HomeMy WebLinkAbout010-840-36-5320-LUP-2004-482 Applicatior.for Land Use Permit(*Non-shoreland*) � o
County of Sawyer � � X
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 �
the property's boundaries.
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED.
PRINT-USE BLACK INK OR PF�NCIL r
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Owner Builder <'
r/�(�%�c�t/ C-�t�-��riOF.. � -_� �� �� �
Mailing Address Mailing ddress O
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City tate,Zip City,Stat Zip ��
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Daytime Phone Daytime Phone -'-,
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Additional Information: Zone District: ��� �
Lot Dimensions: %� ��tcO�t
Date lot was created: �`'.�'.�� Acres: �t �C�'.-�r�c�,l ..�r/•�� o '��
Is there wetland near the proposed structure?If yes,how far � �
Building Land Use Flooctplain:� )�Es (�}No `; �
( )New ( )Filling �
Addition Dred m Drivewa access off of a Check one `D
� ) � ) S g Y � )� cia
O Alteration O Grading O Private Rd O Town Rd. o
(�j'jMoving On ( ) ( )County Hwy ( )State Hwy �,"', �
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Primary Structure Accessory Building Addition � °
O Dwelling O Garage-attached/detached O Deck W w
( )Yeaz round ( )#of car stalls ( )Porch �
O Seasonal {�'Storage Building G�y'Ep� O Enclosed �
O Frame built on site O Screenhouse O Living room
( )Modular/manufactured ( )Greenhouse ( )Kitchen
( )Mobile/manufactured ( )Other ( )Bedroom �
( )Other primary structure ( ) ( )Relocate/enlazge ,
� � O O#ofnew ��
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AdditionalInformation: � ' p
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Type of Construction: 4w W
(�'j Frame ( )Log ( )Pole/metal ( )Block ( )Concrete , ��
( )Other ro �
Construction Cost:Primary Structure$ �
Accessory Building:$ �,'���' Addition:$ x� �`
L7 RS 35/ �; �
Deed:Vol �� � Pg 3 �- Certified Soil Test# C�l"�b(p °O z
CSM:Vol Pg Lot# Sanitary Permit# oi -3 a a � %�
Plat Envelope �r� N ��
Condo Vol Pg Yeaz Installed: cUo
Aff of ex septic Vol Pg Owner When Installed: " �
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Previous office approvals/actions: i��
Vaziance:# LUP:# SP:# CUP:#
Inspection Report:# Change of Zone District: _ �I� �<<�l
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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 .-'" ' ft. wide ft. wide ft. wide f[. wide
� : ft. long ft. long ft. long ft. long
Floor azea � . , / sq. ft. sq. ft. sq. fr. sq. ft.
Hgt.from grade ,,',> to peak ft. hgt. ft. hgt. ft. hgt.
Stories � stories stories stories
# of bedrooms
Rear Lot Line
� . � / , , � '
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Fire Number and Name of Road
1. Enter lot dimensions and indicate north by arrow. Signature Owner�Au�oriz d Agent:
2. Indicate the location and size of the requested construction ,✓�, y��
�.___.. . `SignaNre
activities. ' ���. , / � )
PrintName:� � /t��A�A' )t�DOD,1/
3. Alsq indicate the location and distance to the well, The above ce�ifies that the Iisted informalion and intentions are
true and cnrrecL,that all work shall be pedormed in compliance
Sept1C t2111c and dTalnfield, wetland azeas, lOt 11nes and to the with the requirements of the Sawyer County Zoning Ordinance
antl Ne laws and regulations of the State of Wisconsin, and if
CCritCillriO Of 1�10 702d. ading as ovmet(s)agent, has the permission of the owner(s)to
pedortn the work requestetl on ihis applira6on. The above
persons/s hereby give permission for access to Ne property for
onsite inspedian.
Permit fee: $ i�U ��
September 3, 2004 ����,��E� � (��d11���
Issue Date Signature of Issuing Agent
September 3, 2005 50%Rule: Average Road Setback:
Expiration Date
Office Comments:
' . __ .. � V V I J C_ �v � � U 1 V J V � �� U � V R � �Y
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SCALE : I INCH = 400 FEET FOR ASSESSMENT USE ONLY N01
DRAWN BY : DATE : INTENDED TO SHOW CONCLUSI'VE
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