HomeMy WebLinkAbout010-841-27-5319-LUP-2004-091 Application for Land Use Permit(*Non-shoreland*) o 0
County of Sawyer �, � ' �
PO Box 676 -Haywazd WI 54843 �
715/634-8288 �
*Property 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 SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. �
PRINT-USE BLACK INK OR PENCIL
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Mailing Address Mailing Address � �
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City,S te,Zip ity,Sta e,Zip �� ��
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AdditionalInformation: ZoneDistrict: �R-`� �' �1}
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Lot Dimensions:�o-1.�.(vS X�1 7.��� �7�
X �
Date lot was created: Acres: �,U� - n �'
Is there wetland neaz the proposed structure?If yes,how far ��ln � �
Building Land Use Floodptain:( j Yes�}No CD U�
( )New ( )Filling �
Addition Dred m Drivewa access off of a Check one `D
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O Alteration O Grading O Private Rd �Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy N �
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Primary Structure Accessory Building Addition � °
( )Dwelling ( )Gazage-attached/detached ( )Deck "' �
O Yeaz round O#of car stalls �Porch =
( )Seasonal '�Storage Building ( )Enclosed �
O Frame buIlt on site O Screenhouse O Living room
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen
( )Mobile/manufactured ( )Other ( )Bedroom ,
( )Other primary structure ( ) ( )Relocate/enlazge �
� � ( ) ( )#of new �
AdditionalInformation: � �
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Ty,pe of Construction: � �
�Frame ( )Log �Pole/metal ( )Block ( )Concrete �
( )Other
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Construction Cost:Prunary Structure$ � �
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Accessory Building:$ ,�pQ,OQ� Addition:$ I�(xi�.�� x� ..�
61^c�33 � `
Deed:Vol -7'3� Pg�Z Certified Soil Test# 95 Oa9 79-0� °Q z
CSM:Vol�Pg /03 Lot#� Sanitary Permit# O(-031 0, �
Plat Envelope �'a a Or: �, �
Condo Vol Pg Year Installed: � \
Aff of ex septic Vol Pg Owner When Installed: �- �
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Previous office approvals/actions: �
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Variance:# LUP:# O(-U`{� SP:# CUP:#
Inspection Report:# 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 a �tion, eac alteration in a separate column.
#1.�,� #2, � . (�l� #3. #4.
Size ft. wide wide ft. wide ft. wide
�ft. long �ft. long fr. long ft. long
Floor azea��- sq. ft. �sq. ft. sq. ft. sq. ft.
Hgt.from gtade ��to peak g 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 32 O l.v.
1. Enter lot d'unensions and indicate north by arrow. Sig ature of 0 ner or Autho�}�ed Agent:
2. Indicate the location and size of the requested construction �0 Lry�� �—_
Signatu�
activities.
PrintName: � � T_r"�;����-
3. Also, IncllCate tl]e loc3tlon and diStanCe to the Well, The above cer6fes Ihat ihe listed mfortna6on and intentions are
hue and conecL,that alI work shall be pedomied in compliance
septic tank and drainfield, wetland azeas, lot lines and to the wim me ��qmreme�+� ot me sawyer covory zo�m9 om�oa�ce
and the laws antl regulalions of the Sfate of Wisconsin, and if
CORtCTllriO Of tl'1C iO3d. acting as ovmef(s)agent has the permission of the owner(s)to
perfortn the work 2quested on this application. The above
personsls hereby give permission for access to the property for
onsite inspecUan.
Permit fee: $7� �
April 27 , 2004 �
Issue Date Signature ofIs in gent
April 27 , 2005 50% Rule: AverageRoadSetback:
Expiration Date
Office Comments:
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