HomeMy WebLinkAbout010-224-00-0200-LUP-2004-065 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 -
shall be done in compliance with the requirements of the Sawyer County Zoning Ordinance � �
and the laws and regulations of the State of Wisconsin. b ,
NO CONSTRUCTION MAY BEGIN UNTIL ALL PERMITS HAVE BEEN ISSUED.
����p� �� PRINT-USE BLACK INK OR PENCIL
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�en�ei-� /=/PE/� L-". Z���:��� SE�F �
Owner Builder ~'
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/ys�s w STATt Rol9D 77 SAMt o
Mailing Address Mailing Address � �
h'9/w�J��� w�' s yd'y3 `� °
City,Sta e,Zip City,State,Zip 3 �
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�is 63y �-9�� � �
Daytime Phone Daytime Phone �
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Additional Information: Zone District �' `�
/` ; � �l
Lot Size ��3 X ��° � 3
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Date lot was created /9�'3 Acres � 6�� y
Is the property in a Shoreland District?(within 1000'of a lake or pond,within 300'of a river, 4
creek or stream) If yes,how faz from the shoreline&water name: S�� (3�G Xo���+ L k �
a
Is there wetland near the proposed structure?If yes,how far N O � �
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Building Land Use � �,
a
( )New ( )Filling � Floodplain:( )Yes ( )No # ;;
(�Addition ( )Dredging � �
( )Alteration ( )Grading Chippewa Flowage: ( )Yes (�')No ° „��.,
( )Moving On ( ) � ° �
� � ( ) Driveway:( )State ( )County QC)Town Rd. � �
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Primary Structure Accessory Building Addition °' �
( )Dwelling ( )Garage-attached/detached ( )Deck G�
L (�
( )Yeaz round ( )#of caz stalls OC)Porch � ,*
()()Seasonal ( )Storage Building (X)Enclosed
(�O Frame built on site O Screenhouse O Living room �
( )Modular/manufactured ( )Greenhouse ( )Kitchen �
( )Mobile/manufactured ( )Other ( )Bedroom �
O Other primazy structure O (X)Relocate/ nlarge
� � ( ) ( )#ofnew >
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0
Additional Information:
, ro �
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Type of Cos�struction �
(X)Frame ( )Log ( )Pole/metal ( )Block ( )Concrete F
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( )Other -- �
Construction Cost:Primary Structure$ _
Accessory Building:$ Addition:$ S-o�o vo ;/ �l Z
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Vol 35 4 Pg S 7 of Deed Certified Soil Test# 9�-3 9 3 0
CSM Vol `� Pg 3S Lot# � Sanitary Permit# `19 - b o 3 `�
� a�,� srArE¢# �o�3'� �
Plat Envelope Or:
Condo Vol Pg Year Installed J 9 9 9
Aff of ex septic Vol Pg Owner When Installed:
Gard Gazebo Vol Pg x�E 1'>��/�ov✓t
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Ins ection Date:
Previous Variance: L�� �`.' . 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. #2. #3. #4.
Size �r ft. wide ft. wide ft. wide ft. wide
ft. long ft. long ft. long ft. long
Floor area sq. ft. sq. ft. sq. ft. sq. ft.
Hgt.from gade /6 � to peak ft. hgt. ft. hgt. ft. hgt.
Stories / stories stories stories
# ofbedrooms o
Lot Line or LakelRiver name� �Q� E R�� N o �AKt�
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Fire Number and Name of Road /,��So W So u Tf/ S'fl o R E R o R �
1. Fill in lot dimensions and indicate north by arrow. Signature of Owner or Authorized Agent:
2. Indicate location and size of existing and new structures.
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3. Indicate location of well, septic tank, drainfield. y:'' ��
4. Indicate distance to existing structures, lot lines, septic system.
5. Indicate distance to the ordinary high-water mark of any lake,
pond, river, stream, creek, and name the body of water. P�niName: F/�� {� '- ' ' � "'
The above ceNfes that the listed information and intentions are
6. Indicate any grading or clearing in excess of the construction site. a eess m�me Pr�o�erry roo�s c rsns�ecao eby 9�Ye Pe`m'ss���ror
7. Indicate distance to any wetland.
Permit Fee:
April 15, 2004 ' G9• �
Issue Date Signature of Issuing Agent
April 15, 2005
Expiration Date
Office Comments:
Inspection Date: 50%Rule Applies: Avg. Setback: Within Reservation boundaries:
Restrictions and other information:
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/ 3303 � ; z SHONN AS 60� 1MDTFi FOR
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• ^ �— FOUND MONUMENT
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�� '/ � BEARINGS ARE BASED ON �
� RONAl.DL SECorGovt Lot4 /3 5 ��4 COf EAST �INE OF GOV'T LOT4
��� ' Sec.26,741N,R8W � ASSUMED TOBEAR NI°49�OO��E
� p�As� fd21/2"BrossCpd.
' 5-800 �
. HAYwAytD iron Pipe�CountYCor.
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�. ��, �' OQ� Reat. V-19) AUGUST 19,1983
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