HomeMy WebLinkAbout010-941-34-3102-LUP-2004-384 Application and Use Permit(*Non-shareland*) o o,��� �
--�- County of Sawyer �
PO Box 676 -Haywazd 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. r
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. �
PRiNT—USE BLACK INK OR PENCIL � �
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JR,.� �-�- L��c,�►.u,Ttl ��u c,� ����,�,� �
a �Owner Bui er �'
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Mailing Address Mail' g Address �
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City,�tat,Zip� Cit�ate,Zip . �
�/-,-�3�-�l�� �l���3�-�r� �
Daytime Phone Dayhme Phone Z_
Additional Information: Zone District: /-� / �
Lot Dimensions:��G�"E 5 �
Date lot was created: /- h`t ��'Z Acres: �� �GZ�S o m
Is there wetland near the proposed structure?If yes,how far � �
Building Land Use Floodplain:( �j Yes O No �:;
�New �Filling �
Addition Dred in Drivewa access off of a Check one `D
� ) � ) g B Y � )� oa
O Alteration O Grading (�Cl Private Rd O Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy r,"', �
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Primary Structure Accessory Building Addition � °
( )Dwelling (�Garage-attached/detached ( )Deck �"'„
O Yeaz round (�#of car stalls O Porch �
O Seasonal O Storage Building O Enclosed �
O Frame built on site O Screenl�ouse O Living room � �
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen a
( )Mobile/manufactured ( )Other ( )Bedroom �
( )Other primary structure ( ) ( )Relocate/enlarge
� � ( ) ( )#ofnew � �
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Additional Information: �C A
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Type of Construction: � (�,
qQ Frame ( )Log ( )Pole/metal ( )Block ( )Concrete
( )Other
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Construction Cost:Primary Structure$_ � 5
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Accessory Building:$ /D�UDD.°O Addition:$ �
Deed:Vol ��z Pg 3 z i Certified Soil Test# bz -ZBUU tl4
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CSM:Vol Pg Lot# Sanitary Permit# Q2-3/Z , � I�
Plat Envelope Oc N F.,�
Condo Vol Pg Year 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:
1333� ;-z�,._v�. 6Y
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. i�7 F�vz�� #2. #3. #4.
Size,��/ ft. wide ft. wide ft. wide ft. wide
�ft. long ft. long ft. long ft. long
Floor area_[,,�_sq. ft. sq. ft. sq. ft. sq. ft.
Hgt.from grade to peak ft. hgt. ft. hgt. ft. hgt.
Stories � stories stories stories
# of bedrooms $
Rear ot Line
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Fire Number and Name of Road C��'-� /1� �ADL�:.� �l�
1. Enter lot dimensions and indicate north by arrow. $�"n ture.oF ner r Auth rized Agent:
2. Indicate the location and size of the requested construction ,�,,�;��c��^,�7�
Signature
activities. ��,
Pnnt Name: ��I�/� �� ��LK�%�7-��
3. Also, indicate the location and distance to the well, The above certifies that the listed information and intentions are
true and correct.,that all work shall be performed in compliance
septic tank and drainfield, wetland areas, lot lines and to the with the requirements of the Sawyer County Zoning Ordinance
and the laws and regulations of the State of Wisconsin, and if
centerline of the road. a�c��9 as owner�s�a9e�t,has the permission of the owner(s)to
perfortn the work requested on this application. The above
personsls hereby give permission for access to the property for
onsite inspection.
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Permit fee: $ �(�U �
July 27, 2004 - �
Issue Date Signature of Iss ng ent
July 27 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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