HomeMy WebLinkAbout010-941-23-4231-LUP-2004-481 � • r
Application for Land Use Permit(*Non-shoreland*) o 0
County of Sawyer � � '
PO Box 676 -Haywazd 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 HAVE BEEN ISSUED.
PRINT-USE BLACK INK OR PENCIL '
<<�� I ��� co bl�� � �
S-1a�ea�.� l� �
Owner ,�I / L
Builder a
Q.��;� /��� �� — �� �0 (� ��r"' S7�iee-7 �� �
Mailing Address Mailing Address O
I-(�v� �a�r�_s.�� �`l��3 1/� � ,� ,�A �c�� 5���� � �
City,�State,Z�p ity, tate,Zip
��71 S�l0 3�l—l���C,(`, C 7/S� C�- 3�/—�.S 7�- ,�
Daytime Phone Daytime Phone �
Additional Information: Zone District: `J�-� l
Lot Dimensions:
Date lot was created: // (�J Acres: �� 78 o v�
� � V�
Is there wetland near the proposed structure?If yes,how faz � (A
Building Land Use Floodp}ain:( j Yes O No `�,°
( )New ( )Filling �
�
O Addition O Dredging Driveway access off of a(Check one): �
O Alteration O Grading O Private Rd 9(}Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy i."', �
O O o S
r
Primary Structure Accessory Building _ Addition � °
O Dwelling ,Q�Garage-attache��detache�`,. O Deck W
( )Yeaz round (�#of car stalls,��/ x,3 U ( )Porch �
O Seasonal O Storage Building O Enclosed �
O Frame built on site O Screenhouse O Living room " �
( )Modular/manufactured ( )Greenhouse ( )Kitchen .�
( )Mobile/manufactured ( )Other ( )Bedroom �
( )Other primazy structure ( ) ( )Relocate/enlarge ,
� ) ( ) ( )#of new � ��
Additional Information: A
�
UJ �
i �
T e of Construction:
^�
��'rame ( )Log ( )Pole/metal ( )Block ( )Concrete R., U,1
( )Other -d —1
Construction Cost:Primary Structure$ � �
� �
Accessory Building:$�� C1�`C, no Addition:$ *�
�
Certified Soil Test# l/� °°
Deed:Vol �zy Pg 3D5 � / " z
CSM:Vol Pg Lot# Sanitary Permit# 95•/L�'7 a �
Plat Envelope Or: N �
Condo Vol Pg Yeaz Installed: � ��
�
Aff of ex septic Vol Pg Owner When Installed:
L
Previous office approvals/actions: '
Variance:# LUP:# 45 -221 SP:# CUP:# V'' ,`
��li b`1
Inspection Report:# Change of Zone District: `
�
�I 3 q 7�f
,
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_�fr. wide ft. wide ft. wide fr. wide
�ft. long fr. long ft. long ft. long
Floor azea S 7�P sq. ft. sq. fr. sq. ft. sq. ft.
Hgt.from gacie��to peak ft. hgt. ft. hgt. fr. hgt.
Stories ( stories stories stories
# of bedrooms �
Rear Lot Line
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Fire Number and Name of Road � ��D o7�� l2 � ✓Z o�S� c�e- `��',rti�
1. Enter lot dimensions and indicate north by arrow. Sign2t e of Owner or uthorize gent:
2. Indicate the location and size of the requested construction ��a. ,�. ��
SignaNre
activities.
Pnnt Name:
3. AI50, indicate the location and distance to the well, The above certifes that the listed intormation and intentions are
hue and correct., Nat all work shall be performed in compliance
septic tank and drainfield, wetland areas, lot lines and to the with �he requirement5 of the Sawyer County Zoning ONinance
and the laws and regulations of the State of Wisconsin, and if
CCrit8i�lriC Of YI1C i08d. ading as owner(s)agent,has the permission of the owner(s)to
perfortn the work requestetl on this application. The above
personsls hereby give permission for access to Ne prope4y for
onsite inspecUon.
Permit fee: $ /�v
September 3, 2004 G�/ �
Issue Date Signature ofIssuing Agent
September 3, 2005 50%Rule: Average Road Setback:
Expiration Date
Office Comments:
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GRAPHIC SCALE TAX ASSESSMENT PURPO`.
aoo 0 200 +oo eoa �e� Information contained on this
advisory. Map accuracy is lirr
quolity of the public records
was prepared. It is not inten�
( IN FEET ) substitute for an accurate fie
1 inch = 400 ft.