HomeMy WebLinkAbout010-941-20-1206-LUP-2004-109 Application for Land Use Permit (*Non-shoreland*) o 0
County of Sawyer � � . L
PO Box 676 - Hayward 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.
CONST UCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. �
/�/� !p�)` PRINT-USE BLACK INK OR PENCIL ',
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City, State, Zip City, State, Zip
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Additional Information: Zone District: _� �/
Lot Dimensions: ,3�6 X � �%�,;.� ' G'
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Date lot was created: Acres: `�� �� n '
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Is there wetland near the proposed structure? If yes, how far � .>
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Building Land Use Floadplain:� j 1'es (.�j No `� �,
�j New ( ) Filling � c�
O Addition O Dredging Driveway access off of a(Check one): �,
O Alteration O Grading (� Private Rd O Town Rd. o
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy �,
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Primary Structure Accessory Buildin Addition � °
� Dwelling (x) Garage attache detached O Deck W
(�}Year round (�}# of car stalls ( ) Porch �
O Seasonal O Storage Building O Enclosed �
O Frame built on site O Screenhouse O Living room � �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen `='
( ) Mobile/manufactured ( ) Other ( ) Bedroom � �.-
( ) Other primary structure ( ) ( ) Relocate/enlarge .z �
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Additional Information: A
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Type of Construction: �
�Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete
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Construction Cost: Primary Structure $ �' GY�,c�or� f- �
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Accessory Building: $ Addition: $ �
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.�i cc �Y� CD .�
Deed: Vol Pg Certified Soil Test# (� ,3 -�3�5 � �" z
CSM: Vol �� Pg C��) Lot#�_ Sanitary Permit# C�-Q�0 � �
Plat Envelope �r� N O
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Condo Vol Pg Year Installed: c�
Aff of ex septic Vol Pg Owner When Installed: `� �
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Previous office approvals/actions: 'r,
Variance: # LUP: # SP: # CUP: #
Inspection Report: # Change of Zone District: ����
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Describe the construction using these wlumns. List the dimensions of each structure in a separate '
column. List each story, each addition, each alteration in a separate column. •
#L Dw�a.�,;,;� #2. , ;, ; ,, , #3. #4.
Size Z �i fr. wide � ft. wide ft. wide ft. wide
�� fr. long _-'r� ft. long fr. long fr. long
Floor area /,17(o sq. fr. --7—�—��/ —sq. ft. sq. ft. sq. ft.
Hgt.from gade l�, to pealc � 7 ft. hgt. ft. hgt. fr. hgt.
Stories � �_stories stories stories
# of bedrooms 3
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Fire Number and Name of Road �l C o�'.� �,c�s� ,��
1. Enter lot dimensions and indicate north by arrow. Signatgre�w er o�ed Agent:
2. Indicate the location and size of the requested construction �l ���
SignaNre
activities. 9 ` c,�row
PnntName: �lAiP-'� G.��
3. Also, indlCate t}le loCatlon and disYffi1Ce to tbe well, The above ceNfies that the listed information and intentions are
lrue and correct.,that all work shall be peAormed in compLance
septic tank and drainfield, wetland azeas, lot lines and to the w�m me ����me�ts or me sav,ye� co���y zoo��9 om��a��
and the laws and regulafions of the Spte of Wisconsin, and if
CCIlteT'�1riC Of Y}IC L03d. acting as owner(s)agent, has the permission of the owner!s)to
peAortn the work requested on this application. The above
personsls hereby give permission for access to ihe pmpe.ry for
� onsite inspection.
Permit fee: $ �C����5�' ��'
April 29 , 2004 '
Issue Date Signature of Issui A e t
April 29 , 2005 50% Rule: AverageRoadSetback:
Expiration Date
Office Comments:
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