HomeMy WebLinkAbout006-439-31-2104-LUP-2004-332 Application for Land Use Permit(*Non-shoreland*) o o �
County of Sawyer � � �
PO Box 676 -Haywazd WI 54843
715/634-8288
*Property that is not located within 300'of a creek,river or stream or within 1000'of a O
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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CkA¢.�Es �: C3 �FG'o�D 5a�n�a a
Owner Builder N'
�(o°I �JQcKtc- Av�n�u C _ �� �
Mailing Address Mailing Address �
Man�s�.c ,w� s3�i� � �
City,State,Zip City,State,Zip �
G�e•aa�(-�3gy I �
Daytime Phone Daytime Phone
Additional Information: Zone District: ��'�
Lot Dimensions: 3 36�j� (3a0�
Date lot was created: Acres: �C7 0
Is there wetland near the proposed structure?If yes,how faz �
Building Land Use Floodptain:��-j 3'es� (vj'No :;
(t�'New ( )Filling �
O Addition O Dredging Driveway access off of a(Check one): �
O Alterarion O Grading O Private Rd (✓�own Rd o
( )Moving On ( ) ( )County Hwy ( )State Hwy �,`'j �
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Primary Structure Accessory Building Addition � °
(✓rDwelling ( )Garage-attached/detached ( )Deck W
( )Year round ( )#of caz stalls ( )Porch �
(.�Seasonal ( )Storage Building ( )Enclosed �
O Frame built on site O Screenhouse O Living room �- �
( )Modular/manufactured ( )Greenhouse ( )Kitchen C
( )Mobile/manufactured ( )Other ( )Bedroom O _ "
( )Other primazy structure ( ) ( )Relocate/enlazge � \
( � ( ) ( )#of new -C �
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AdditionalInformation: .�,, >
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Type of Construction: p �
(v)'Frame ( )Log ( )Pole/metal ( )Block ( )Concrete -�
( )Other ,�
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Construction Cost:Primary Structure$ ld�6Y� � d
:° �Accessory Building:$ Addition:$ �
Deed:Vol (y�z Pg�_ Certified Soil Test# °•'° z
CSM:Vol Pg Lot# Sanitary Permit# O� -0 oZ�} {� Q, �
Plat Envelope Or: �, �
Condo Vol Pg Yeaz Installed: �
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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:# �
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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 column.
#1. C�,l� �� #2. #3. #4.
Size ft. wide fr. wide ft. wide ft. wide
3 d fr. long ft. long ft. long ft. long 1
Floor azea Zti sq. ft. sq. ft. sq• fr• S9• fr•
Hgt.from grade .�.0 to peak ft. hgt. ft. hgt. ft. hgt.
Stories�_ stories stories stories
# of bedrooms��
Rear Lot Line
E' 330 ` �
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Fire Number and Name of Roa � 3 �tJ r]t�L�R� Q d�•
1. Enter lot dimensions and indicate north by arrow. t of 0 ne hor zed Agent:
2. Indicate the location and size of the requested construction
Signa r
activities. s � FFORD
Print Name:
3. Also, indicate the location and distance to the well, The above certifes that the listed infortnation and intentions are
We and correct.,that all work shall be perfortned in compllance
septic tank and drainfield, wetland azeas, lot lines and to the with ihe 2quirements of the Sawyer Counry 2oning Ordinance
and the laws and regulations of Ne STate of Wisconsin, and if
centerline of the road. acting as owner(s)agent nas me permission ot tne owner(s)to
peAorm the work requested on this application. The above
� personsls hereby give pertnission for aceeu to the property(or
ry ,� onsite inspection.
Permit fee: $ � / S
July 6 2004 / ���� `
Issue Date Signature of Issuing Agent
July 6 2005 50%Rule: Average Road Setback:
Expiration Date
Office Comments:
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