HomeMy WebLinkAbout006-439-31-3301-LUP-2004-259 SP�� �AL us�' �- �
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.
PRINT-USE BLACK INK OR PENCIL 1
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( �Gr�i S 1� •�cx.�le Jc.;�,_.� a
Owner Builder <'
JGo �c5•.,�1v,�..,� L'7. p. �
Mailing Address Mailing Address �
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City,Sta e,Zip City,State,Zip (�
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Daytime Phone Daytime Phone �'�
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Additional Information: Zone District: �
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Lot Dimensions: ,�o�.�55� X �3��•� �
Date lot was created: ���v7��a Acres: /� �y o �
Is there wetland near the proposed structure?If yes,how far �
Building Land Use Floodptain:f� )Yes (�j No �
�j New ( )Filling �
Addition Dred in Drivewa access off of a Check one `D
� ) � ) g g Y � )� do
O Alteration O Grading O Private Rd (�Q Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy i,"', �
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Primary Structure Accessory Building Addition � °
Q�Dwelling (}�Gazage-attached/detached O Deck W �/�
(�Yeaz round � ( )#of car stalls ( )Porch � ,U��
O Seasonal O Storage Building O Enclosed � u
O Frame built on site O Screenhouse O Living room �
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen �
( )Mobile/manufactured ( )Other ( )Bedroom � a
( )Other primazy structure ( ) ( )Relocate/enlazge �
� � ( ) ( )#of new W �
Additional Information: P
cH cn
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Type of Construction: w �.�
Q�Frame ( )Log ( )Pole/metal ( )Block (�O Concrete � —
( )Other � _.,�
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Constracticn Ccst:Primar;�Structu:e$ �o�j C`t�-U � �
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Accessory Building:$ Addition:$ � �
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Deed:Vol y�a Pg ��� Certified Soil Test# Q - � '� Ur tl4 z
CSM:Vol Pg Lot# Sanitary Permit# �� - ��b o, �
Plat Envelope Or: �;, y,^
�
Condo Vol Pg Year Installed: �
Aff of ex septic Vol Pg Owner When Installed: " �
Previous office approvals/actions: _
Variance:# LUP:# SP:# CUP:#
Inspection Report:# Change of Zone District:
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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 columa
#1. t �., Il:��� #2. c � ' z� #3. #4.
Size c>' . wide ���. wide ft. wide ft. wide
�� ft. long �_ft. long R long ft. long
Floor area�� sq. ft. � sq. ft. sq. ft. sq. ft.
Hgt.from gade s��5 to pealc ft. hgt ft. hgt. ft. hgt.
Stories�_ stories stories stories
# of bedrooms_�__
Rear Lot Line
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Fire Number and Name of Road 7i r�-�� T�---r' ��-< <
1. Enter lot dimensions and indicate north by arrow. Si na�t+j e f wner h rized A ent:
2. Indicate the location and size of the requested construction 9� "����� 9
SignaNre
activities.
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Pnnt Name: � "�"�"5 � • 4�"�p
3. Also, 1ndiCate The loCatlon&Tld C�isYariCe to the Well, The above ceRifies ihat the listed infortnation and Intentions are
true antl covecL,ihat all work shall be pedormed in compliance
Sept1C tari1C&Tld ClrainFleld, wetl3rid areas, lot 11nes 3Tld To Y�le with the requiremenGs ot ihe Sawyer County Zoning Ordinance
and the laws and regulations of the State of Wisconsin, antl If
Centetllne Of ttle Ioad. acting as owner(s) agent,has the pertnission ot the owner(s)to
perform ihe work requested on this application. The above
personsls hereby give permission for aceess to the property for
onsite inspection.
Permit fee: $ c�� � J� ���
June 10, 2004 ;�
Issue Date Si ature of Issuing Agent
June 10, 2005
50% Rule: Average Road Setback:
Expiration Date
Office Comments:
IT IS TAE PROPERTY OWNER'S RESPONSIBILITY TO SUBMIT THIS FORM TO
THE TOWN BOARD FOR THEIR ACTION AND TO RETURN THE COMPLETED
FORM TO THE ZONING DEPARTMENT
Town of �"�`�"°�
County of Sawyer
s./3� �
Date
SUBJECT: Town Board Consideration of a Special Use Application for t� �s�ruction of a Year-
,� �.�°, �t� ���,'�
round or Seasonal Dwelling in the Forestry One (F-1) Zone District � �, ", , .. ,� � ,, : ,,R�,!
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TO: Sawyer County Zoning Administration ;� ' ` ���, � 2 2��� ; ;
P. O. Box 676 �`. � , �
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Hayward, Wisconsin 54843-0676 "
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Owner: �'1�.�-�< J� �,�,v-�
Address:
Approval is desired for the construction of the dwelling(s) indicated on the property owner's
Application for a Special Use Permit. (This application is to be presented to the Town Board for
review.)
By Action of thP Town Board, �ase is: (�) AYYroved O Denied O Tabi�d
Comments: � ' �� —�� �..��
a rll_e.,e��it-r ;� �4 Gt ��i,�c�.o i �� i.rlZ..ec.4 .i1��p .� �J .��v Dl��� ,
Chairman f
Supervisor �'' �1�� � -_` , �
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Supervisor `"f�-� " �.-,� ,�
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