HomeMy WebLinkAbout006-439-30-3408-LUP-2004-211 Application for Land Use Permit(*Non-shoreland*) L '
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County of Sawyer �
PO Box 676 -Hayward WI 54843
715/634-8288 �
*Property that is not located within 300'of a creek,xiver 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 ISSUER .�
PRINT-USE BLACK INK OR PENCIL '
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Mailing Address Mailing Address � `
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City,State,Zip ity,State,Zip �
'l(`�-(ok� -313(� �IS-(���7-313� �'
�ytime Phone Daytime Phone Z
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Additional Information: Zone District: /2 I� 1 �
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Lot Dimensions: (I,��X 13a-0 J`
Date lot was created: :�'��I'�3 Acres: S �C(�S 'k_=s`���-� � �
Is there wetland near the proposed structure?If yes,how faz �C.) v � �
Building Land Use Floodplain:�( j 3'es� O No � `;
�;New ( )Filling � �
Addition Dred m Drivewa access off of a Check one CD
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O Alteration O Grading O Private Rd O Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy i.wi �
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Primary Structure Accessory Building Addition � ° �
�jDwelling ( )Garage-attached/detached ( )Deck "' �''�
( )Yeaz round ( )#of car stalls �Porch = �
( )Seasonal ( )Storage Building ( )Enclosed � �
O Frame built on site O Screenhouse O Living room �
( )Modular/manufactured ( )Greenhouse ( )Kitchen �
( )Mobile/manufactured ( )Other ( )Bedroom ��
( )Other primazy structure ( ) ( )Relocate/enlarge
� � ( � ( )#of new � �+
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AdditionalInformation: -w A c�iy
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Type of Construction: ^ �
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�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete ,
( )Other ,�
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Construction Cost:Primary Structure$ �� D��� o
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Accessory Building:$ Addition:$ �
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Deed:Vot 'S` Pg� Certified Soil Test# ��('�_ "° z
CSM:Vol Pg Lot# Sanitary Permit# (�y-I�`� o, '�
Plat Envelope �r� N —�
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Condo Vol Pg Year Installed: co �
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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: `1C�I b 1
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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. //�o/c ti- #3. #4.
Size r�L� ft. wide (�ft. wide ft. wide fr. yvide
�ft. long c�� ft. long ft. long �t. long
Floor area.� sq. ft. � sq. ft. sq. ft. sq. ft.
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Hgt.from grade to peak ft. hgt. ft. hgt. ft. hgt.
Stories �_ stories stories '� stories
# of bedrooms a2--
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Fire Number and Name of Road �c.c���-� /�,�C
1. Enter lot dimensions and indicate north by arrow. e of Ow er or Authorized Agent:
2. Indicate the location and size of the requested construction � �a. .t�.� .
ignaWre
activities. /
PnntName: �%.St� ..Sf'/�P �' _
3. Also, lndicate the locatlon and dlstance to the well, The above certifies tnat tne listed information and intentions are
We and conect., that all work shall be performed in compliance
septic tank and drainfield, wetland areas, lot lines and to the w�m me requ�rements or ma sawye�co�nry zonin9 o�a�nance
and the laws and regulations of the State of Wisconsin, and if
C8rit0I'11ri0 Of t}10 I03d. acting as owner(s)agent, has Ihe pertnission of the owner(s)to
perform ihe work requested on this application. The above
personsls hereby give permission for aaess to the property (or
onsite inspedion.
Permit fee: $ �7So�
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Ma��, ?004 �� � '� —
Issue Date Signature of Is 'ng ent
May 24 , 2005 50% Rule: AverageRoadSetback: _
Expiration Date
Office Comments:
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