HomeMy WebLinkAbout010-941-21-3102-LUP-2004-053 Application for Land Use Permit(*Non-shoreland*) o o ;h
County of Sawyer � :'
PO Box 676 -Hayward WI 54843
715/634-8288 J 0
*Properiy 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 SIIALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. R 1
/�/�$PK7 PRINT—USE BLACK INK OR PENCIL,.�l
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Owne Builder ��
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Mailing Address Mailing Address O �
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Ciry,S te,Zip City,State,Zip �
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Daytime Phone Daytime Phone ��
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Additional Information: Zone District: t�-,
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Lot Dimensions: � lo O X La C�^C
Date lot was created: Acres:�_� n
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Is there wetland near the proposed structure?If yes,how faz �
Building Land Use Floodplain:� j�es (j(j No :° �
(�New ( )Filling � �
O Addition O Dredging Dxiveway access off of a(Check one): �
O Alterarion O Grading O Private Rd �Town Rd. o
O Moving On O O County Hwy O State Hwy i,"',
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Primary StnzcYure Accessory B m Addition � °
(�, Dwelling �Garag attache etached O Deck W
�Year round O#of car s a s O Porch =
( )Seasonal ( )Storage Building ( )Enclosed � �
O Frame built on site O Screenhouse O Living room �
�Modular/manufactured ( )Greenhouse ( )Kitchen ,� r`'
( )Mobile/manufactured ( )Other ( )Bedroom � �
( )Other primary structure ( ) ( )Relocate/enlarge � '
� � ( ) ( )#of new 'C U
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Additional Information: p
�
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Ty e of Construction: �
(�Frame ( )Log ( )Pole/metal ( )Block ( )Concxete �
( )Other �
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Construction Cost:Primary Shuctuxe$ �O� �nr� o
:?
Accessory Building:$ Addition:$ � �
�/$01 �`1S `°
Certified Soil Test#����- ��C °Q
Deed:Vol (n l`7 Pg o`�-�7 1 I � Z
CSM:Vol Pg Lot# Sanitary Permit# ��/- 0�j o1 o, 7�
Plat Envelope Or: i i �''
Condo Vol Pg Year Installed: � i��
Aff of ex sepric Vol Pg Owner When Installed:
s,
Previous office approvals/actions: �
Variance:# LUP:# SP:# CUP:#
Inspection ReporC:# Change of Zone District: �,�%5
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1a38�
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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.
#L ��=�I1;w� #2. � - « � ,i #3. #4.
Size . wide ' ft.wide ft. wide ft. wide
�_ft. long ,2� ft. long ft. long ft. long
Floor azea 1 e`��j sq. ft. �J3� sq. ft. S4• ft. Sq• ft.
Hgt.from gade � �' to peak 1 C;,- I ft. hgt. ft. hgt. ft. hgt. '
Stories�_ �_ stories stories stories
# of bedrooms�_
Rear Lot Line
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Fue Number and Name of Road :�\t � ��f � � � ��� C
1. Enter lot dimensions and indicate north by arrow. Si nature of OWR2P�or Authorized Agent:
2. Indicate the location and size of the requested construction
� � ignffiure
8ChV1Y1BS. �� ��°° ��' �c, h^�Sc-�
Pnnt Name�,
3. AISO, 1ndlCate the IoCatlon and d15tanCe to the well, The above cedifes that the listed intormation and intentions are
true and correct.,that all work shall be pedormed in compliance
sepY1C taTllc ancl C�ralnfield, wetland aT'eas, lot llnes and to the with the requirements of the Sawyer County Zoning ordlnance
and the laws and reguiations of the St21e of Wisconsin, and if
C0riY0Illll0 Of tk10 TO&C�. actlng as owner�s)agent, has the permission of the owner(s)to
per(orm ihe work requested on this application. The above
personsls hereby give permission for aceess to the property for
onsile inspec6on.
Permit fee: $ �') �:'� `�" -��:K`� ':-z-�
March 22, 2004 ' —
Issue Date Signature of Is ing gent
March 22, 2005 50%Rule: AverageRoadSetback: _
Expiration Date
Office Comments:
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