HomeMy WebLinkAbout010-941-16-4103-LUP-2004-439 �
. Application for Land Use Permit (*Non-shoreland*) o 0
County of Sawyer � �
PO Box 676 -Hayward WI 54843 �
715/634-8288
*Properiy 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. � � �
PRINT—USE BLACK INK OR PENCIL
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Owner Builder �i��� � �:
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Mailing Address Mailing Address O �
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City, State, Zip City, State, Zip �j
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Daytime Phone Daytime Phone r,
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Additional Information: Zone District: �d—� �
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Lot Dimensions: �
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Date lot was created: Acres: l• $_5 n
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Is there wetland near the proposed structure? If yes, how far � �
Building Land Use Floadp�ain:( j Yes �No ° �
( )New ( ) Filling � N
� 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-attache etached , O Deck W
(� Year round ' ' (� # of car stalls 3�j x 2�;, ' ( ) Porch �
( ) Seasonal ��X �3 Z ( ) Storage Building ( ) Enclosed �
(� Frame built on site ( ) Screenhouse ( ) Living room � �
Modular/manufactured ( ) Greenhouse ( ) Kitchen � �-�
( ) Mobile/manufactured ( ) Other ( ) Bedroom —' .-
( ) Other primary structure ( ) (� Relocate/enlarge � '
� � ( � ( ) # ofnew
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AdditionalInformation: � A
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Type of Construction: .-_...
(� Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete `p �
( ) Other ,.�
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Construction Cost: Primary Structure $ � �
Accessory Building: $� ���.�� Addition: $'- �� L��-'� � �
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Deed: Vol (�z 9 Pg 2,'7 9 Certified Soil Test# $�,-Ol 9 �"
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CSM: Vol Pg Lot# Sanitary Permit# �g - ��� o, %`�
Plat Envelope �r� N
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Condo Vol Pg Year Installed: �
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Aff of ex septic Vol Pg Owner When Installed: "
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Previous office approvals/actions: t�
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Variance: # LUP: # SP: # CUP: # ,;�,� �
Inspection Report: # Change of Zone District: ���2.,
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Describe the construction using these columns. List the dimensions of each structure in a separate
column. List each story, each addition, each alteration in a separate column.
#1. Flornz add,t���-% #2. C�c�r4�e. #3. #4.
Size � O fr. wide 3o ft. wide ft. wide ft. wide
.3 Z ft. long ZCo fr. long fr. long ft. long
Floor area�sq. ft. 7$O sq. ft. sq. ft. sq. ft.
Hgt.from grade 1!o to peak� 5 .ft. hgt. ft. hgt. fr. hgt.
Stories I l stories stories stories
# of bedrooms NiA
Rear Lot Line
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Fire Number and Name of Road u ()L� � �1 5T � ��7
1. Enter lot dimensions and indicate north by arrow. Signature of Owner or Qut orized�,ent:
2. Indicate the location and size of the requested construction ��LC�y�,(G 111� � k!
Sgnature
activities. Q b�q l,c)�LI�OZ��L-
Print Name: ' `u
3. Also, indicate the location and distance to the well, The above certifies thal Ne listed infortnation and intentions are
We and cortect.that all work shall be peAormed in compliance
septic tank and drainfield, wetland areas, lot lines and to the w�m mB ���remeois of ine sawyer co��ry zo���g om�oa�ce
and the laws and regulalions of the Shate of Wisconsin, and if i
CCIIYCLIlriO Of 1.I1C t0&a. acting as ovmet(s)agent, has the pertnission of the owner(s)to �
perform the work requested on this application. The above
personsls hereby give permission for access to the property for
onsite inspectian.
Permit fee: $ ��0�
Al1gllSt 17� ZOO�+ AA �.����� / ^ m 1J
Issue Date Signature ofI s i genf
August 17, 2005 50% Rule: AverageRoadSetback:
Expiration Date
Office Comments:
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'S�wYER RO'
SMONN RS 88' N10M
FOR MAPPING PURPOSES.
GRAPHIC SCALE TAX ASSESSMENT PURPOSE�
o Zao q� 80a ieoo Information contoined on this m�
advisory. Map accuracy is limitec
quality of the public records fro��
was prepared. It is not intended
( IN FEET ) su6stitute for an accurote field
1 inch = 400 ft.