HomeMy WebLinkAbout010-841-20-1203-LUP-2004-250 Application for Land Use Permit(*Non-shareland*) o 0
County of Sawyer � ��
PO Box 676 -Hayward WI 54843
715/634-8288 � O
*Property that is not located within 300'of a creek,river or stream ox within 1000'of a S'
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
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Owner Builder ' N; �
I��Id � .S�e R�9-�� �5�1� t�t,l��A��-,s+e�i� �.
Mailing Address Mailing Address � �
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City, tat ,Zip City, ta ,Zip
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Daytime Phone Daytime Phone .�
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Additional Information: Zone District: �t—1 ra
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Lot Dimensions: 3��% X ���
Date lot was created: Acres: �-�� n
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Is there wetland near the proposed structure?If yes,bow far �
Building Land Use Floodg}ain:�j Yes OC)�No � =°
Q�New ( )Filling �
Addition Dred in Drivewa access off of a Check one CD
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O Alteration O Grading O Private Rd O Town Rd. o
O Moving On O O County Hwy (�}State Hwy �,"', �
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Primary Structure Accessory Building Addition � °
( )Dwelling ( )Garage-attached/detached ( )Deck W
( )Year round ( )#of car stalls ( )Porch =
O Seasonal O Storage Building O Enclosed �
O Frame built on site O Screenhouse O Living room � �
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen �
( )Mobile/manufactured �Other ( )Bedroom G .-
( )Other primary structure ( )� �����•�� �� ( )Relocate/enlarge � �,
� ) � ) ��J � -� ��� � )#of new � CT)
Additional Information: A
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Type of Construction: by
( )Frame ( )Log (�(Pole/metal ( )Block ( )Concrete " ��
( )Other ,�
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Construction Cost:Primary Structure$ �'���b �
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Accessory Building:$ ���s�C> Addition:$ � S-
Deed:Vol 3C1 � Pg�_ Certified Soil Test# 01 -I o5 p 5-c-,� °4 z
CSM:Vol Pg Lot# Sanitary Permit# Of �-c�/to 0;3-i�E3.`� o, �
Plat Envelope �r� N �
Condo Vol Pg Year Installed: �
Aff of ex septic Vol Pg Owner When Installed: �-' �
Previous office approvals/actions: �� �� �
p�� ti57 l/''
Variance:# LUP:# 4��-3d 9 SP:# CUP:# �1
Inspection Report:# Change of Zone District: �I a�'vl�
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111�1
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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 fr. wide ft. wide ft. wide
�^� �0"� �_ft. long ft. long ft. long ft. long
n.H4cA�.e
Floor area�(� sq. ft. sq. ft. sq. ft. sq. ft.
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Hgt.from gade��_to peak ft. hgt. ft. hgt. fr. hgt.
Stories�����..a �o��" stories stories stories
# of bedrooms '
Rear Lot Line
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Fire Number and Name of Road ��j_�(� V� ��- ,�t e t�d 1�
1. Enter lot dimensions and indicate north by arrow. Sigpature of Owne or uthorize Agent:
2. Indicate the location and size of the requested construction i,St.
SignaNre
activities. 1
PrinWame: �ZG .�nQ L� ��sthl
3. Also, InC�lCate the loCaUon and d1StanCe to the well, The above cer6fes that me Ilsted infortnatlon and intentlons are
true and conecl.,that aIl work shall be performed in compliance
Sept1C taT1�C and dralnfleld, Wetland 3T'eas, lot lines BTId to the with ihe requirements ot the Sawyer Counry Zoning ordinance
and the laws and regula6ons of the State of Wisconsin, and if
1 11 acting as ownef(s)agent, has ihe permission of the owner(s)to
centerline of the road. �„O k%�
perform ihe work requested on this applica�on. The ahove
personsls hereby give permission for aaess to the property for
onsite inspedion.
Permit fee: $
June 9, 2004 -
Issue Date Signature of I i Agent
June9, 2005 50% Rule: AverageRoadSetback:
Expiration Date
Office Comments:
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