HomeMy WebLinkAbout008-174-07-0100-LUP-2004-560 /
Application for Land Use Permit(*Non-shoreland*) o o �
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 wrthm 1000'of a �
flowage,lake ox pond or does not have any of the above waterbodies located within � b
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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Builder �
Owner �� f`�i �h�'t�� .�.
/3�� N. S<<�vS�7" /jE-�.,�� 1�r � . .. L7.�'�` �� �
Mailing Address Mailing Address �
/3i/c l,+�-c�c d �v/ 5`/�! 7 C G:I"� �'6'C: N 1,{,- / `� �/� 2 Z v :;
City,State,Zip City,State,Zip
�i5' - 3�-�,- 3-� 3v 7is"-`�%s"Y - 35'�G �.
Daytime Phone Daytime Phone �
Additional Information: Zone District: ��-I ' �
Lot Dimensions: ,�GC' /� �G�� / r
Date lot was created: Acres: , -`JS n
0
Is there wetland near the proposed structure?If yes,how far /1I V � 'C
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Building Land Use Floodp}ain:� J I'es O No :;
�New ( )Filling � �
O Addition O Dredging Driveway access off of a(Check one): � �
O Alteration O Grading O Private Rd �Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy „"j �
� ) � ) o �
t�
Primary Structure Accessory Building Addition � °
( )Dwelling �Garage-attached/detached ( )Deck W
O Year round (3)#of car stalls O Porch .-
( )Seasonal ( )Storage Building ( )Enclosed �
0
O Frame built on site O Screenhouse O Living room
( )Modular/manufactured ( )Greenhouse ( )Kitchen /�
( )Mobile/manufactured ( )Other ( )Bedroom '3
( )Other primary structure ( ) ( )Relocate/enlarge � �
( ) ( ) ( )#of new
AdditionalInformation: 'C „
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�T e of Construction: i� �
Frame ( )Log ( )Pole/metal ( )Block ( )Concrete O
( )Other �
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Construction Cost:Primat,y Structure$ �
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.�Accessory Building:$ '���,�0(a `' Addition:$ �
�J �
Deed:Vol fc�y-'� Pg 3�$-"� Certified Soil Test# °Q �
CSM:Vol Pg Lot# Sanitary Permit# `]3—/y�j � 7
Plat Envelope Or: �,
Condo Vol Pg Year Installed: � y� � "' �
Aff of ex septic Vol Pg Owner When Installed: � �
�i,.:< i
Previous office approvals/actions: �
Variance:# LUP:# SP:# CUP:# ;7
Inspection Report:# q 5- /Ul Change of Zone District: � ��{
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Describe the construction using these columns.List the dimensions of each structure in a separate ' �
column.List each story,each addition,each alteration in a separate wlumn.
#1. "/� #2. #3. #4.
Size �(, ft.wide ft.wide ft.wide ft.wide
� �� ft.long ft.long ft.long ft Iong
Floor area �j 3 C sq.ft. sq.ft. sq.ft. sq.ft.
Hgt.from gade�to peak ft.hgt. ft.hgt. ft.hgt.
Stories�_ stories stories stories
#of bedrooms [';
Rear Lot Line
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Fire Number and Name of Road /2i l a /V 5�� ��S e f �3 P�G� ��'-
1. Enter lot dimensions and indicate north by arrow. Signa e of Owne r orized Agent:
2. Indicate the location and size of the requested construction „� �g� � _a,;1.,'1z,�--�
��-�S'ignature
activities. ��{
PnntName:�l L.,L/-{N �- - .� e C��r��
3. Also,1ndlCate tlle IoCatlon and dl5tance to the well, The above certifles that the listad Information and intentions are
true and covect.,that ail work shall be pedormed in compliance
septic tank and drainfield,wetland areas,lot lines and to the w�m cne re���remem5 or me sawyer co��ry zo���9 ordma��
and the laws antl regulations of the Shate of Wisconsiq and if
COritEIllriO Of t110 TOad. acting as owner(s)agent,has lhe permission of the owner(s)to
pedorm the work requested on this applicatlon. The above
personsls hereby give permission for access to the property for
c, onsite inspection.
Permit fee:$ ���(�,/�O
OctnhPr 7� 9004 _
Issue Date Signature ofIss i g ent
October 7, 2005 50%Rule: Average Road Setback:
Expiration Date
Office Comments:
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