ( )Log ( )Pole/metal ( )Block ( )Concrete ,�
( )Other
Construction Cost:Primary Structure$ �
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Accessory Building:$ (n.��f�; — Addition:$ ���- � L�
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Deed:Vol�Pg 2/9 Certified Soil Test# °O
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CSM:Vol Pg Lot# Sanitary Permit# �1� C � �� ` ��C) o, 7
Plat Envelope Or: N �
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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: �?��`�' �
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Variance:# LUP:# SP:# CUP:# �
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Inspection Report:# Change of Zone District: � ��z81�
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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 in a separate column.
#1. . — ] �tE #2. ' 62,q� �fnz��G�� #3. ;'�� '/< #4.
Siz�ft. wide �_ft. wide � ft. wide ft. wide
�a�_ft. long � ���fr. long � L_ ft. long ft. long
Floor azea��c� I �i sq. fr. � sq. ft. sq. ft.
Hgt.from gade to peak ft. hgt. ft. hgt. ft. hgt.
Stories � stories stories stories
# of bedrooms�
� 0� f� Rear Lot Line ,
� � ` � i � - ��, ,
� 70�
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Fire Number and Name of Road
1. Enter lot dimensions and indicate north by arrow. Signatu of Own r Auth ' d A
2. Indicate the location and size of the requested construction ,T
Signalure
activities.
PnnWame: �E < <i ���'✓�Fr2. �/ltil�
3. A1S0, 1ndlCate the IoCatlon and d1StanCe to the well, The above ceNfes ihat me listed intormation and intentions are
hue and correct.,ihat all work shall be performed in compllance
septic tank and drainfield, wetland azeas, lot lines and to the wiN the requirements of the Sawyer County Zoning Ordinance
and Ne laws and regulations of the Sfale of Wisconsin, and R
CCritOillne Of tlle ioad. acting as owner(s)agent,has the pertnission of the o�rier(s)to
perform the work 2quested on ihis appliratio�. The above
personsls hereby give permission for aceess to Ne propedy for
onsite inspecfion.
Permit fee: $ ���/
July 12 2004 —
Issue Date Signature of Issu g ent
July 12, 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments: ���� �Q�,� �� 3a�, `�'� `;-.7flii = �'/�� �-Z
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JUL-09-04 08 : 10 AM RIGLEMON RPPRAISAL SERV. 608 378 3023 P_ 01
Bent By: 6AW7ER CO�N'Y 2oning; 715B3B 3277� Jul•2-04 10:6GAM; PagO 1/I '
SawylT Councy innlag Adminlitrn � lon
PO Box 6 '16
x � yword , WI 548a7 - U67d
Tel � 715 634 • 8288
Fax � 71 � 638 - 3277
o -mail : raonio � , � ec � � o .vyercoun [ yaov . org
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