HomeMy WebLinkAbout006-439-06-3206-LUP-2004-541 ✓�
Application for Land Use Permit(*Non-shoreland*) o 0
County of Sawyer � O
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 boundazies. �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. C.
PRINT-USE BLACK INK OR PENCIL �
L 1 �iZ-R�-7 f� K R Ka-v��Fr.�� �-�m+�'� �
Owner Builder �' �
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Mailing Address Mailing A dress O
�l4Pt�F�Er U� l v���y 7 lo � �
City,State,Zip City,Stat , ip �, /
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Daytime Phone Daytime Phone , �
AdditionalInformation: ZoneDistrict �`R� —�
f � +I i7
Lot Dimensions:��y^ � �`C
Date lot was created: Acres: ��� o �
Is there wetland near the proposed structure?If yes,how faz �i � �
Building Land Use Floodptain:( j Yes �No � �
( )New ( )Filling �� � �
Addition Dred m Drivewa access off of a Check one `D
b� ( ) B� g Y ( )� da
( )Alteration ( )Grading ( )Private Rd (�Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy �,`", �
� ) � ) o �
t�
Primary Structure Accessory Building Addition � °
�Dwelling ( )Gazage-attached/detached ( )Deck ,,"`, �
( )Yeaz round � )#of car stalls ( )Porch = �
�j Seasonal 1 1 Storage Building O Enclosed � s
O Frame built on site O Screenhouse �Living room S`
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen �
( )Mobile/manufactured ( )Other ( )Bedroom � �e
( )Other primazy structure ( ) ( )Relocate/enlarge ` � � 7
� � ( ) ( )#of new � I r' �
��' 1
AdditionalInformation: � A -i
�j � �
W �
Type of Construction: � C�
�tj Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �'
„' ^�
( )Other ^�
"� y C!�
Construction Cost:Primary Structure$ �j�(„c�...�.-ir � � �
Accessory Building:$ ` � Addition:$ 7,��' � �'`�
Deed:Vol �`��^ Pg /�-�= Certified Soil Test# G i-/y� tl4 z �
CSM:Vol Pg Lot# SanitaryPermit# 9i�-��/ �P-.�5/ C+� I.Zy � � �
Plat Envelope Or: i;,
Condo Vol Pg Yeaz Installed: �C,7 0 •
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Aff of ex septic Vol Pg Owner When Installed:
�i�l���(�
Previous office approvals/actions: �"� -��� �� C
pC�Bti�
Variance:# LUP:# 9$ y5�� SP:# CUP:#
Inspection Report:# Change of Zone District: �,��Ip�
C�`-
Describe the construction using these columns.List the dimensions of each structure in a separate
colum 'st each story,each addition,each alteration in a separate column.
#1.—��� #2. #3. #4.
Size " ` ft.wide ft.wide ft.wide ft.wide
��• fr.long ft.long ft.long ft.long
Floor area ��: sq.fr. sq.fr. sq.ft. sq.ft.
i
Hgt.from gade�to peak�ft.hgt. ft.hgt. ft.hgt.
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Stories�_ stories stories stories
#of bedrooms�_
Rear Lot Line
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Fire Number and Name of Road �G' L� ��2,
1. Enter lot dimensions and indicate north by arrow. gi pf Q n � r Authorized A e '
2. Indicate the location and size of the requested construction
Signalure
activities. ' �„ � �
Prin�Name: 1+--E� ���N'E✓2—
3. Also,lndicate the locatlon and distance to the well, The above certifes that Me listed information and intentions are
hue and wrrect.,ihat all work shall be peAormed in wmpliance
septic tank and drainfield,wetland areas,lot lines and to the with ihe requirements o(lhe Sawyer County Zoning ONinance
and the laws and regulations of the State of Wiscronsin,and if
CenteTllne Of tlle I'o8d. acfing as ownef(s)agent,has the permission ot ihe owner(s)to
peAortn me work requested on this application. The above
� �/�' persons/s hereby give permission for aaess to Ne property for
onsite inspection.
Permit fee:$ �`
September 29, 2004
Issue Date Signature ofiss g nt
September 29, 2005 50%Rule: Average Road Setback:
Expiration Date
Office Comments:
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