HomeMy WebLinkAbout002-940-32-3201-LUP-2004-583 � 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. ��
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. p r�
R�- �� PRINT-USE BLACK INK OR PENCIL x I
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Owner Builder y�� ��
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Mailing Address Mailing Address —' � O �
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City,State,Zip City, tate,Zip
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Daytime Phone �, - � , Daytime Phone p
Additional Information: Zone District: �-� f
Lot Dimensions: �L/^4��ti �C �t� M��e �
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Date lot was created: ��}8 9 Acres: �� o �
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Is there wetland neaz the proposed structure?If yes,how far /i/O �
Building Land Use Floodpkain:� )Yes OO No :° p
( )New ( )Filling � �
O Addition O Dredging Driveway access off of a(Check one): � �
(�)Alteration O Grading O Private Rd OQ Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy �,"', �
O O o S
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P'mary Structure Accessory Building Addition � °
(�Dwelling ( )Gazage-attached/detached ( )Deck W
( )Year round ( )#of car stalls ( )Porch � O
O Seasonal O Storage Building O Enclosed �
O Frame built on site O Screenhouse O Living room � �
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen �
(l A
( )Mobile/manufactured ( )Other ( )Bedroom ��'� �..'�n
( )Otherprimary structure ( ) ( )Relocate/enlarge �'�
( � ( ) ( )#of new '- v�
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AdditionalInformation: W p �
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Type of Construction: ��� W
( )Frame -�}�o� ( )Pole/metal ( )Block QZj Concrete , N
( )Other ,�
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Construction Cost:Primary Structure$ � �
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Accessory Building:$ lAddition:$ 2 D D 0 0.00 � t
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Deed:Vol �/p�- Pg 77 Certified Soil Test# `��:c '' �i`� °O z
CSM:Vol Pg Lot# Sanitary Permit# o, 7�
Plat Envelope Or: �;, �
Condo Vol Pg Year Installed: Q n,.�,t �-c; l�11�Z'S �
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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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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. ¢�„sr� �h,� #2. #3. #4.
Size_�� ft. wide ft. wide ft. wide ft. wide
�� ft. long fr. long fr. long ft. long
Floor azea 1�/D$ sq. fr. sq. ft. sq. ft. sq. ft.
Hgt. from gade to peak fr. hgt. ft. hgt. ft. hgt.
Stories stories stories stories
# of bedrooms �
Rear Lot Line � "� � �
44 � �(
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Fire Number and Name of Road j 6 -�0 'L v�' ��v �u,r �� .
1. Enter lot dimensions and indicate north by azrow. / �ign e o wner��thoriZed Agent:
2. Indicate the location and size of the requested construction tc,ti; �� z�w��
Signature
activities. �� ,.0
PdnWame: /VLcI�'L4,✓� �eC.� Q�^
3. Also, 1ndlCate tlle IoCatlon and diStanCe to the Well, The above ceRifes that ihe listed infortnation antl inteNions are
true and conect, that all work shall be performed in compliance
septic tank and drainfield, wetland azeas, lot lines and to the with the requiremenGs of the Sawyer County Zoning Ordinance
and the laws and regulations of the State of Wisconsin, and if
centerline of the road. actinq as owner(s) agem, has me permission oi the owneqs) to
pedorm the work 2quested on this applica�on. The above
personsls hereby give permission for access to ihe property for
onsite inspection.
Permit fee: $ �� ,
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October 14 , 2004 _
Issue Date Signature ofI i gent
October 14 , 2005 50% Rule: Average Road Setback:
Expiration Date
D�1C0C.OITIIT1CI1tS: �C��t�� L- t.c:.-4 =[Z-�� ���t %:., i. �� �i ��� .lc.• ��� '�C � -._.E- < '�. :.' t �� aL ,:. ( (� l �'L�Y�.��
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TOWN OF gA�S
SEC . 32 TWP 40 N . �
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