HomeMy WebLinkAbout006-440-33-4301-LUP-2004-308 ,`.._
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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 �
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Owner Builder c
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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
Additional Information: Zone District: �� �� �
Lot Dimensions:
Date lot was created: Acres: 3�, �� ��� `-c�� n
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Is there wetland near the proposed structure? If yes, how far � �z
Building Land Use Floadptain:( j �es ( j No � �
( )New ( ) Filling �
� Addition ( ) Dredging Driveway access off of a(Check one): �
( ) Alteration ( ) Grading ( ) Private Rd ( ) Town Rd. o
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy N �
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Primary Structure Accessory Building Addition � °
(�Dwelling ( ) Garage-attached/detached ( ) Deck W
( ) Year round ( )# of car stalls ( ) Porch �
O Seasonal O Storage Building O Enclosed �
( ) Frame built on site ( ) Screenhouse �Living room �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen �
( ) Mobile/manufactured ( ) Other ( ) Bedroom .-
( ) Other primary structure ( ) ( ) Relocate/enlarge A
� � ( ) ( ) # ofnew �
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AdditionalInformation: ,.a p
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Type of Construction: �
(�j Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete � �
( ) Other ,..�
Construction Cost: Primary Structure $ � �
Accessory Building: $ , �Addition: $ ,�������- �� �
y 9 3 z y3 � . � �J
Deed: Vol c7�c� Pg�_ Certified Soil Test# � z
CSM: Vol Pg Lot# Sanitary Permit# o, �
Plat Envelope �r� N
Condo Vol Pg Year Installed:� ��'�S'���'?� �� r` `�� �
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Aff of ex septic Vol Pg Owner When Installed:
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Previous office approvals/actions: �
Variance: # LUP: # �(p- 30 SP: # CUP: #
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Inspection Report: # Change of Zone District: �\p`�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.
y #1. #2. #3. #4.
Size �-: ft. wide fr. wide ft. wide ft. wide
E '-, _ft. long ft. long fr. long fr. long
Floor azea�sq. ft. sq. fr. sq. ft. sq. fr.
Hgt.from gade to peak 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 �� J� h�o ��<e( 5 c��!/ /���f°
1. Enter lot dimensions and indicate north by arrow. Signatufe of Owner or Authorized Agent:
2. Indicate the location and size of the requested construction '� j��=��h Fj-���1:�
/` Signature
activities.
Pnnt Name:
3. Also, lndicate the locatlon and dlstanCe to the well, The above cedifies ihat tne listed iniortnation and intentions are
hue and correct., that all work shall be performed in compliance
septic tank and drainfield, wetland areas, lot lines and to the with the requiremenGs of the Sawyer Counry Zoning Ordinance
antl ihe laws and regulafions of the S4�le of Wisconsin, and if
C2nteTllne Of the ioad. acting as owner�s)agent,has the permission o(the owner(s)to
peAorm the work requested on ihis applicatioa The above
personsls hereby give permission for aaess to the properry for
�.� onsite inspection.
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Permit fee: $ / , 7
June 28, 2004 � . � � �
Issue Date Signature of Issuing Agent
hmP 9R, 9nn5 50% Rule: Average Road Setback:
Expiration Date ;� � � � � � � �� � �
Office Comments:
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