HomeMy WebLinkAbout006-439-22-4401-LUP-2004-479 �
Application for Land Use Permit(*Non-shoreland*) o 0
County of Sawyer � �
PO Box 676 -Haywazd WI 54843
715/634-8288
*Properry that is not located within 300'of a creek,xiver 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 '
��rr� L �d�-��..Ti��_ �i�a�2r.� c���-n a
Owner ' Builder e�
�'
/��-�O ���ii"/Da�J�� �.
Mailing Address / Mailing Address O �
c�QC�l6if�l!� fw// ,"53��i��7 �
City,State,Zip � City,State,Zip
Zcz- 7�2� �3� �2-�,x�-iy�, �
Daytime Phone j�{/p2,tG Daytime Phone� �
Additional Information: Zone District - -- ^
Lot Dimensions: "—
�
�Date lot was created: Acres: �o ��.Q�S o
Is there wetland near the proposed structure?If yes,how faz �
Building Land Use Floodplain:-( j Yes O No ✓' :° �
( )New ( )Filling �
Dred in Drivewa access off of a(Check one): � �
( )Addition ( ) g� g S' .
O Alteration O Grading O Private Rd O Town Rd. o
O Moving On O (�l CounTy Hwy O State Hwy i,`", �
� ) � ) o �
t"
Primary Structure Accessory Building Addition � °
O Dwelling Qd Garage-attache etached O Deck W
( )Year round ( )#of car stalls ( )Porch =
( )Seasonal ( )Storage Building ( )Enclosed `D
O Frame built on site O Screenhouse O Living room � �
( )Modular/manufactured ( )Greenhouse ( )Kitchen RS
( )Mobile/manufactured ( )Other ( )Bedroom �
( )Other primary structure ( ) ( )Relocate/enlarge
� � ( ) ( )#of new � �Cn
�
AdditionalInformation: � �
N c�
� �
1 �
Type of Construction: -�
Qc)Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �
( )Other ,ti ,.,j
Construction Cost:Primary Structure$ ` � d
Accessory Building:$ Addition:$ x� �
�
Deed:Vo( y�I Pg S'7 Certified Soil Test# °Q z
CSM:Vol Pg Lot# Sanitary Permit# o, '7�
Plat Envelope Or: i;, �C
Condo Vol Pg YearInstalled: ����y- -�,� �g�.�, � �
Aff of ex septic Vol Pg Owner When Installed: � �
Previous office approvals/actions:
Variance:# LUP:# SP:# CUP:#
Inspection Report:# Change of Zone District: ���1
c��_ I
�� (,83 R
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. l-,a�2A #2. #3. #4.
Size �t ' ft. wide ft. wide ft. wide ft. wide
�6 i ft. long ft. long ft. long ft. long R
Floor azea_{�._sq. fr. sq. ft. sq. ft. sq. ft.
Hgt.from gade�_to peak ft. hgt. ft. hgt. ft. hgt.
Stories I stories stories stories �
# of bedrooms No��� i
Rear Lot Line
s
5� ��A�(� �
Fire Number and Name of Road 57�7l�/ f���-/`h
1. Enter lot dimensions and indicate north by arrow. Signat e of Ow r or Authorized gent:
2. Indicate the location and size of the requested construction �
SignaNre
activities.
PnntName: o ' �-
3. Also, 1nd1C2te the IoCatlOn and d1StanCe to the well, The above ceNfes t at the Isted intorma ion and intentions are
true and conect.,that all work shali be performed in compliance
septic tank and drainfield, wetland areas, lot lines and to the with the requirements of the Sawyer County Zoning Ordinance
antl the laws and regulations of the Sfate of Wisconsiq and if
CentBTllne Of tlle LOad. acting as owner(s)agent, has tha pertnisslon of the owner(s)to
pedortn the work requesled on lhis application. The above
personsls hereby give permission for access to the property for
onsite inspedion.
Permit fee: $
September 3, 2004 ��.E3i�,L� G%�di�'����
Issue Date Signature of Issuing Agent
September 3, 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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