HomeMy WebLinkAbout010-941-30-2203-LUP-2004-006 Application for Land Use Permit o o • ��
County of Sawyer � �_^
PO Box 676 -Haywazd WI 54843
715/634-8288 �
The undersigned hereby makes application for a Land Use Permit and agrees that all work y_
shall be done in compliance with the requirements of the Sawyer County Zoning Ordinance
and the laws and regulations of the State of Wisconsin. �
NO CONSTRUCTION MAY BEGIN UNTIL ALL PERMITS HAVE BEEN ISSUED. _
j�lN S r�K7 PRINT—USE BLACK INK OR PENCIL
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Owner ' Builder °' O
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Mailing Address �� Mailing Address � �
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City,State,Zip City,State,Zip
(c;3'�-d�:;3.� �
Daytime Phone Daytime Phone
Additiona]Information: Zone District �a
Lot Size
Date lot was created /d•a3-a3 Acres _�r1P R
Is the property in a Shoreland District?(within 1000'of a lake or pond,within 300'of a river,
creek or stream) If yes,how far from the shoreline&water name:
Is there wetland near the proposed structure?If yes,how far yt�� �oo� �
Building Land Use �
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( )New ( )Filling Floodplain:( )Yes (�)No # ;;
( )Addition ( )Dredging � o
O Alteration (✓�Grading Chippewa Flowage: O Yes (�No �,
(J)Moving On ( ) r"
( ) ( ) Driveway:( )State ( )County (x)Town Rd. � �
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Primary Structure Accessory Building Addition
( )Dwelling ( )Gazage-attached/detached ( )Deck � �
( )Year round ( )#of caz stalls ( )Porch
( )Seasonal ( )Storage Building ( )Enclosed �
( )Frame built on site ( )Screenhouse ( )Living room 9� �
( )Modular/manufactured ( )Greenhouse ( )Kitchen �
(.7 Mobile/manufactured ( )Other ( )Bedroom �
( )Other primary structure ( ) ( )R�locate/enlazge
( ) ( ) ( )#ofnew >
, �
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Additional Information: � c�d� `�-`y�` I'"�
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Type of Construction �
( )Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �
( )Other Mo�•�c
Construction Cost:Primary Structure$ Bo,��� _ � �
Accessory Building:$ Addition:$ Z
p�. �. �'.��aS.SJ 7y
Vol Pg of Deed Certified Soil Test# D y"QD5
CSM Vol Pg Lot# Sanitary Permit# 97-yM3 ��i/'005 �
Plat Envelope Or: �
Condo Vol Pg Year Installed
Aff of ex septic Vol Pg Owner When Installed:
Gard Gazebo Vol Pg
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Previous Variance: LUP: q0-a ly� Inspection Date: + �
Rz-N �17-�oV� 9'1-(a5
130�1
Describe the construction using these columns. List the dimensions of each structure in a separate y
column. List each story, each addi iyn, each alteration in a separate column.
#1. #2. ��Ilqt�'�,:. #3. #4.
Size 1(o ft. wide �_ft. wide ft. wide ft. wide
�(�ft. long �`� ft. long ft. long ft. long
Floor azea �a,� _sq. ft. �sq. ft. sq. ft. sq. ft.
Hgt.fivm gcade�_to peak ft. hgt. ft. hgt. ft. hgt.
Stories i stories stories stories
# oFbedrooms�
ot Line Lake/River name:
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Fire Number and Name of Road l-]6Ff1_l�l Cr,s� �'•�� �d
1. Fill in lot dimensions and indicate north by arrow. Signa re,of 9wner or Authorized Agent;
2. Indicate location and size of existing and new structures. ,G' `�-J�f
3. Indicate location of well, septic tank, drainfield.
4. Indicate distance to existing structures, lot lines, septic system.
5. Indicate distance to the ordinary high-water mazk of any lake,
pond, river, stream, creek, and name the body of water. P���Na"�:
The above certifes ihat Ne listed information and intentions are
6. Indicate any grading or clearing in excess of the construction site. we and correct Tne atove perso��s nerety y�ve Pe�m�ssio�ro�
access to Ne property foronsite inspedion.
7. Indicate distance to any wetland.
Perniit Fee: - °°
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January_� 2004
Issue Date Signature of Iss � g gent
January 13 , 2005
Expiration Date
Office Comments:
Inspection Date: 50%Rule Applies: Avg. Setback: Within Reservation boundaries:
Restrictions and other information:
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MAPPING PURPOSES.
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