HomeMy WebLinkAbout008-937-20-5303-LUP-2004-668 /I�o�r - -
Application for Land Use Permit (*Shoreland*) o o `
County of Sawyer � �
PO Box 676 - Hayward WI 54843
715/634-8288 �
*Property that is located within 300' of a creek, river or stream or within 1000' of a �
flowage, lake or pond or has 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 Q-
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Mailing Address Mailing Address � �
, � t_ __ .��%! _ � (�� �"�d�l �
. Cit State Zi �
City, State, Zip Y> > P
Daytime Phone Daytime Phone
Additional Information: Zone District: � �Q(Z�,�
Lot Dimensions: J �p`;� �
r� 4% "' �-,
Date lot was created: � ' Acres: `/, � �'_
Is there wetland near the proposed structure? If yes, how far L f I< �-,, �" Y� � o
Building Land Use Floodplain: ( ) Yes ( )No �
OO New ( ) Filling Chippewa Flowage: ( ) Yes ( ) No �
( ) Addition ( ) Dredging Driveway access off of a(Check one): � �
( ) Alteration (� Grading ( ) Private Rd ( ) Town Rd. �
( ) Moving On ( ) ( ) County Hwy (� State Hwy `�' �.
� ) � ) � �
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Primary Structure Accessory Building Addition o 0
( ) Dwelling ( ) Garage-attached/detached ( ) Deck � Q
( ) Year round ( )# of car stalls ( ) Porch W V,,
( ) Seasonal ( ) Storage Building ( ) Enclosed �
O Frame built on site O Screenhouse O Living room c�
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen �
( ) Mobile/manufactured ( ) Other ( ) Bedroom �
( ) Other primary structure (X) /�G'G� ����,� �.l ( ) Relocate/enlarge (p "
( ) ( ) ( ) # of new '
-o
W
AdditionalInformation: 'J .�
N �
e �
Type of Construction: � �''
( ) Frame ( ) Log (�Pole/metal ( ) Block ( ) Concrete V' '�
W
( ) Other � �
Construction Cost: Primary Structure $ ro �
Accessory Building: $ �: ���:���. o o Addition: $ � �
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Deed: Vol 3�d 9 Pg 5/y Certified Soil Test# �—6(vy � z
CSM: Vol Pg Lot# Sanitary Permit# 9 3 •oY9 °Q 7�
Plat Envelope r: `�""Q.r;.�,. o,
��,:� �0
Condo Vol Pg Year�nstalled: �;
"Loads and Flows": Vol Pg Owner Wlien Installed: � �
. � �
.1�''�-�: ,
Previous office approvals/actions: �b� z,�� t " ?� �'�r �
Variance: # LUP:# Q 3- p$4, SP: # CUP: # �9V
Inspection Report: # Change of Zone District: �,p�
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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 . �-;: ; , �z ,.i , ,;: #2. #3. #4.
Size ft. wide ft. wide ft. wide ft. wide
.r,, �� ft. long ft. long ft. long ft. long
Floor area ,� �,, ± sq. ft. sq. ft. sq. ft. sq. ft.
Hgt. from grade :� ; to pealc ft. hgt. ft. hgt. ft. hgt.
Stories � stories stories stories
# of bedrooms --
Lake/Pond/Flowa e/River/Stream Name
Fire Number and Name of Road /� U '; N l��''�s ��,`� 7�M b er 7✓'a�/s L.a•� �
1. Enter lot dimensions and indicate north by arrow. Si ture of Owj�e or thorized Agent:
2. Indicate the location and size of the requested construction ��
Signature
activities. ����„c,✓ G f�'E [-L,�v9��
Print Name:
3. Also, indicate the location and distance to the well, The above certifies that the listed information and intentions are
true and correct., that all work shall be perfortned in compliance
with the requirements of the Sawyer County Zoning Ordinance
septic tank and drainfield, wetland areas, lot lines, and the laws and regulations of the State of Wisconsin, and if
centerline of the road and waterbodies. aot��s as ow�er�s� a9e�t, has the permission of the owner(s) to
perform the work requested on this application. The above
personsls hereby give permission for access to the property for
onsite inspection.
Permit fee: $
Total land area within 300' of the waterbody: (A) d
Total impervious surface area [including this project] (B) � ��';
(B) / (A) x 100 = % Used �:-' (Shall not exceed 15%[or 25% with a conditional use permit].)
Shoreli� �� +"t'^n Prntartinn �rhi .
November 29 , 2004 - — �
Issue Date Signature of Issui A e t
Novmeber 29 , 2005
50% Rule: Average Road Setback:
Expiration Date
Office Comments:
CERTIFIE � SURVEY MAP �
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