HomeMy WebLinkAbout004-839-08-5123-LUP-2004-134 ������,1•4',!:tNC�J '
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Application for Land Use Permit(*C�^r���?*) � �
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County of Sawyer �, � �,
PO Box 676 -Haywazd WI 54843 -
715/634-8288 n
*Property that is located within 300'of a creek,river or stream or within 1000'of a �
flowage,lake or pond or has any of the above waterbodies located within
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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Owner 3 Builder a
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Mailing Address Mailing Address � �� ' (�
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City State,Zip City,State,Zip �' ��
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Daytime Phone Daytime Phone -
Additional Information: Zone District:
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Lot Dimensions: �� 2 � ��� T��°
Date lot was created: Acres: �
Is there wetland near the proposed structure?If yes,how far o
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Building Land Use Floodplain:O Yes (v No Ts
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(v)New O Filling Chippewa Flowage:O Yes (� No �o
O Addition O Dredging Driveway access off of a(Check one): �
O Alteration (�j Grading (�JJ Private Rd O Town Rd. �
( )Moving On ( ) ( )County Hwy ( )State Hwy °Q
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Primary Structure Accessory Building Addition o 0
( )Dwelling ( )Garage-attached/detached ( )Deck �
O Yeaz round O#of car stalls O Porch L,
( )Seasonal (y�Storage Building ( )Enclosed =
O Frame built on site O Screenhouse O Living room c� ;n
( )Modular/manufactured ( )Greenhouse ( )Kitchen � �
( )Mobile/manufachued ( )Other ( )Bedroom o
( )Other primary structure ( ) ( )Relocate/enlazge �'^
( � ( ) ( )#ofnew � ?
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Additional Information: ;
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Type of Construction: ' �
( )Frame ( )Log (J�Pole/metal ( )Block ( )Concrete
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( )Other ,�
Construction Cost:Primary Structure$ ��f' ,� �
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Accessory Building:$ � � � �� Addition:$ N f� � �y
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Deed:Vol �3 �` Pg -1/ Certified Soil Test# �I � - �q Z � Z
CSM:Vol Pg Lot# SanitazyPermit# O� - t`i G � �
Plat Envelope Or: o, �
Condo Vol N A Pg ��+ A Yeaz Installed: Z��'�?� i�
"Loads and Flows": Vol Pg Owner When Installed: � �
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Previous office approvals/actions: �
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Variance:# LUP:# DO'a� SP:# CUP:# ��
Inspection Report:# Change of Zone District: �v
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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. P��� (3�r r� #z. #3. #4.
Size ;�:-: ft. wide ft. wide ft. wide ft. wide
�r C ft. long ft. long ft. long fr. long
Floor area I Z OC sq. ft. sq. ft. sq. ft. sq. ft.
Hgt from grade �c� 1 to peak ft. hgt. ft. hgt. ft. hgt.
Stories ��:'�9 stories stories staries
#of bedrooms �� �,
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f Lake/Pond/Flowa e/River/Stream ame �a� ��vu'+ at �e ' '
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Fire Number and Name of Road (o R 3 k t�/ ..�o na�'1 �o a �
1. Enter lot dimensions and indicate north by arrow. Signat re of Ownerqr Aut orized Agent:
2. Indicate the location and size of the requested construction �`7�{.v(,Q _,''1• /�g ' �;J•--_
� SignaN
activities. Ill,!{f�i C� ��`�'l c�f�1--�-•
PnntName:
3. Also, 1ndlCate the loCatlon and C�istanCe to the Well, The above certifies that the listed information and intentions are
true antl correcL,that all work shall be pedortned in compliance
septic tank and drainfield, wetland areas, lot lines, with the requirements of the Sawyer County Zoning Ordinance
and the laws and regulalions of the Shate of Wisconsin, and if
centerline of the road and waterbodies. ac��e as owoer�s�a9ent nas cne Pe��55�0� or me ow�e��s��o
perform the work 2quested on this application. The above
� personsls hereby give pertnission for access lo the pmperty for
r, Q onsiteinspection.
Permit fee: $ � t��
Total land area within 300' of the waterbody: (A)
Total impervious surface azea [including this project] (B)
(B) / (A) x 100 =%Used (Shall not exceed 15%[or 25% with a conditional use permit].)
Shoreline Vegetation Protection Area: Mitigarion Required? O Yes O No
May 5 2004 '
Issue Date Signatuxe of Iss ng nt
May 5, 2005 50% Rule: Average Road Setback: _
Expiration Date
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Office Comments: � - ' �
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