HomeMy WebLinkAbout010-941-34-3311-LUP-2004-290 Application for Land Use Permit (*Non-shoreland*) o o �
County of Sawyer ^ � �
PO Box 676 - Hayward 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.
S U Z�-nn`F G.(},� P�NT-USE BLACK INK OR PENCIL � ,
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Owner Builder c'
/S S , -��t/r✓� /�-� � � 7�v 7 /y4J� .S'.S �� �
Mailing Address Mailing Address �
T/F�/w�GC i Gt/( ,�Y�`f� �«'G ���� , ��. �`l`��c� c�
Cit�tate, Zip City, State, Zip ln
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Daytime Phone Daytime Phone �
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Additional Information: Zone District: �/G cvic/ D � 4'�/Gc,tp
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Lot Dimensions: ���i1' ���L� �
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Date lot was created: /�78 a la$I?� Acres: �. l6 O n �
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Is there wetland near the proposed structure?If yes, how far � �
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Building Land Use Floodptain:( j I'es �j No �
�Q New ( ) Filling �
O Addition O Dredging Driveway access off of a(Check one): �
( ) Alteration ) Grading ( ) Private Rd (� Town Rd. o
( ) Moving On (� ( ) 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 �
( ) Seasonal � Storage Building ( ) Enclosed �
( ) Frame built on site ( ) Screenhouse ( ) Living room � �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen � ��
( ) Mobile/manufactured ( ) Other ( ) Bedroom `
( ) Other primary structure ( ) ( ) Relocate/enlarge � '
� � ( ) ( ) # of new L'�`
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Additional Information: ;
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Type of Construction: �v r-^1
( ) Frame ( ) Log (� Pole/metal ( ) Concrete �.
( ) Other `
o d � '�
Construction Cost: Primary Structure $ 9 3� � � �
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Accessory Building: $ Addition: $ �
,-,
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Deed: Vol 3 !d Pg I � Certified Soil Test# �g- �� � UQ z
CSM: Vol�`- _Pg 389 Lot# l z Sanitary Permit# `1$ - l 3 '7 o, �
Plat Envelope � 389 Or: �, ,
Condo Vol Pg Year Installed: ���� - 7�I' �
Aff of ex septic Vol Pg Owner When Installed: �-' �
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Previous office approvals/actions: �
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Variance: # LUP: # �3- y 9`� SP: # CUP: #
Inspection Report: # Change of Zone District: ����,��q�l
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Describe the construction using these columns. List the dimensions of each structure in a separate �
wlumn. List each story, each addition, each alteration in a separate column.
#1. #2. #3. #4.
Size��ft. wide ft. wide fr. wide ft. wide
_y�ft. long ft. long fr. long ft. long
Floor area T D� sq. ft. sq• ft• S4• ft• Sq. ft'
Hgt.from g�ade /Y � to peak ft. hgt. fr. hgt. fr. hgt.
Stories- / stories stories stories
# of bedrooms�_ � I �5 (
Rear Lot Line
4S`
S�CR l e
F-�� 3U� � '�6Y '
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6 `� �'
(o � m 55 � �
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T �y s�T�
80
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Fire Number and Name of Road /,Sg 7S� Cv ��� 'ti� ���_�- ^ �, �i
1. Enter lot dimensions and indicate north by arrow. Sig ture of Owner4LA horized Agent:
2. Indicate the location and size of the requested construction � C.�i� �/
/�� Signa ire
activiries. � � �
Print Name: �u�e.� . �0 FINE.�J
3. Also, lnC{1caY0 tlle LoC3tlOn and dlStanCC to the well, The above ceNnes that the�Isted Information antl Intentions are
irue and croned.,Mat all work shall be pedormed in compliance
septic tank and drainfield, wetland areas, lot lines and to the w�m tne �e�m�eme�c� of ine sawye�co��ry zo��o9 obma�ce
and the laws and regulations of the Shate of Wisconsin, and if
CenteI'line of tlle Io8C1. acling as owner(s)agent, has the pertnission ot the owner(s)to
perform the work requested on this application. The above
personsls hereby give permission for aaess to the property for
onsite inspecUon.
Permit fee: $ �OC'
June 22, 2004 _
Issue Date Signature ofIssu t
June 22, 2005
50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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