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 � �
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Mailing Address Mailing Address �
f�AYt/�� 6�/ s��fiy� � �
City,State,Zip City,State,Zip �
63�-�.�ys� 5�;�-� �
Daytime Phone Daytime Phone �" y
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Additional Information: Zone District 6'('f�
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Lot Size d- � 4,
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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
(� .$�G/c df/�<<E D.�c y ( ) ( )#of new p
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Additional Information: �'
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Type of Construction �
(�, Frame � ( )Log ( )Pole/metal ( )Block ( )Concrete �
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( )Other �
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Construction Cost:Primary Structure$ 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 _ _ �
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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: ��
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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 �� 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.
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Hgt.from grade �� to peak ft. hgt. ft. hgt. ft. hgt.
Stories � stories stories stories �
# ofbedrooms 2
L,ot Line or Lake/River name:
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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. �
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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.
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Permit Fee:� /,,f� -,,, S
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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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