HomeMy WebLinkAbout010-841-35-2106-LUP-2004-281 Application for Land Use Permit(*Non-shoreland*) o o `
County of Sawyer �, �
PO Box 676 -Hayward WI 54843 --f-�
715/634-8288 O
*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. �
y� pK7 PRINT-USE BLACK INK OR PENCIL �'
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Owner Builder <
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Mailing Address Mailing Address � �
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City, tate,Zip City,State,Zip �
7�5 C�3 f 2�-2�
Daytime Phone Daytime Phone I
Additional Information: Zone District: IQR'l
Lot Dimensions I
Date lot was created: Acres: �/. �4 0 �„
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Is there wetland near the proposed structure?If yes,how far G
B'uilding Land Use Floodplain:� )Yes {�Q No =9 �
(�t�New ( )Filling � �
Dred m Drivewa access off of a Check one `D
( )Addition ( ) g� g Y � �� �
O Alteration O Grading O Private Rd O Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy N �
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Primary Structure Accessory Building Addition � °
(�Dwelling (X1 Gazage-attached/deERehed (�Deck W
(>c�Year round (Z)#of car stalls O Porch .=
O Seasonal O Storage Building O Enclosed �
Q�1 Frame built on site O Screenhouse O Living room � �
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen �
( )Mobile{manufactured ( )Other ( )Bedroom � �
( )Other primary structure ( ) ( )Relocate/enlarge
� � ( ) ( )#of new �
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AdditionalInformation: �n p
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Type of Construction: � c
(jQ Frame ( )Log ( )Pole/metal ( )Block ( )Concrete l�j�
( )Other
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Construction Cost:Primary Structure$ /���IJO �
Accessory Building:$ Addition:$ � �
Deed:Vol 7 90 pg /?: Certified Soil Test# �—(3� °0 z
CSM:Vol Pg Lot# Sanitary Permit# �� - �9� o, %°
Plat Envelope �r� N �
Condo Vol Pg Yeaz Installed: �
Aff of ex septic Vol Pg Owner When Installed: " �
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Previous office approvals/actions: �
Variance:# LUP:# SP:# CUP:#
Inspection Report:# Change of Zone District: la��b�
5 �`
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3�958
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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. (�7Ce rac� #3. L�rcJ`� #4.
Size 2b�_3 D fr•wide a�. fr.wide _�_ft.wide fr.wide
_�pz_fr.long �a ft.long /�' ft.long ft.long
Floor azea /4�p sq.fr. �='� sq.ft. /�<) sq.ft. sq.ft.
Hgt.from gade Z%� to lxak= --ft.hgt. ft.hgt. ft.hgt.
Stories / stories stories stories
#of bedrodms�_
Rear Lot Line
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Fire Number and Name of Road
1. Enter lot dimensions and indicate north by arrow. Signature of Owner or Authorized Agent:
2. Indicate the location and size of the requested construction ?�
Signature
activities. � �/
PnntName: ��s�G��"��-•���
3. Also,1ndiCate the location and distance to the well, The above ceAifes that the listed in(ormation and iNe�ons are
true and corted.,that all work shall be peAormed in compliance
septic tank and drainfield,wetland areas,lot lines and to the with the requirements of the Sawyer County Zoning Ordinance
and ihe laws and regulations of the Sfate o(Wisconsin,and if
centerline of the road. acting as owner(s)aqent,has tne permission ot tne owner(s)to
pertortn the work requested on ihis application. The above
personsls hereby give permission for access to the property for
�t��/l�� onsite inspectian.
Permit fee:$ c���f 1�� �
June 22, 2004 —
Issue Date Signature of Issu� g t
June 22, 2005
50°/o Rule: Average Road Setback:
Expiration Date
Office Comments:
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