HomeMy WebLinkAbout010-941-14-4105-LUP-2004-323 �
Application for Land Use Permit(*Non-shoreland*) � o .
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 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 AAVE BEEN ISSUED.
nvinrT_rrcE BLACK INK OR PENCIL
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Owner -y f- Builde� <'
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Mailing Address ' Mailing Address �
/74i.l.ri:.✓c7' /�T ��/d �/ ) tt(�Ji k�r��.J�- 5��i`i3 �n �
City, tate,Zip ,�� City,St�te,Zip �,y,�dG, w�rK � � �
7/S- 63y`/��I�� 63�I-a`]oo c�3y-vz8r �,�3y-b,oa
Daytime Phone /lain e Wcr k 5 Daytime Phone � (�,
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AdditionalInformation: ZoneDistrict: �—�
Lot Dimensions:
Date lot was created: 1�i� /D-l�-j]8 Acres 5 n
0
Is there wetland near the proposed structure?If yes,how faz CZ7l� � �
Building Land Use Floodp}ain:� )Yes ( No :R ('
( )New ( )Filling �
(vYAddition O Dredging Driveway access off of a(Check one): a`D, tiQ
( )Alteration ( )Grading (v)'Private Rd ( )Town Rd. o �
( )Moving On ( ) ( )County Hwy ( )State Hwy ; �
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Primary Structure Accessory Building Addition �o ° I
( )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 � �
( )Other primazy structure ( ) ( )Relocate/enlarge
� � � � ( )#ofnew � �
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AdditionalInformation: � p
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Type of Construction: UI 1�
(�.�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete ��'�
( )Other .d �
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Construction Cost:Primary Structure$ � o
Accessory Building:$ Addition:$ �GO�3 � �
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Deed:Vol 855 Pg_ �� Certified Soil Test# 4(n- 1(n( °Q
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CSM:Vol_�Pg /G`� Lot# Sanitary Permit# 9!�-ld5 0� I'�_
rkll7� Or: N `"
Plat Envelope
Condo Vol Pg Yeaz Installed: ;: �
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Aff of ex septic Vol Pg Owner When Installed:
`l�t-i'y
49-`+�� �
Previous office approvals/actions: 9 9'399 W
99-3� �
Variance:# LUP:# q5-�� SP�# CUP:#
Inspection Report:# 45-2�2 Change of Zone District �51�
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Describe the construction using these columns. List the dimensions of each structure in a separate
column. List each story, each addi on, e�ch alteration in a separate column
#1. Qi �e(' #2. � I: #3. #4.
Size / ft. wide _1Q_ft. wide ft. wide ft. wide
_�_ft. long �_ft. long ft. long fr. long
Floor area sq. fr. /�0 sq. fr. sq. ft. sq. fr.
Hgt.from giade %3 , to peak�_ft. hgt. ft. hgt. ft. hgt.
Stories_�__ stories stories stories
# of bedrooms�_
Rear Lot Line
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Fire Number and Name of Road S �° J //'A �rr f"9/ K
1. Enter lot dimensions and indicate north by arrow. e of 0 r or h rized A ellt:
2. Indicate the location and size of the requested construction � "
Signature
activities. /� c
Pnnt Name: l%�,�Y'1 3 J/71 I
3. Also, 1ridiCate the IoCatlon 3rid dlStanCe to the wel], The above ceNfes that the Ilsted intormation and intenCions are
true and correct.,that all work shall be pedormed in compliance
septic tank and drainfield, wetland areas, lot lines and to the w�m me req��remeoi5 or me sa"�yer co��ry zo�m9 omma�ce
and the laws and regulations of the State of Wisconsin, and if
CCritOLllriO Of Y�10 I'03C�. actlng as owner(s)agent, has the permission of the owner(s)to
perfortn the work requested on this application. The above
personsls hereby give permission for access to lhe property for
onsite in pection. _ l' /
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Permit fee: $
July 6, 2004 �j�������a�� ���������� _
Issue Date Signature of Issuing Agent
July 6, 2005
50% Rule: Average Road Setback: _
Expiration Date
Office Comments:
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