HomeMy WebLinkAbout010-133-00-1500-LUP-2004-199 Application for Land Use Permit(*Non-shoreland*) r ,�,
County of Sawyer
o �
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 � �
�
�van X'un� �ry �r`�S� la,f'� �os �
Ow er Builder � �' �
�y��l �v. ����v �,� E S�s u.. /-//�4/� �T �:
Mailing Address Mailing Address �
O
��te. �a�i' . �.�.2Z' s y��.< /Y1irlonq /�}�ySl S� � �
City,State,Zip City,State,Zip �`
�ls- g3y - S�a o �is-�/66-y�/y 1 �
Da}�time Phone Daytime Phone
�+.
Additional Information: Zone District:_ R -'�
Lot Dimensions: y�y?39 X•?�3.ll K�I-.�� �
x.?�y8y �
Date lot was created: )� J�( /d3 Acres: �� � � 'c
c
Is there wetland near the proposed structure?If yes,how far N�� ,� �
c
Building Land Use Floodptain-f )Yes (�No :°
�New ( )Filling � '�
O Addition O Dredgin� Driveway access off of a�(Check one): �
O Alteration �Grading r �$e �j private Rd O Town Rd. �
( )Moving On ( ) S`� ( )County Hwy ( )State Hwy �,
\ �_ � � A O
O
C"�
Primary Structure Accessory Building Addition � �
�Dwelling �Garage ttache etached �Deck W
�Year round �#of car sta s-a O Porch �.
( )Seasonal ( )Storage Building ( )Enclosed ::
O Frame built on site O Screenhouse O Living room % �
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen � �
( )Mobile/manufactured ( )Other ( )Bedroom Q
( )Other primary structure ( ) ( )Relocate/enlarge � �
( )_ ( ) ( )#of new � W �
vW �, �
Additional Information: `i ° p
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i � �
Type of Construction: o��' �
�j Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �
( )Other
ro �Construction Cost:Primary Sriucture$ 78 p0o �
m
Accessory Building:$ Addition:$ s� .,�
-� �rf�-.. �o \
Deed:Vol 3 a i g Certified Soil Test# ���—/[?f�� °Q z
CSM:Vol Pg Lot# Sanitary Permit# (? `j '/ �3�Z o, �
PlatEn�elope Or: N �
Condo Vol Pg Year Installed: �
Aff of ex septic Vol Pg Owner When Installed: � �
i
W
W
Previous office approvals/actions: •
Variance:# LUP:# SP:# CUP:# �W
Inspection Report:# Change of Zone District c��'^1�
�`7"19
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.
0V #2. #3. L #4. deck
Size AS ft. wide A 9 ft. wide t. wide to ft. wide
6'4, ft. long
Floor area 15 �e� sq. ft.
Hgt. from grade ) 3 to peak
Stories
# of bedrooms
Fire Number and Name of Road
ft. long
sq. ft.
ft. hgt.
stories
1. Enter lot dimensions and indicate north by arrow.
2. Indicate the location and size of the requested construction
activities.
3. Also, indicate the location and distance to the well,
septic tank and drainfield, wetland areas, lot lines and to the
centerline of the road.
3d ft, long
fSgQ sq. ft.
ft. hgt.
stories
of
r(o ft. long
sq. ft.
ft. hgt.
stories
Agent:
SignaWe'
print ame; AK v rJA
The above certifies i at the listed information and intentions are
true and correct., that all work shall be performed in compliance
with the requirements of the Sawyer County Zoning Ordinance
and the laws and regulations of the State of Wisconsin, and if
acting as owner'(s) agent, has the permission of the owner(s) to
perform the work requested on this application. The above
personsls hereby give permission for access to the property for
onsite inspection,
Permit fee: $ a A , 0 0 \- '�O
, SAWYER COUNN PfAT OF HiDDEN WOODS OF HAYWARD m
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