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HomeMy WebLinkAbout010-162-00-0100-LUP-2004-208 Application for Land Use Permit o ...�/ County of Sawyer V � O PO Box 676 -Hayward WI 54843 � 715/634-8288 The undersigned hereby makes application for a Land Use Permit and agrees that all work � shall be done in compliance with the requirements of the Sawyer CounYy Zoning Ordinance 1 and the laws and regulations of the State of Wisconsin. � � NO CONSTRUCTION MAY BEGIN UNTIL ALL PERMITS HAVE BEEN ISSUED. � PRINT—USE BLACK INK OR PENCIL S� J � ;�a,U�iv5Ci69��'�Z 'J i�/�w � �� ��'`�`S a � Owner B ilder � � /�/3��'��r B s�t����� �� Mailing Address Mailing Address � f�AYt/�� 6�/ s��fiy� � � City,State,Zip City,State,Zip � 63�-�.�ys� 5�;�-� � Daytime Phone Daytime Phone �" y ��s. � Additional Information: Zone District 6'('f� /�� �/2G U i Z' ^,r� Lot Size d- � 4, / t Date lot was created �Q�Z Acres c�� ���J �� /�� � Is the property in a Shoreland District?(within 1000'of a lake or pond,within 300'of a river, � creek or stream) If yes,how faz from the shoreline&water name: ,?/ C� � r Is there wetland near the proposed structure?If yes,how far ;"✓ U � Building Land Use � (�New ( )Filling � Floodplain:( )Yes (�No # � ( )Addition ( )Dredging �` o O Alteration O Grading Chippewa Flowage: O Yes (�j)No Q � ( )Moving On ( ) c o ( ) ( ) Driveway:( )State ( )Counry ( )Town Rd. , �N/i/V�9�t %i� � Primary Structure Accessory Building Addition eu ( )Dwelling ( )Garage-atYached/detached � O Year round O#of car stalls �����r�1i o ( )Seasonal ( )Storage Building ( )Enclosed O Frame built on site O Screenhouse O Living room � ( )Modular/manufactured ( )Greenhouse ( )Kitchen � Ar (�Mobile/manufactured ( )Other ( )Bedroom ° ( )Other primazy structure � ( ) ( )Relocate/enlarge (� .$�G/c df/�<<E D.�c y ( ) ( )#of new p � � � Additional Information: �' �p'�" ✓l`✓��/'fi�'/ �7�iF-S �LL/� �//� �� ��� !/�/iF�GNv4f4 w �1 ' �� � �- Type of Construction � (�, Frame � ( )Log ( )Pole/metal ( )Block ( )Concrete � ti � ( )Other � ` � � Construction Cost:Primary Structure$ O�� �UG � � Accessory Building:$_ Addition:$ � z a � 7y J/,�oZ�j� .!'FI�GInIFi�j ;�U� w Vol Pg ofDeed Certified Soil Test#,9�L tiC�O�/ /SS�i�o �; � CSM Vol Pg Lot# Sanitary Permit C�' � �'��j _ _ � \ i � Plat Emelope �r• �U U � Condo Vol Pg Yeaz Installed Z � Aff of ex septic Vol Pg Owner When Installed: /I_ Gard Gazebo Vol Pg L/� 0(�/� G�(/�/�,� F�G��G 0��/�'�'�� ��ai� r�- �-��`/'`�- �ac �io ,oy. �.���yZ ��. Previous Variance: LUP: Inspection Date: �� /� � /�/!'I'��t�!/�/"/� iCJIL�FG� ' �l8(oa 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 �� fr. wide ft. wide ft. wide ft. wide I(/ � ft. long ft. long ft. long ft. long , Floor area�� sq. ft. sq. ft. sq. ft. sq. ft. i Hgt.from grade �� to peak ft. hgt. ft. hgt. ft. hgt. Stories � stories stories stories � # ofbedrooms 2 L,ot Line or Lake/River name: ��� �� ��JD/�- �` �l ,�� u, . � Z oc S G . � GG� Sv ' � � � � �� /a o ' ��, !� � a7 '° r � � p '�` }� li'E � c �£�/S�/ . � �—_ \ �10L����L � f79/✓Ll �C 0 STI/�GJ G _____ _� Fire Number and Name of Road 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. � , j�y'� 4. Indicate distance to existing structures, lot lines, septic system. � 5. Indicate distance to the ordinary high-water mazk of any lake, S T,��i,�!�N S d��7"L pond, river, stream, creek, and name the body of water. P��iName: The above certi0es ihat lhe listed infortnation and intentions are 6. Indicate any grading or clearing in excess of the construction site. ecceesstou,e p perety roonst rsnsp�ec6oneby give permiss�on ror 7. Indicate distance to any wetland. � � � -� 7S—�� _ � � c C Permit Fee:� /,,f� -,,, S �c � i Ma�7L � �(1�L Issue Date Signature of sui Agent May 24 , 2005 Expiration Date OfficeComments: ��-� ����ti' ����c�K�r-+ �������� ��isSu�' U�-te C�"e ^�— Inspection Date: 50% Rule Applies: Avg. Setback: Withinf eservation boundaries: ' Restrictions and other information: (�'' '"! 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