HomeMy WebLinkAbout004-838-24-1201-LUP-2004-336 �
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. � 1
PRINT-USE BLACK INK OR PENCIL �
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Owner R�e.uaec�.tabe Builder c:
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Mailing Address Mailing Address ' �
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City, State, Zip City, State, Zip �
7�.��'` ����1�-���� '�/�— ���— ��5`�5s '
Daytime Phone Daytime Phone �
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Additional Information: Zone District: �—�.
Lot Dimensions: / �L'� � ���.�� �
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Date lot was created: Acres: � G'= �,f o � � �
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Is there wetland near the proposed structure? If yes, how far �`�_ � � �
Building Land Use Floadplain:� j Yes ( j No ° �.
(�New ( ) Filling �
O Addition O Dredging Driveway access off of a(Check one): �
( ) Alteration ( ) Grading ( ) Private Rd (}�'Town Rd. o
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy ,;
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Primary Structure Accessory Building Addition � °
( ) Dwelling ( ) Garage-attached/detached ( ) Deck W
( ) Year round ( ) # of car stalls ( ) Porch �
O Seasonal (�} Storage Building O Enclosed �
( ) Frame built on site ( ) Screenhouse ( ) Living room �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen �
( ) Mobile/manufactured ( ) Other ( ) Bedroom �
( ) Other primary structure ( ) ( ) Relocate/enlarge �
� � ( ) ( ) # of new
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AdditionalInformation: � A
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Type of Construction:
( ) Frame ( ) Log ('�Pole/metal ( ) Block ( ) Concrete n ,�'
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( ) Other ,� ,�
Construction Cost: Primary Structure $ ����� � �
Accessory Building: $ �L, G�G`� Addition: $ � •
�s/�� � �
Deed: Vo? �._ 3�Pg__��___ Certified Soil Test# Q� ��p Z� `� z
CSM: Vol Pg Lot# Sanitary Permit# CSC� - ,�'7� a, �
Plat Envelope 4r� N �
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Condo Vol Pg Year Installed: �o
Aff of ex septic Vol Pg Owner When Installed: �-' �
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Previous office approvals/actions: '
Variance: # LUP: # pU-38 f SP: # CUP: #
Inspection Report: # Change of Zone District: �'�c�
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`�979
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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. #2. #3. #4.
Size .3o ft.wide fr.wide ft.wide ft.wide
U ft.long ft.long ft.long ft.long
Floor area / 4U sq.ft. sq.ft. sq.ft. sq.fr.
Hgt.from gade�to peak fr.hgt. fr.hgt. fr.hgt.
Stories � stories stories stories
#of bedrooms
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4
Rear Lot Line
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Fire Number and Name of Road /Z��`'/l�/ ��Li/i'a'ets- �Ez�c
1. Enter lot dimensions and indicate north by arrow. Signat e of wi�ne or Authon�Agent:
2. Indicate the location and size of the requested construction �%����
SignaNre
2CtlVitiCS. PriniName:�'��rt'S� /��jli'S�c`T—/
3. AISo,1ndiCate the IOCation and d15tanCe to the Well, The above ceNSes that the listed intormalion and intentions are
true and cortect.,that all work shall be performed in cromollance
Sept1C tazlk ancl clralnfielcl,wetland azeas,lot 11nes and to t}�e with the requirements of the Sawyer Counry Zoning Ordinance
and lhe laws and regulations of the Shate of Wisconsin,and if
centerllne of the road. ading as owner(s)aqenL nas the permission of the owner(s)to
perform the work requesled on this appticatioa The above
personsls hereby give permission for access to the property for
� onsite inspection.
Permit fee:$f/�/���
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July 7 2004 ^ � �'�l � —
Issue Date Signature ofIssuing Agent
T„1�7 ?005 50%Rule: Average Road Setback:
Expiration Date
Office Comments:
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