HomeMy WebLinkAbout006-439-06-2302-LUP-2004-477 Application for Land Use Permit(*Non-shoreland*) o o `—
Courity of Sawyer �, � O
PO Box 67¢ -Haywazd WI 54843
7f15/634-8288 �
*Property that is ttot located within 3b0'of a creek,river or streazn 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 I Builder < �
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Mailing Address � Mailing Address O
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City,State,Zip ' City,State,Zip
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Daytime Ph.one Daytime Phone
AddiUonal dnformation: Zone District:,�-'�Z- J
Lot Dimensions:
Date lot was created: Acres: ',�-z• 3� o
Is there wefland near the proposed structure?If yes,how faz �� �o
Building Land Use Floodptaiu:-f-j 3'es (!�No :R
(54)New ( )Filling �
O Addition O Dredging Driveway access ofF of a(Check one): �
O Alteration O Grading O Private Rd ¢q Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy i,"j �
� ) _ � ) o S
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Primary Structure Acces'sory�Building Addition .n'c �
�Dwelling ( )Garage-attached/detached ( )Deck W
(�-Yeaz round ( )#�of caz stalls ( )Porch �
O Seasonal O Sforage Building O Enclosed �
�Frame built on site ( )Screenhouse ( )Living room � �
( )Modu7ar/manufactured ( )Greenhouse ( )Kitchen g �
( )Mobile/manufactuted ( )Other ( )Bedroom 6 Q'
O Other piimary structure O i O Relocate/enlarge ' N
� ) ( ); ( )#of new �'�„ �
� E
AdditionalIInformation: p .:�
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Type of Coa�struction: C �
�,Frame ( )Log ( )Polehnetal ( )Block ( )Concrete N
( )Other ro ,.�
Conshuction Cost:Primary Structure$;(w'-��r�'"`� � �
Accessory Building;$ AddiUon:$ � W
� 3zy5l8 ' _ � �
Deed:Vol_ Pg �: Certified Soil Test# c'I'��'�S� °Q z
CSM:Vol_ Pg Lot# I Sanitary Permit#� C�"`�—�q o, 7y
Plat Envelope T Or: r, I�
Condo Vol Pg ' Yeaz Instailed: � �
Aff of ex septic Vol Pg Owner When Installed: `-'
V
Previous office approvals/acrions: �
Variance:# LUP:# SP:# CUP:# �
Inspection 12eport:# C(�ange of Zone District: �'�
g�2 di`,
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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. /ti1/"r%lllFlc��� #2. L�Fr #3. #4.
Size 3�, fr.wide ZZ ft.wide fr.wide fr.w'ide
�i7' ft.long Zz ft.long ft.long ft.long
Floor azea 17.� sq.ft. .��J sq.ft. sq.ft. sq.ft.
Hgt fmm gade �5'� to peak ft.hgt. ft.hgt. fr.hgt.
Stories 1f'z stories stories stories
#of bedrooms�_
I' C L ' � Rear Lot Line
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Fire Number and Name of Road 7�u2`�i N /vdP�r ���✓L� ��
1. Enter lot dimensions and indicate north by arrow. S� tn of 0 er Aut rized Agent:
2. Indicate the location and size of the requested constntction �s�l�E�'t_
� s��n�re
activities. �^-� � �,�nti�
Print Neme: �l r4�L�i1 41
3. Also,indicate the location and distance to the well, �he above ceNNes thet ihe f�sted Intom�ibn ard In�entions are
Vue and cortect,Uret all work shall be peAamed In compliance
septic tank and drainfield,wetland azeas,lot lines and to the ���Q���of ihe Sawyer County Zoniig Ordinance
�erW the levis and regulatlons of ine State ot Wlsconsh,and if
centerline of the road. �cnns�o«ner(s�a�ent nas rhe�erm�san or me owne�s�m
�e�tqm the woAc requestetl on thb applkallon. The above
personds hereby gNe pertnissbn fa access to Me property for
ensite ir�spectlon.
Permit fee:$ o2a�s r�
September 3, 2004 /����- ,�L///f�'%'e�
Issue Date Signature of Issumg Agent
September 3, 2005 0
50/o Rule: Average Road Setback:_
Expiration Date
Office Comments:
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