HomeMy WebLinkAbout002-940-05-1207-LUP-2004-491 Application for Land Use Permit(*Non-shoreland*) o o • �--�
County of Sawyer � �
PO Box 676 -Haywazd WI 54843 O
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 PERMITS HAVE BEEN ISSUED. �
PRINT-USE BLACK INK OR PENCIL �n �
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Owner Builder N' �
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Mailing Address Mailing Address O �
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City,State,Zip City,State,Zip
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�,s �3�f- �166�, �v
Daytime Phone Daytime Phone � �.
Additional Information: Zone District: �s�D�C=� � �
Lot Dimensions:
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Date lot was created: Acres: �
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Is there wetland near the proposed structure?If yes,how far �3� G
Building Land Use Floodpkain:���j�Yes O No :<
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( )New ( )Filling �
(�Addition O Dredging Driveway access off of a(Check one): �
O Alteration O Grading O Private Rd Q�Town Rd. o
O Moving On {�J I�A' O County Hwy O State Hwy �,"'i �
( ) ( ) o S
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Primary Structure Accessory Building Add�tion � °
( )Dwelling ( )Garage-attached/detached �Deck W
( )Year round ( )#of caz stalls ( )Porch �
O Seasonal O Storage Building O Enclosed �
O Frame built on site O Screenhouse O Living room `� �
( )Modular/manufactured ( )Greenhouse ( )Kitchen � �
( )Mobile/manufactured ( )Other ( )Bedroom v �
( )Other primazy structure ( ) ( )Relocate/enlarge 1'� '`
� � � � ( )#ofnew � �?
Addi ional Informatio�}, r `� �
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Type of Construction: '� �
(�fame ( )Log ( )Pole/metal ( )Block ( )Concrete �
( )Other .,y .�
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Construction Cost:Primary Structure$�-�-�— o
Accessory Building:$ t `r Addition:$ ��� �
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Certified Soil Test# 4 -N31 "•°
Deed:Vol (o/9 Pg 3 z 8 .5 " z
CSM:Vol�_Pg �eY? _Lot#� Sanitary Permit# 45-y!9 0, �
Plat Envelope d �p���� p��z� Or: � �
Condo Vol Pg Yeaz Installed: � �
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Aff of ex septic Vol Pg Owner When Installed:
Previous office approvals/actions: e
Variance:# LUP:# Q�-5(,i SP:# _ CUP:# �
Inspection Report:# Change of Zone District: C�/ I(��
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Describe the construction usin��umns.List the dimensions of each structure in a separate
column.List each story,each ddit' ch alteration in a separate column.
#1. (�2cK, #2. #3. #4.
Size_�ft.wide ft.wide fr.wide fr.wide
�ft.long ft.long ft.long ft.long � '
Floor area /9� sq.ft. sq.ft. sq.fr. sq.ft.
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Hgt.from grade��to peak ft.hgt. fr.hgt. ft.hgt. i
Stories�� stories stories stories
#of bedrooms�_
Rear Lot Line 0 T TO C Al E '
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Fire Number and Name of Road 9�/1� ����`o� v'�
1. Enter lot dimensions and indicate north by arrow. Sig ature of ner or Autl�orized Agent:
2. Indicate the location and size of the requested construction
activities.J J7
i,J d;�E �-�' I-ko�S 4J ��S�i nature
PnnlName:p��A� �//rMrJ��""4"�✓
3. Also,1ndlCate tlle lOCatlon and d1St3riCC to Y.�1C we��, The above ceRifles ihat the listed inio�mation and intentions are
We and correct.,mat all work shall be performed in compliance
septic tank and drainfield,wetland azeas,lot lines and to the with the requirements of the Sawyer County Zoning Ordinance
antl ihe laws and regulations of the State of Wisconsin,antl if
Centerllne Of the IOad. acting as owneY�s)agent has the permission oi the owner�s)to
peAortn the work requesled on ihis appiicafion. The above
personsls hereby give permission for aaess ro the property for
onsite inspection.
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Permit fee:$ �5 `
September 9, 2004 �� ,� �(1 ��—�D,u�T_��--
lssue Date Signature of Issuii A e t �
September 9, 2005 0
50%Rule: Average Road Setback:
Expiration Date
Office Comments:
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APE%SURYEYORS
P.O.BO%60] Cl1EN7 BFAO k JAMIE ZIMMEk4AN
HAYWAR�,M1 51813
715-6J1-34J5
SAWYER COUNTY CERTIFIED SURVEY MAP #
LOCATFD IN THE SW7/4 OF THE NEi/4 OF SECTION 5,T4�N,R9W,TOWN OF BA55 LAKE, SAWYFR C0.'M.
SUR1�£YORS NOTE ��y�U 1 6
7HIS SURVEY IS A REfRACEAlENT
Of LOTS 19 k 20 SAWrER C0. p�y�y��
CERTIFlED SUR4EY�1058 8Y y�,��w,
SWANSON IN 1976. �p�a��b���r
hiE INTENT OF THIS SURVEY IS TO N �,�p��r�
ESTABl1SH A NEW BOl1NDARY IJNE ���„�
BET15£EN LOTS 19&20 � e ���d��
BEARINGS ARE REFERENCED TO hIE W E
sout�R.o.w.uNE oF rowH Ro. p 0 �
ASSUMED TO BEAR S85'00'00'E S �a,��_��1tr`/n � •,�
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