HomeMy WebLinkAbout006-439-30-3403-LUP-2004-480 �
Application for Land Use Permit(*Non-shoreland*) o o �-
County of Sawyer � � ,�—`
PO Box 676 -Haywazd WI 54843 0
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. 1
PRINT-USE BLACK INK OR PENCIL
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Owner Builder �� �
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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: � n
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Is there wetland near the proposed structure?If yes,how faz �
Building Land Use Floodptain:� )Yes ( j No :°
(��)New ( )Filling �
O Addirion O Dredging Diiveway access off of a(Check one): �
O Altexation O Grading O Private Rd O Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy �,"', �
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Primary Struchzre Accessory Building Addition � °
( )Dwelling �Garage-attached/detached ( )Deck W
( )Year round ( )#of caz stalls ( )Porch =
O Seasonal O Swrage Building O Enclosed �
O Frame built on site O Screenhouse O Living room �
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen � �
( )Mobile/manufactured ( )Other ( )Bedroom
( )Other primazy structure ( ) ( )Relocate/enlarge �
� � � � ( )#of new �
AdditionalInformarion: t,,� >
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Type of Construction: �
(�'Frame ( )Log ( )Pole/metal ( )Block ( )Concrete ,�
( )Other � ,�
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Construction Cost:Primary Structure$ � �
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Accessory Building:$ Addition:$ x�
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Deed:Vol Pg Certified Soil Test# °Q z
CSM:Vol Pg Lot# SanitaryPermit# 03'O,l�l� o� %°
Plat Envelope �r� N
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Condo Vol Pg Yeaz Installed: c�
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Aff of ex septic Vol Pg Owner When Installed:
Previous office approvals/actions:
Variance:# LUP:# 03-,2(a3 SP:# CUP:#
Inspection Report:# Change of Zone District:
W �3C/�
i��+5�
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Describe the construction using these wlumns. List the dimensions of each structure in a separate
column. List each story, each addition, each alteration in a separate column.
#L #2. #3. #4.
Size ft. wide ft. wide ft. wide ft. wide
ft. long fr. long ft. long ft. long
Floor area sq. ft. sq. ft. sq. ft. sq. ft.
Hgt.from grade to peak ft. hgt. ft. hgt. ft. hgt.
Stories stories stories stories
#ofbedrooms---"'"'�-- � ,'
Rear Lot Line �
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Fire Number and Name of Road � '"� `- ' i h '� +
1. Enter lot dimensions and indicate north by anow. Signak of Owner or uth,qrized Agent:
2. Indicate the location and size of the requested construction , �r cr ��«�-
SignaNre
activities. �., �� � � ,��,
Pnnt Name�, ��t ��['r
3. Also, 1nd1CSYE tlle IoCatlon and d1StanCC to tlle well, The above certifes ihat the Ilsted iniortnation and intentions are
true and cortect, �hat all work shall be peAormetl in compliance
septic tank and drainfield, wetland areas, lot lines and to the w�m me �eq���emencs or me sawye� co��ry zo���9 om�oa�ce
antl the laws and regulations of the St21e of Wiscronsin, and if
cente2line Of tlle Ioad. acting as owner(s)agent, has ihe permission o(the owner(s)to
pedorm the work requestetl on this applicalion. The above
personsls hereby give permission for access to the property for
v� onsite inspection.
Permit fee: $ �n�—
September 3, 2004 ��,�,��,f�y,.,���2��i
Issue Date Signature of Issuing Agent
September 3, 2005 0
50/o Rule: Average Road Setback: _
Expiration Date
Office Comments:
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