HomeMy WebLinkAbout006-146-03-1700-LUP-2004-163 ,- � Application far Land Use�Permit(*Non-shoreland*) o o .
County of Sawyer V � L`,
� � �� ��PO Box 676 -Haywazd VJI 54843 — '
� � 715/634-8288 -�
*Property that is not located within 300'of a creek,river or stream or within 1000'of a �U
flowage,lake or pond or does not have any of the above waterbodies located within 5 �
the property's boundaries. `'Q
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. � ��
PRINT-USE BLACK INK OR PENCIL �
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Owner Builder �' �
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Mailing Address Mailing Address � � ���
�Ore��. �T S�(�J� � �
City,State,Zip City,State,Zip �
'7�5 - a�(o v�CL�G7 S/-�'b�_ � �
Daytime Phone Daytime Phone , �. �
Additional Information: Zone District: i'` � �
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Lot Dimensions:
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Date lot was created: Acres: '-/3 0
Is there wetland near the proposed structure?If yes,how faz G �
Building Land Use Floodptain:f j Yes O No
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�New ( )Filling � p
Addition Dred in Drivewa access off of a Check one CD S
� ) � ) g B Y � )� 60
O Alteration O Grading O Private Rd (�Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy N �
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Primary Structure Accessory Building Addition � °
( )Dwelling �)Gazage-attached/detached ( )Deck W
O Year round (�#of car stalls O 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 -
( )Other primary structure ( ) ( )Relocate/enlarge �
� � ( � ( )#of new i
Additional Information: A
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Type of Construction: u�
�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �,�
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( )Other ,�
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Construction Cost:Primary Shucture$ �
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Accessory Building:$� t� Addition:$ x� v�:
3 f S'/7,r' 3 i 4 S J(p `°
Deed:Vol s�c �Pg 3��/ Certified Soil Test# 93`�Gy °4 z
CSM:Vol Pg Lot# Sanitary Permit# 93•3!�/ � 7y
Plat Envelope �r� N �
Condo Vol Pg Yeaz Installed: rn
Aff of ex septic Vol Pg Owner When Installed: � �
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Previous office approvals/actions: W
Vaziance:# LUP:# SP:# CUP:#
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Inspection Report:# Change of Zone District:
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S"7N8
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�`L ft. wide ft. wide ft. wide ft. wide
-�' U ft. long ft. long ft. long ft. long
Floor area (, � sq. ft. sq. ft. sq• fr. 59� fr•
Hgt.from grade to peak ft. hgt. ft. hgt. ft. hgt.
Stories stories stories stories
# of bedrooms
Rear Lot Line
P �r'_ .. ;_. �)..���� :�l ; . ..
Fire Number and Name of Road '� CJ l� 1��� `7 �—� Sfi
1. Enter lot dimensions and indicate north by arrow.
Signature of Owner or Authorized Agent:
2. Indicate the location and size of the requested construcrion
. SignaNre ,
activities.
' Print Name: �
3. AlsO, 1ndlCate the IoCation and d1St211Ce to the Well, �Zhe above ceRifes ihat the Ilsted iniormation and intentions are
true�and covect, that all work shall be pedormetl in compllance
septic tank and drainfield, wetland areas, lot lines and to the w�m m�eqd�rsme�a or me sewyer co��ry zo�i�9 ord��ao�
and the laws and�regUlations of the State of Wisconsin, and if
C8rit0LI1R0 Of Y110 LOad. acting as owner(s)agent, has the permisslon of the owner(s)to
pedorm the work requested on this applica�on. The above
personsls hereby give pertnission for access to lhe property for
onsite inspection.
Permit fee: $ I D C� �G' C
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May 11 , 2004 � ( �
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Issue Date Signature of Issuing Agent
May 11 , 2005
50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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3rd Street . � 1
David G Crisman
7015 N StreeC
Loretta Wf 54896 lY X 18"existing .
715-26G-�3rT"""�' .��
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Lot Size 100 X 108 19 /
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Le al Descri tion i
Section Townshi 39 :
Nor[h Range 4 West Se c
Village of Loretta j p�
Sawyer County , I 05 '
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1► � ' - New Garage �
♦ �� 34 X 20 v
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S � ��1 _ _ _ IOFT
10 feet
House 36 X 24
4th Street
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SEC. 3 TWP 39 N . R. 4 W
SCALE I"= �00'
NW oF S.E.
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