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Home My WebLink About010-174-00-0800-LUP-2004-193 �' }� \ Application for Land Use Permit (*Non-shoreland*) o o . � County of Sawyer � � k� 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. '` CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. � /..�� Pj(j PRINT-USE BLACK INK OR PENCIL �1 � G. � W�-t�� C lY:7.� �/' �� (i i J�l�Y�'t�� / �(�� ✓ �� Owner Builder „ �: � �- �� 1�� '� R� /� S�e � ��z � /��` �� 10 � Mai ing Addres� �� Z Mailing Address ( , _, O �� L1��r Gi` � ��J // ��G'Z`"' �-� `�� J y�yJl r_ � � � � �ty, St�te, Z'� ,� City, �tate, Zi �� r �� - �� S I i S_ � 3 y�_ �j� � �--. � � l 1 � `7 � Daytime Phone Daytime Phone , J Additional Information: Zone District: � '" t � Lot Dimensions: Date lot was created: Acres: � -7 Z o Is there wetland near the proposed structure? If yes, how far � � Building Land Use Floadptain:-( j Yes (;�j No `� � (�New ( ) Filling � O Addition O Dredging Driveway access off of a(Check one): � ( ) Alteration ( ) Grading ( ) Private Rd ( ) Town Rd. o O Movina On O O County Hwy O State Hwy N � ) D � ) o � � r Primary Structure Accessory Building Addition � ° (}() Dwelling ( ) Garage-attached/detached ( ) Deck W (� Year round O # of car stalls O Porch � O Seasonal O Storage Building O Enclosed � O Frame built on site O Screenhouse O Living room � ( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen ��3 ( ) Mobile/manufactured ( ) Other ( ) Bedroom , � ( ) Other primary structure ( ) ( ) Relocate/enlarge ' � � � � ( ) # of new _ � AdditionalInformation: � � � � .�. v� � � Type of Construction: ` ( ) Frame � Log ( ) Pole/metal ( ) Block ( ) Concrete _,: `� � ( ) Other b � Construction Cost: Primary Structure $ '7�i �7 f"''�� _ � � � Accessory Building: $ Addition: $ � �^ • , L � v�, Deed: Vol -� � == Pg ` �:- Z- Certified Soil Test# �J `� — G � � Z Lot# Sanitary Permit# (� � '' � �� o� � CSM: Vol Pg �_ Plat Envelope Or: N "- � Condo Vol Pg Year Installed: � � � Aff of ex septic Vol Pg Owner When Installed: " 1 � Previous office approvals/actions: LUP: # SP: # CUP: # . � Variance: # ,` Inspection Report: # Change of Zone District: izj�b�� I b0� � 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 � � #2. �,� #3. 1d �^� #4. Size "Z $ ft. wide __�l�ft. wi e �_ft. wide ft. wide �_ft. long ,��-__fr. long _L(�ft. long fr. long Floor area �� sq. ft. 57�. sq. fr. 14 � sq. ft. sq. ft. , Hgt.from gade 2 � to peak ft. hgt. �hgt. ft. hgt. , n „ Stories Z stories � stories stories # of bedrooms�_ �� \ Rear Lot Line j � �j�W(�� 6� � ?�� /3 ,��e �0� '�Z , I (N vd/ � N / / I �I ,� 'J ; N � N , i � � ; � � � � � � O -- ____ \ Fire Number and Name of Road - ? i ,G � �� < 1. Enter lot dimensions and indicate north by arrow. Signa r of Owner o uthorized Agent:_ 2. Indicate the location and size of the requested construction � /✓ SignaNre activities. Pnnt Name: 3. Also, IndlCate t}le loCatlOn 3nd diStanCe to the well, The above certifes that the listed inFortnation and intentions are We and correct.,ihat all work shall be peAormed in compliance septic tank and drainfield, wetland azeas, lot lines and to the with ihe requiremenGs of ihe Sawyer County Zoning ONinance and the laws and regulations of the State of Wiscronsin, and if CenteL�lne of the Toad. acUng as ownet(s)agent, has the permission ot the owner(s)to pedorm the work requested on this application. The above personsls hereby give permission for aceess to ihe property(or onsite inspedion. c 1S c� �'i Permitfee: $ o�� Ol �S- May 18 , 2004 ��mA�� x�`�-c/ -��n 6�� Issue Date Signature ofIs uin gent � � � May 18 , 2005 0 50/o Rule: Average Road Setback: _ Expiration Date Office Comments: 2301 twi �.� . .. __ ._. . 130J 6 ,.vin�. . � l�J 35.JS�C. .BO�C. � � 0101325 2� 010-941-23 1J13 Z ' t.76�C. 070-941-23 � � • • 1304 5 L51Ac. 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