HomeMy WebLinkAbout006-439-04-3401-LUP-2004-602 Application for Land Use Permit (*Non-shoreland*) +�
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County of Sawyer � �
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 boundaries. �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. �
PRINT-USE BLACK INK OR PENCIL �
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Owner Builder c:
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Mailing Address Mailing Address O j
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City, State, Zip City, State, Zip I
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Daytime Phone � ( �_ Z'��,— �a2l I Daytime Phone �
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Additional Information: ..� �one District: � � �
F f�. 39����►�' � C�
Lot Dimensions: y(' r4 S
Date lot was created: Acres: �C� . �S 38� `�g n
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Is there wetland near the proposed structure? If yes, how far No �
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Building Land Use Floadp�ain�( j �es �No `� pr.
( )New ( ) Filling � �
O Addition O Dredging Driveway access off of a(Check one): �,
( ) Alteration ( ) Grading ( ) Private Rd ( ) Town Rd. o
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy N �
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Primary Structure Accessory Building Addition � °
( ) Dwelling Garage;�/detached ( ) Deck ,`;;
O Year round �3) # of car stalls O Porch `�
( ) Seasonal ( ) Storage Building ( ) Enclosed �°
O Frame built on site O Screenhouse O Living room % �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen .
( ) Mobile/manufactured ( ) Other ( ) Bedroom �.- �
( ) Other primary structure ( ) ( ) Relocate/enlarge 'E �
( � ( ) ( ) # ofnew � �
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AdditionalInformation: t �
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Type of Construction: "�'
(}� Frame ( ) Log (�;�/metal ( ) Block ( ) Concrete �
( ) Other
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Construction Cost: Primary Structure $_ _ � �
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Accessory Building: $� �j. ����C} q�ui�;;,r Addition: $ � �„�
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�--Deed: Vol '��Pg �I'3 Certified Soil Test# �
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�CSM: Vol Pg Lot# Sanitary Permit# � 7�
Plat Envelope Or: N �'
Condo Vol Pg Year Installed: �r��D`r- (�i�e� �
Aff of ex septic Vol Pg Owner When Installed: � ��
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Previous office approvals/actions: ----
� Variance: # LUP: # SP: # CUP: #
'�ection 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. �'��`P� #2. #3. #4.
Size �a.- ft. wide ft. wide ft. wide ft. wide
3 ! ft. long ft. 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
# of bedrooms�
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Rear Lot Line
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-- -, Fire Number and Name of'�'Road��"'�3q70 w S� �� 7v �
1. Enter lot dimensions and indicate north by arrow. Si nature of Owner Qr Aut rized Agent:
2. Indicate the location and size of the requested construction _i,� •�
ignature �
activities.
Print Name: �i.t�_Y�rvi L[ �_
3. Also, indicate the location and distance to the well, The above certifies that the listed information and intentions are
t r u e a n d c o r r e c t.,t hat 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
and the laws and regulations of the State of Wisconsin, and if
centerline of the road. a�t��9 as ow�er�s�a9e�t, has the permission of the owner(s)to
perform the work requested on this application. The above
persons/s hereby give permission for access to the property for
onsite inspection.
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Permit fee: $�_
October 20, 2004 - —
Issue Date Signature of Iss 'ng ent
October 20, 2005
50%Rule: Average Road Setback:
Expiration Date
Office Comments:
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