HomeMy WebLinkAbout010-941-25-2222-LUP-2004-367, .. /
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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 J ,
the property's boundaries. r'
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. ,- �
H /'S'j' PRINT—USE BLACK INK OR PENCIL
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Owner Builder c'
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Mailing Address Mailing Address �
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City, State, Zip City, State, Zip �. �
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Daytime Phone Daytime Phone
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Additional Information: Zone District: � ' �
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Lot Dimensions:
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Date lot was created:� ;,� ,:� �;� %o ;� Acres: /, � ; o
Is there wetland near the proposed structure?If yes, how far f ! ` �
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Building Land Use Floodptain:( j �es ( j No �°
(�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 N �
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Primary Structure Accessory Building Addition � �
(� Dwelling (�) Garage-attached/detached ( ) Deck W
(� Year round (��)# of car stalls � O Porch �
O Seasonal O Storage Building ( j Enclosed �
( ) Frame built on site ( ) Screenhouse ( ) Living room � �
(� Modular/manufactured ( ) Greenhouse ( ) Kitchen � �--
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( ) Mobile/manufactured ( ) Other ( ) Bedroom r� �
( ) Other primary structure ( ) ( ) Relocate/enlarge -r� �
( ) ( ) ( ) # of new ;, ��
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AdditionalInformation: ;� A
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Type of Construction: � ���
(?� Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete J
( ) Other
b �Construction Cost: Primary Structure $ 7�,: ;;�� ., �
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Accessory Building: $ s��o� Addition: $ � �
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Deed: Vol g Certified Soil Test# �;,� J `),�` °°
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CSM: Vol�Pg �j'-/ Lot#�_ Sanitary Permit# L `'1 -��3G� o, �
Plat Envelope ��=�7Z Or: �, ,-.
Condo Vol Pg Year Installed: �
Aff of ex septic Vol Pg Owner When Installed: � �
Previous office approvals/actions: �r;
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Variance: # LUP: # SP: # CUP: # '� �;
,'� �Inspection Report: # Change of Zone District: � I�j
7 t� ,.lA
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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. H e � ': t' #2. .> A �2�G E #3. ..��_,u� � r�"'� #4. �i7F�L:��",»°�,�' _
Size ,� 6- b" ft. wide ����,z!,��ft. wide 1 � ft. wide � 8" ft. wide
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66�o" ft. long y���`ft. long !G% ft. long � ft. long
Floor area�7 4� sq. fr. i ;,� 6 0 sq. fr. sq. f[. 3 �P �(� sq. fr.
Hgt.from gade 13: � to peak /3'-3„ ft. hgt. ft. hgt. ft. hgt.
Stories / �_stories stories stories
# of bedrooms�_
aso•�s
Rear Lot Line
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Fire Number and Name of Road i ni H r e t r R � �a -, L • � l.��
1. Enter lot dimensions and indicate north by arrow. Signa re f Owner or Author' ed Agent:
2. Indicate the location and size of the requested construction C.
SignaNre
activities.
Pnnt Name:�jQ��a h A! ��. /�'�� ,� �i��
3. Also, 1ndlCate the IoCatlOn and dlstance to flle Well, The above certifies ihat the listed information and intentions are
irue and covect.,ihat all work shall be peAortned in compliance
septic tank and drainfield, wetland areas, lot lines and to the w�m tne r�u�remen� ot tne sa�+yer coun�y zo��n9 o��nance
and lhe laws and regulations of lhe S+ate of Wisconsin, and if
C0IIt0Tllri0 Of t110 f08d. acting as owner(s)agent, has the permission of ihe owner(s)to
pedortn the work requested on this applirafion. The a6ove
' personsls hereby give permission for axess to ihe properry for
�� onsite inspedion.
Permit fee: $ �a� � ��� � �S
July 20 2004 �� �l�^ ���1F��'
Issue Date Signature ofIssuing Agent
July 20, 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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