HomeMy WebLinkAbout006-440-34-1101-LUP-2004-701 Application for Land Use Permit o o '
County of Sawyer ti � �_
PO Box 676 -Hayward WI 54843 ,.-J
715/634-8288 V �
The undersigned hereby makes application for a Land Use Permit and agees that all work �
shall be done in compliance with the requirements of the Sawyer County Zoning Ordinance �D �
and the laws and regulations of the State of Wisconsin. �
NO CONSTRUCTION MAY BEGIN UNTIL ALL PERMITS HAVE BEEN ISSUED. 1
PRINT-USE BLACK INK OR PENCIL �'�
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Owner � Builder < O
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M 1 g Address , Mailing Address � o
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Cit ,State,Zip City,State,Zip
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DaTytime hone Daytime Phone �
Additional Information: Zone District �-�
Lot Size �
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Acres Z4 Y8 r
Is the property in a Shoreland District?(within 1000'of a lake or pond,within 300'of a river, r
creek or stream) If yes,how faz from the shoreline&water name: �.
Is there wetland near the proposed structure?If yes,how faz o��
Building Land Use ro
( )New ( )Filling Floodplain:( ) es (�No # :;
(�y,�Addition ( )Dredging '� �
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( )Alteration ( )Grading Chippewa Flowage: ( )Yes ( )No g �
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� �Moving On � � Driveway:( )State ( )County ( )Town Rd. �
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Primary Structure Accessory Building Addition o
(r)Dwelling ( )Gazage-attached/detached ( )Deck �
( )Yeaz round ( )#of car stalls ( )Porch -c �
Stora e Buildin ( )Enclosed '
(p�Seasonal ( ) g 8 -�
O Frame built on site O Screenhouse O Living room Q �
( )Modular/manufactured ( )Greenhouse ( )Kitchen �
( )Mobile/manufactured ( )Other ( )Bedroom �;,
( )Other primary structure ( ) ( )Relocate/enlarge
� � ( ) ( )#of new p
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0
Additional Information:
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Type of Construction �
�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �
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( )Other �
Construction Cost:Primary Structure$ �(1CY7�J °�'
Accessory Building:$ — Addition:� ;\ z
r�.azzzas � z
Vol Pg of Deed Certified Soil Test#
CSM Vol_ _Pg _Lot# _ Sanitary Permit#
Plat Envelope # Or: �
Condo Vol Pg Year Installed {�r�u�
Aff of ex septic Vol Pg Owner When Installed:
Gazd Gazebo Vol Pg
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Previous Variance: LUP: yz--�-'`� Inspection Date: ,`��-
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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. #3. #4.
#2.
Size al� ft. wide S�' ft. wide � ft. wide ft. wide
��� ft. long :i:� ft. long �? � ft. long ft. long
Floor area �—. sq. ft. �_ ' ,t _ sq. ft. o� '��/ sq. ft. sq. ft.
Hgt. from grade i`�_ to peak � ft. hgt. �/ ft. hgt. ft. hgt.
Stories 1 l stories � stories stories
# of bedrooms
Lot Line or Lake/River name:
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� Fire Number and Name of Road 7�'y � �u�a� �y � C G-
1. Fill in lot dimensions and indicate north by arrow. Signature of Owner or Authorized Agent:
2. Indicate location and size of existing and new structures. �
3. Indicate location of well, septic tank, drainfield. ���^�� �
4. Indicate distance to existing structures, lot lines, septic system.
5. Indicate distance to the ordinary high-water mark of any lake,
pond, river, stream, creek, and name the body of water. an�t Name:
The above certifies that the listed information and intentions are
6. Indicate any grading or clearing in excess of the construction site. accessto tne p��y toons i�ns�ecchoneby 9ive permission io�
7. Indicate distance to any wetland.
Permit Fee: �1��� "�
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December 30 . 2004 �
Issue Date Signature of Issuing gent
December 30 , 2005
Expiration Date
Office Comments: j
Inspection Date: 50% Rule Applies: Avg. Setback: '
Restrictions and other information: '
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