HomeMy WebLinkAbout006-439-05-1110-LUP-2004-244 , _ - ' v%.
Application for Land Use Permit(*Non-shoreland*) o 0
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 f✓
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. 2 �
PRINT-USE BLACK INK OR PENCIL ("
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Owner Builder < �
II)�ilnU�( ��tATr'1 C�l7U�ti f�oGC�. `�vr�e �:
Mailing Address Mailing Address � �
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City,S— ta p City,State,Zip
�11 S Zldp - Zol3
Daytime Phone Daytime Phone �
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Additional Information: Zone District: �
�QZ d-�9-o�/ �H h/(,�dH
Lot Dimensions:�._pr��X ��Ic�l l3��=
Date lot was created: Acres: �. �� n
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Is there wetland near the proposed structure?If yes,how faz �S�� � �
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Building Land Use Floodptain:f j Yes (;C)No =;
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(x)New ( )Filling �
O Addition O Dredging Driveway access off of a(Check one): �
O Alteration O Grading O Private Rd O Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy N �
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Primary Structure Accessory Building Addition � °
(K)Dwelling (.)Gazage-attached/detached ( )Deck W
( )Year round ( )#of caz stalls ( )Porch �
(X)Seasonal ( )Storage Building ( )Enclosed �
(�Frame built on site O Screenhouse O Living room �
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen O
( )Mobile/manufactured ( )Other ( )Bedroom A
O Other primary structure O O Relocate/enlarge 6
� � ( ) ( )#of new � �
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AdditionalInformation: -D A
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Type of Construction: �
(k)Frame ( )Log ( )Pole/metal ( )Block ( )Concrete
( )Other
-c �Construction Cost:Primary Structure$ 02 S.cX�o �
Accessory Building:$ Addition:$ � �
�3V73�2� �
Deed:Vo1 pg Certified Soil Test# °O
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CSM:Vol Pg Lot# Sanitary Permit# p�/�/(e 'Z � �
Plat Envelope Or: �, �
Condo Vol Pg Yeaz Installed: �
Aff of ex septic Vol Pg Owner When Installed: � �
Previous office approvals/actions: �
Variance:# LUP:# SP:# CUP:#
Inspection Report:# Change of Zone District:
. �1i5�,
3q315 _
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Describe the construction using these columns. List the dimensions of each structure in a separate ' \
column. List each �tory, each addition, each alteration in a separate column.
#1.��� #2. #3. #4.
Size . ,2 y ft. wide ft. wide fr. wide 8. wide
�_ft. long ft. long ft. long ft. long
Floor area '7�sq. ft. sq. ft. sq. ft. sq. ft.
Hgt from gcade�to peak fr. hgt. ft. hgt. ft. hgt.
Stories� stories stories stories
#of bedrooms�
��/�5r w �°-+ '-a�' p /
Rear Lot Line
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Fire Number and Name of Road
1. Enter lot dimensions and indicate north by arrow. Sign re of 0 ner or Authorized Agent:
2. Indicate the location and size of the requested consriuction � ��,� ��y�J
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activities. � !�
Pnnt Name: T'Ct f N�L n ���E.�F',t�
3. Also, indicate the location and distance to the well, rne aeo�e�r�ees mac me rsced mrorrr�anoo a�d �n��5 are
hue and cortect., that all work shall be pedormed in compliance
septic tank and drainfield, wetland areas, lot lines and to the with the requiremen4s of the Sawyer Counry Zoning Ordinance
and ihe laws and regulations of�he State of Wisconsin, and if
centerline of the road. acting as owner(s)agent has tne permission of the owner(s)to
perform the work requested on this application. The above
persons/s hereby give permission for access to ihe property for
_ onsiteinspecfion.
Permit fee: $ � 7,�„ � '��
June 7, 2004
Issue Date Signature ofIss A ent
June 7, 2005
50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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