HomeMy WebLinkAbout002-133-04-0900-LUP-2004-469 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 �
the property's boundaries. � 1
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMTTS HAVE BEEN ISSUED. �n
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Owner �� Builder o: �
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Mailing Address Mailing Address . O
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City, State, Zip City, State, Zip ��
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Daytime Phone Daytime Phone � C�
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Additional Information: Zone District: ?�
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Lot Dimensions: /�! 7 X Z�� � T�
Date lot was created: Acres: � �� n
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Is there wetland near the proposed structure? If yes, how far � r =
Building Land Use Floadptain:� j Yes (v�10 � �
(�,if New ( ) Filling � T�
O Addition O Dredging Driveway access off of a(Check one): � �
( ) Alteration ( ) Grading ( ) Private Rd (vjTown Rd. o
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy N �
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Primary Structure A,,�cessory Building Addition � °
(✓�Dwelling (N iarage-attache e ( ) Deck W
(v�Year round ( ) # of car stalls ( ) Porch �
( ) Seasonal ( ) Storage Building ( ) Enclosed �
(�rame built on site ( ) Screenhouse ( ) Living room �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen `�
( ) Mobile/manufactured ( ) Other ( ) Bedroom .-
( ) Other primary structure ( ) ( ) Relocate/enlarge � �
� � ( � ( ) # of new Ct�
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Additional Information: (1 �,r t? A
1 I � �'� o��' ac� ed Ar�.'� � Co.n`���v�r ��� ';� rr
( � s�'ory �we � ���� w c�
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Type of C�onstruction: o�
(�Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete �+ q�
( ) Other ,..d y
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Construction Cost: Primary Structure $_���� _ �
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Accessory Building: $ Addition: $ � W
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Deed: Vol�{� Pg�/q Certified Soil Test# dy-�S � z
CSM: Vol Pg Lot# Sanitary Permit# O y- �33 7 0, �
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Plat Envelope Or: N �
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Condo Vol Pg Year Installed: � �
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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: # D(�
Chan e of Zone District: � �� �
Inspection Report: # g �
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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 col�mn. �,
#1. L�we I �Ihal #2. U}i � ,-} ,�Ro�in� #3. , ac c CsaVc�Z #4. Z S�'or./
Size_�wifr de ��ft. widel����`' � z�-I ft. wide IZ ft. wide
� (o ft. long �_ft long ��ft. long �ft. long
Floor area -�ao sq. fr. � Z sq. ft. 5-1�o sq. ft. y3Z sq. fr.
Hgt.from gade a�� to peak I I ft. hgt. �y ft. hgt. ft. hgt. v
Stories ��'z _L stories � stories stories
# ofbedrooms�_ S �k1 � �PpEr `-;{o�'y Ur�.r-� C'�n +<.Y �F' pu1F'.1 ',;,�
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8 X � �r�� ry POVC� �; --�X20 at Yact? (�P� I�
} cU Tckit R�ar Lot Line
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Fire Number and Name of Road � i r c ( e JY�� �y w ��`�
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1. Enter lot dimensions and indicate north by arrow. Sign r ol'Qt►t orized Agent:
2. Indicate the location and size of the requested construction
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activities.
PnnWame: ���IPv _� ��(� �
3. AISo, inC�iCate the IoCatlon and d15tanCe to the well, The above ce 'fies ihat the listed intormation and intentrons are
hue and correct., �hat all work shall be peAormed in compliance
Sept1C t3T11C anC�dralnfleld, wetland BTeas, lot lines and to Ylle with the requirements of the Sawyer County Zoning ordinance
and ihe laws and regulations of the Shate of Wisconsin, and if
CCriYCi11riC Of 1.�'1C I03d. acting as owner�s)agent, has the pertnission of the owner(s)to
pedortn the work requesletl on this applicatioa The above
personsls hereby give permission for access to the property for
onsite inspection.
Permit fee: $ p��
September 2, 2004 -
Issue Date Signature of su n Agent
September 2, 2005
50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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. SCALE� I�� = 200 �
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/ COUP.T OREILLES LAKE