HomeMy WebLinkAbout010-128-00-0600-LUP-2004-181 Application for Land Use Permit 1VonSiwr��aii� o 0
County of Sawyer � �-
PO Box 676 -Hayward WI 54843
715/634-8288 \ 4
The undersigned hereby makes application for a Land Use Permit and agrees that all work �R
shall be done in compliance with the requirements of the Sawyer County Zoning Ordinance �- �
and the laws and regulations of the State of Wisconsin. y
NO CONSTRUCTION MAY BEGIN UNTIL ALL PERMITS HAVE BEEN ISSUED. `�
PRINT-USE BLACK INK OR PENCIL �
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Owner Build °'
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Mailing Address Mailing Address � �+
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City tate,Zip City, tate,Zip
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Daytime Phone Daytime Phone r
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Additional Information: Zone District �'� L
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Lot Size S
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Date lot was created Acres � � �C �'� �—
Is the property in a Shoreland District?(within 1000'of a lake or pond,�vithin 300'of a river, S
creek or stream) If yes,how far from the shoreline&water name: o
Is there wetland near the proposed structure?If yes,how far o �
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Building Land Use G
(�New ( )Filling Floodplain:( )Yes �No # �;
( )Addition ( )Dredging '� �
( )Alteration �Grading Chippewa Flowage: ( )Yes (�No ';> �
( )Moving On ( ) �"'
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( ) ( ) Driveway:( )State ( )County (�'Town Rd. \
Primary Structure Accessory Building Addition
( )Dwelling (5Q Garage-attache etached , ( )Deck
O Year round (Z)#of caz stalls 4 `�� O Porch
( )Seasonal ( )Storage Building ( )Enclosed
O Frame built on site O Screenhouse O Living room �
( )Modular/manufactured ( )Greenhouse ( )Kitchen +
( )Mobile/manufactured ( )Other ( )Bedroom
( )Other primazy structure ( ) ( )Relocate/enlarge
( ) ( ) ( )#ofnew P
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Additional Information: "
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Type of Construction �
(�'Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �
( )Other '
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Construction Cost:Primary Structure S ��'
Accessory Building:$ Addition:$ � z
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Vol Pg of Deed Certified Soil Test# `��- �`i� y
CSM Vol Pg Lot#�J _ Sanitary Permit# 9�'"J'�
Plat Envelope Or: �
Condo Vol Pg Yeaz Installed
Aff of ex septic Vol Pg Owner When Installed:
Gard Gazebo Vol Pg
Previous Variance: LUP: R`1"53� Inspection Date: S-7���
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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�ft. wide ft. wide ft. wide ft. wide
i
y� ft. long ft. long fr. long ft. long
Floor azea/ �� sq. ft. sq. ft. sq. ft. sq. ft.
Hgt.from gade Z-� to peak ft. hgt. ft. hgt. ft. hgt.
Stories � stories stories stories
# ofbedrooms
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Lot Line or Lake/River name: � � �
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� Fire Number and Name of Road ��� '��- C 1 �a �� �
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.
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,
per.d, river, stream, creek, and name the body of water. Pnnt Name: Se�w. J2. /`-��+`�
The above certifes that ihe listed Infortna6'or✓�nd inten6ons are
(7. II1d1C3te any P�T3ding OT'Cle3tlrig 1R eXCCSS of t110 ConStI'l1CYlon Slte. we and correct.The above personsls hereby give permission(or
access to the property for onsite inspection.
7. Indicate distance to any wetland.
Pernut Fee:
Ma� � � , �nna — 7�-
Issue Date Signature of Iss g ent
May 13 , 2005
Expiration Date
Office Comments:
Inspection Date: 50%Rule Applies: Avg. Setback Within Reservation boundaries:
Restrictions and other information:
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