HomeMy WebLinkAbout006-439-06-3201-LUP-2004-164 ,
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Appli�ation for Land Use Permit (*Non-shoreland*) o o _
County of Sawyer �' �
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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 po
nd or does not have any of the above waterbodies located within � ���
the property's boundaries. �'i �
CONSTRUCTION SHALL N PTR NT I USE BLACK INK OR PENCIL M�TS HAVE BEEN ISSUED. �
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��� ���iT l�C'_��; � �P�M � � � r�x:. ,
Builder �.
Owner _.
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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 �I"�
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Additional Information: Zone District: ` R,�"� � �' � � �,
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Lot Dimensions: � lo�o � � �J �� �
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Acres: J - � I n
Date lot was created: ? V - - o ^
Is there wetland near the proposed structure? If yes,how far t�v � � �
Fload lain. Yes o � C,
Building Land Use P � � � 1V � �
�New ( ) Filling �
O Addition O Dredging Driveway access off of a(Check one): � ''
Private Rd �(Town Rd.
( ) Alteration ( ) Grading � ) �
O Moving On (�Le�e� �o t ��rec��I O County Hwy O State Hwy , � N
� ) _3u�ld;a� acc.ess c��-�- c� pt'��c:�� o S
� ) �rc�.:� �c.cess c� -�oc,,�� r-,
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Accessor Buildin Addition _ ;a �
Primary Structure Y g k �, �
( i T�:��elling O Garage-att�chec?!d�tach�d � ) TJe�_ w
( ) Year round ( ) # of car stalls ( )Porch -� � ��� Z
( ) Seasonal ;�Storage Building ( ) Enclosed � � �
O Frame built on site O Screenhouse O Living room z ��
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen � `�L. �
( ) Mobile/manufactured ( ) Other ( ) Bedroom C� -- 5
Other rimar structure ( )
( ) Relocate/enlarge �i` � �,
� � � p y � � ( ) # ofnew �� �, �
� � � _ . C� l � � �N t
Additional Information: -�-'h�
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Type of Construction: '
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( ) Frame ( ) Log �ole/metal ( ) Block ( ) Concrete � �
( ) Other 'b� '� �n
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Construction Cost: Primary Structure $ � �
C�4 Addition: $ '� � � ``
Accessory Euilding: $ o����• ` '�
m I 3
# 3�$�(07 cm
Deed: Vol Pg __ Certified Soil Test# : Z �
Lot# Sanitary Permit# c� a 'Do`1 P o� � ..�.
CSM: Vol Pg � �
Plat Envelope Or: N .�
Year Installed: v�d D� -r �� �� � I
A Condo Vol rg � �
Aff of ex septic Vol Pg Owner When Installed: "
����L� W ����� G
Previous office approvals/actions:`� ���c by hne. r
Variance: # LUP: # Q - !8 SP: # CUP: # �
Inspection Report: # Change of Zone District: �r
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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 i#3 separate column. #4.
#1 . e. �he #2• ft. wide
Size 1 8 ft. wide ft. wide ft. wide
ft. lon ft. long
3 � ft. long ft. long g
Floor area 5`��o sq. ft. sq. ft. sq. ft. sq. ft.
' ft. hgt. ft. hgt. ft. hgt.
Hgt. from grade /` � ._ �I�
Stories
( stories stories stories
# of bedrooms _Q_
Rear Lot Line
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Fire Number and Name of Road �7 D3 `f � • G � �'� t� R�' � � "�� � � sy89�
1 . Enter lot dimensions and indicate north by arrow. Signature of Owne or Authorized Agent:
2. Indicate the location and size of the requested construction Sign re
aCt1V1t18S. Print Name: �e � � v E" C� � �'
The above certifies that the listed information and intentions are
3. Also, indicate the location and distance to the well, true and correct., that all work shali be performed in compliance
with the requirements of the Sawyer County Zoning Ordinance
septic tank and drainfield, wetland areas, lot lines and to the and the laws and regulations of the State of Wisconsin, and �r
acting as owner(s) agent, has the permission of the owner(s) to
centerline of the road. Perform cne wor� requested o� cn�s application. The above
` � v�C ; � �,� ti� �� �^ � Y\ �c�`,��a,� � ,� � personsls hereby give permission for access to the property for
N D -T� F '-,t.`M� E s�!• �- t onsite inspection.
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Permit fee: $ f�
May 11 , 2004 _
Issue Date Signature of Iss i g nt
May 11 , 2 0 0 5 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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_ SEC. 6 TWP 3 � N.
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