HomeMy WebLinkAbout008-937-17-5301-LUP-2004-234 Application for Land Use Permit (*Non-shoreland*) r � �'_
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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 <'
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Mailing Address Ma�ng Address S �I? �
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City, State, Zip City, State, Zip �
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Daytime Phone Daytime Phone �
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Additional Information: Zone District: �R— � �
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Lot Dimensions:
Date lot was created: Acres: 3 � �_5 8 n �
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Is there wetland near the proposed structure? If yes, how far � S
Building Land Use Floadptain:( j �es ( j No � (6
( )New ( ) Filling �
(q� 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-attached/detached (� Deck W �
( ) Year round ( ) # of car stalls -� � �
( ) Seasonal ( ) Storage Building ( ) Enclosed �
O Frame built on site O Screenhouse O Living room �
O Modular/manufactured O Greenhouse O Kitchen g I
( ) Mobile/manufactured ( ) Other ( ) Bedroom c� �
( ) Other primary structure ( ) ( ) Relocate/enlarge � '
� � ( � ( ) # ofnew � �
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Additional Information: ,� �
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Type of Construction: N
( ) Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete � �
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�) Other Dec�k �va;�s ( �: ���d � �
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Construction Cost: Primary Structure $ �` �c7Cj°�J � �
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Accessory Building: $ Addition: $ � �
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Deecl: Vc�l. ,5(c9 _P�35Y Certified Soil Test# q�],38(o _ ___ � �
CSM: Vol Pg Lot# /�' Sanitary Permit# 1��� q 7-yay a, �
Plat Envelope Or: N 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: —
Variance: # LUP: # q?� l�38 SP: # CUP: #
Inspection Report: # Change of Zone District: • ,j-S Ib��
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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.
#1. 1�ec:Y- #2. #3. #4.
Size JS� fr. wide ft. wide ft. wide ft. wide
a�/ ' ft. long ft long ft. long ft. long � �
Floor area � (o O sq. fr. sq. ft. sq. fr. sq. ft.
Hgt. from gade to peak ft. hgt. fr. hgt. ft. hgt.
Stories — stories stories stories
# of bedrooms —
Rear Lot Line
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Fire Number and Name of Road �p � 9 g (/�/ S L�/1��� � 1 f{ (' N !l� �
1. Enter lot dimensions and indicate north by arrow. .
at af Owner o�Author�ized Agen
2. Indicate the location and size of the requested construction �� ���f� � o o �,.-� � �., �.
Si naNre
acrivities. �— �� �'� — - ,
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Pnnt Name: ,��--- � iL
3. Also, 1nQiCate tlle loCatlon and C1iStanCe to the well, The above ceNfies that the listed Informalion and inteNions are
true and cronect., that all work shall be perfortned in compliance
septic tank and drainfield, wetland areas, lot lines and to the w�m me �e�wreme�� or me sawyer co��h zo�m9 om��a�ce
and ihe laws and regula�ons of the State of Wisconsin, and if
centerline of the road. ading as owner(s) agent, has me permission ot ihe owner(s) to
perfortn the work requested on this applirafioa The above
personsls hereby give permission for aceess to Ne property for
onsite inspedion.
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Permit fee: $ `�.5
Tiina 3 , �nn4 ��//,/,G�� � /'r�'���i
Issue Date Signature ofIssuing Agent
June 3 , 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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SCALE : I INCH = 400 FEET FOR ASSESSMENT USE ONLY N(7T
DRAWN BY : DATE : 7-5_ $t} INTEN�ED TO SHOW CONCLUSIVE
COLON �: ) INDICATES GOVT. LOT gOUNDARY�L CAT ONS �P �R