HomeMy WebLinkAbout008-937-01-2301-LUP-2004-373 ,
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Application for Land Use Permit (*Non-shoreland*) o 0
' 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 ar 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 �
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Daytime Phone Daytime Phone
Additional Information: Zone District: �
Lot Dimensions: �
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Date lot was created: � � - '��f�� �'� Acres: > >�/ n �
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Is there wetland near the proposed structure? If yes, how far �/,� �
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Building Land Use Floadptain:-� j Yes (�No `� '
(v)'New ( ) Filling � ���
O Addition O Dredging Driveway access off of a(Check one): �,
O Alteration �Grading O Private Rd (�Town Rd. o
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy ,W �
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Primary Structure Accessory Building Addition � °
� Dwelling ( ) Garage-attached/detached ( ) Deck W
( ) Year round ( ) # of car stalls (�'orch �
( ) Seasonal ( ) Storage Building ( ) Enclosed �
(�'�'rame built on site ( ) Screenhouse ( ) Living room � ,J,
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen � i
( ) Mobile/manufactured ( ) Other ( ) Bedroom � .-
( ) Other primary structure ( ) ( ) Relocate/enlarge � '
� � ( � O # ofnew � �_
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AdditionalInformation: o A
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Type of Construction: � '
(,�'�rame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete -
( ) Other ,� ,�
Construction Cost: Primary Structure $ •'%_�. �7 c c�. ...: � �
Accessory Building: $ Addition: $ � �`�
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Deed: Vol�Pg .��� Certified Soil Test# --- �" Z
CSM: Vol Pg Lot# Sanitary Permit# C�� - �2 y � o, �
Plat Envelope �r� N ��
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Condo Vol Pg Year Installed: c�
Aff of ex septic Vol Pg Owner When Installed: '; `� �
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Previous office approvals/actions: �
Variance: # LUP: # SP: # CUP: #
Inspection Report: # Change of Zone District: (�, �/ �jr5l�,�f
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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. #2. #3. #4.
Size _' c�, ft. wide ft. wide fr. wide ft. wide
} Z ft. long ft. long fr. long ft. long
Floor azea ' sq. fr. sq. ft. sq. ft. sq. ft.
Hgt.from gacie //-� to pealc ft. hgt. ft. hgt. ft. hgt.
Stories / stories stories stories
# of bedrooms �
Rear Lot Line
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Fire Number and Name of Road /=/'' -_` + ! � ' '
1. Enter lot dimensions and indicate north by arrow. Si n ce�fAwn f o Authorized A ent:
2. Indicate the location and size of the requested construction 1( 9 i/1,C✓lc(/��.i,�r�� 9
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activiries. �'�
PnnWame: /�/�l-�EL L , i_k'��E'
3. Also, indlcate the locatlon and dlstance to the well, The above certifes that the listed information and intentions are
true and cortecL,ihat all work shall be peAortned in compliance
septic tank and drainfield, wetland areas, lot lines and to the wan tne r���reme��s or me sawyer co��ry zoo�o9 om'��ance
and ihe laws and regutations of the State of Wisconsin, and if
CBTItCL1iriC Of tk1C iO3d. acting as owner(s)agent, has the permission of the owner(s)to
pedortn the work requested on lhis application. The above
persons/s hereby give permission for awess to the property for
onsite inspection.
Permit fee: $ 175. 00
July 21, 2004 �
Issue Date Signature of Iss i g ent
July 21, 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
TOWN OF EDGE�V
SEC. I TWP37 N. R
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