HomeMy WebLinkAbout008-937-20-1404-LUP-2004-318 M�- -;�-- _ �.
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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. `�
�"'� q�,d PRINT-USE BLACK INK OR PENCIL b '
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Owner � Builder ¢'
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Mailing Address � "�""""s�"''''�"'�� y� �
Vc�...1111 1UUl l.
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City, State, Zip City, State, �ip
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Daytime Phone Daytime Phone �
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Additional Information: Zone District: ���-' � ',,
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Lot Dimensions: ��� ��✓�� � `- GV
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Date lot was created: � � � Acres: �� �� � �R�.
Is there wetland near the proposed structure? If yes, how far �
Building Land Use Floadptain:( j IFes (�No °
( )New ( ) Filling �
( )Addition ( ) Dredging Driveway access off of a(Check one): �,
`�:Alteration O Grading O Private Rd O Town Rd. o
. � ( ) Moving On ( ) ( ) County Hwv (� State Hwv �''
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Primary Structure Accessory Building Addition � °
( )Dwelling � Garage-attach /detached� ( ) Deck W
�Year round (�# of car stalls ( ) Porch � f�,
"(' ) Seasonal ( ) Storage Building ( ) Enclosed � ��`,�
( ) Frame built on site ( ) Screenhouse ( ) Living room � �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen d
( ) Mobile/manufactured ( ) Other ( ) Bedroom �
( ) Other primary structure ( ) ( ) Relocate/enlarge '
� � ( ) ( ) # of new ,� �
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Additior�al form) ation: �=�- � ���������'� ��+'� �������� �/Q��',�J� �
�-�-C; i►1C-��E� /t✓iK �'�""� �N"� ����"C�3�t ' /71�G3 � /- " �r7i� S'7P S � A
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f j ,��1� �7�►PnC� �/� T a� u�1�����' is ��� �'�ss�nc � � �
1l`� �rf ��' � / �� r� �
T e of(:onstruction: I�Petil D��l ��' ���� �S�'��c�u/`� �'�'S"rt' � `�
Yp e 1 � �..
��Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete � ��
( ) Other__ __--__. �
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Construction Cost: Primary Structure $ � � �L''G � �
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Accessory Building: $ Addition: $ ^ ��,�,R
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Deed: Vol Pg_ _ Certified Soil Test# �'�`QSi C�(��� � z
CSM: Vol Pg Lot# Sanitary Pei-mit#_ �� "L`�`�� � G'`{ —z� � v� �
Plat Envelope �r� 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: �y_ ��� �
Variance: # LUP: # �j�� �/�y SP: # CUP: # �
Inspection Report: # Change of Zone Distric : � �'r�''K1 ��� ��"" �/�"l �1p�
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ilescribe 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. �fl� #2. #3. #4.
Size fr.wide ft.wide fr.wide ft.wide
�ft.long ft.long ft.long fr.long
Floor azea��s .8. sq.ft. sq.ft. sq.ft.
Hgt.from giade � ��to peak ft.hgt. ft.hgt. ft.hgt. t
Stories I stories . stories stories
#of bedrooms Q��q!!
(Ji)� Rear Lot Line ____..
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Fire Number and Name of Road ��ta� el'9 �� �f a �o /,sR
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1. Enter lot dimensions and indicate north by azrow. Si e of 0 ne r athorize Agent:
2. Indicate the location and size of the requested construction
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activities.
P�int Name:
3. Also,1ndiCate tlle IoCatlOn and dlstance to tlle wel�, The above certifes that the listed information and intentions are
We and cortecl.that aIl work shall be performed in compliance
septic tank and drainfield,wetland areas,lot lines and to the with ihe requiremenLs of the Sawyer County Zoning Ordinance
and Ne laws and regulations of the Stale of Wisconsin,and if
CCnteI'11ri0 Of t110 road. ac6ng as owner�s)agent,has Me permission ot the owner(s)to
pedortn the work requested on this application. The above
qersonsh,hemby give oermission for zccess to the 9roperty for
� �~ � � onsite inspec6on.
Permit fee:$ �� .�� ���
June 30, 2004 Gi[/ �
Issue Date Signature ofIssuing Agent
June 30, 2005 50%Rule: Average Road Setback:
Expiration Date
Office Comments:
CJF EDGEWATER
TWP 37N. R.9W
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