HomeMy WebLinkAbout008-937-29-3402-LUP-2004-022 ,�-._____
Application for Land Use Permit (*Non-shoreland*) o o -
County of Sawyer � �
PO Box 676 - Hayward WI 54843
715/634-8288 �r
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*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 c;
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Mailing Address Mailing Address �
'Q�rz.�.�wQa�� VU � .S`��� 7 ��u �k c i�/I �
City, State, Zip City, State, Zip �
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Daytime Phone Daytime Phone
Additional Information: Zone District: � f�
Lot Dimensions:
Date lot was created: Acres: ���•' �� o
Is there wetland near the proposed structure? If yes,how far � �
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Building Land Use Floodptain:� j 1'es ( j No `�
�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 ,,,
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Primary Structure Accessory Building Addition �
( ) Dwelling (�() Garage-attache detached ( ) Deck � �:
( ) Year round ( )# of car stalls ( ) Porch � ,�,
( ) Seasonal ( ) Storage Building ( ) Enclosed ;
( ) Frame built on site ( ) Screenhouse ( ) Living room � �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen �,
( ) Mobile/manufactured ( ) Other ( ) Bedroom � �
( ) Other primary structure ( ) ( )Relocate/enlarge � A
� � � � ( ) #of new ,�,� �
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Additional Information: ,� A
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Type of Construction: ���� �;J
( ) Frame ( ) Log �) Pole/metal ( ) Block ( ) Concrete �:' \;
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( ) Other �
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Construction Cost: Primary Structure $ �
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yAccessory Building: $ /'S��d� Addition: $ � �
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Deed: Vol�i Pg� Certified Soil Test# 87��� �
CSM: Vol Pg Lot# Sanitary Permit# 8�" 4'�5 0, �
Plat Envelope Or: N
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Condo Vol Pg Year Installed: � �
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Aff of ex septic Vol Pg Owner When Installed: `�'
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Previous office approvals/actions: C'
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Variance: # LUP: # $'1 — �t 9 SP: # CUP: # L
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Inspection Report: # Change of Zone District: G� �
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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 columa
#1. �iv.,�cw�i #2. #3. #4.
Size�_ft. wide ft. wide ft. wide ft. wide
2� ft. long ft. long ft. long �� l�g
Fioor area . Io o� sq. ft. sq. fr. sq. fr. sq. fr.
Hgt.from grade to peak ft. hgt. ft. hgt. ft. hgt.
Stories stories stories stories
# of bedrooms
Rear Lot Line �' `�,
A���l,� M�-� • '
Fire Number and Name of Road d 6 3 b4 W ,S�rm�µ��� .�
1. Enter lot dimensions and indicate north by arrow. Signat e of Own r r �thorized Agent:
2. Indicate the location and size of the requested construction ^^-- �'
Sgnature
activities.
Print Name:
3. Also, 1ridlCate the IoCatlon and d15Y.3T1Ce to tlle well, The above ceRifes that the listed iniortnation and intentions are
irue and conect.,that all work shall be performed In compliance
Sept1C ta[11C ftllC�d7alnfleld, wetland 2leas, lot 11nes anC�to tlle with ihe requiremenfs ot the Sawyer County 2oning Ordinance
and Ne laws and regulations of the State oi Wisconsin, and if
CCnt8i11riC Of thC i0ad. acUng as owner(s)agent has the permission of the owner(s)to
peAortn the work requested on this application. The above
personsls he�eby give permission for access to ihe property for
onsAe inspection.
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Permit fee: $ ��
February 9, 2004 - z� _
Issue Date Signature of sui Agent
February 9, 2005 50%Rule: Average Road Setback: _
Expiration Date
Office Comments:
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REPLACE EXISTING GARAGE �
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SCALE: I INCH=�}pp FEE
DRAWN BY: D
COLON (:) INDICATES GO