HomeMy WebLinkAbout010-841-20-1107-LUP-2004-444 . 1 , �
_ Application for Land Use Permit(*Non-shoreland*) o 0
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. �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. �
�[' � PRINT-USE BLACK INK OR PENCIL � '
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Owner Builder �'
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Mailing Address� Mailing Address O
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City,State,Zip City,State,Zip
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Daytime Phone Daytime Phone `
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Additional Information: C�t�I ' Zone District: 1( �' � �
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Lot Dimensions: ��Yy x `-S�u j 1 .
LA:;1..;�/'e��r-✓ �O
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Date lot was created: �-/%-,�i Acres: � ��<v o �
Is there wetland near the proposed structure?If yes,how faz �,S T��3� �
Building Land Use Floodptain:� j Yes O No `;
( )New ( )Filling � R
�Addition O Dredging Driveway access off of a(Check one): �
O Alteration O Grading O Private Rd ( Town Rd. o
O Moving On O O County Hwy Q(�State Hwy ti,
� ) O o S
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Primary Structure Accessory Building Addition � °
( )Dwelling ( )Garage-attached/detached (it�Deck W
( )Year round ( )#of caz stalls ( )Porch �
O Seasonal O Storage Building O Enclosed �
O Frame built on site O Screenl�ouse (�Living room �-- �
( )Modular/manufactured ( )Greenhouse (�Kitchen n �
( )Mobile/manufactured ( )Other ( )Bedroom C �
( )Other primazy structure ( ) �Relocate/enl�
� � ( ) ( )#of new �
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AdditionalInformation: � A
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Type of Construction: v
�Frame ( )Log ( )Pole/metal ( )Block (,,}Concrete �, �
\
( )Other ,ti ,� \
Construction Cost:Primary Structure$ � � \
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Accessory Building:$ Addition:$ �sUn, � .� �I
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Deed:Vol Pg Certified Soil Test# � ;t5 Z3� tl° z
CSM:Vol�Pg, J Lot#� Sanitary Permit# b 75-13z o, %� ,
Plat Envelope ��� Or: ,;, �
�, C
Condo Vol Pg Yeaz Installed: � ��
Aff of ex septic Vol Pg Owner When Installed: I"
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Previous office approvals/actions: �
Variance:# LUP:# SP:# CUP:# '
Inspection Report:# Change of Zone District: � ��(
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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. #2. #3. #4.
Size b ft.wide ft.wide ft.wide fr.wide
o�`� f[.long ft.long ft.long f�.long�
Floor area �`�`� sq.ft. sq.ft. sq.ft. sq.ft.
Hgt.from grade IS to pealc ft.hgt. ft.hgt. fr.hgt. '
Stories � --stories � stories stories
#of bedrooms�� I
Rear Lot ine
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v \ `�SeP�`C' �� „�"�� � �,
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Fire Number and Name of Road � ���-��li`� �- ��^'Y � �
1. Enter lot dimensions and indicate north by arrow. Si re of Own,er or A thorized Agent:
2. Indicate the location and size of the requested construction ���
Signatu �
activities.
PnntName: ���i�'/✓��i, /�/f�/E��
3. AISo,IndlCate tlle IoC3tlon and d15tanCe to tlle Well, The above ceRifies Nat ihe listetl information and intentions are
true and coned.,that all work shall be peAormed in compliance
septic tank and drainfield,wetland azeas,lot lines and to the w�m me�e����eme�u or me sawye�co��ry zoom9 o�a��a��
and Ne laws and regulapons of the State of Wisconsin,and if
CCRYeT�lrie Of tI1C i08d. acting 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 the propeRy for
onsite inspedion.
�OC�
Permit fee:$ S
August 19, 2004
Issue Date Signature ofIss �ng ent
August 19, 2005 0
50%Rule: Average Road Setback:
Expiration Date
Office Comments:
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