HomeMy WebLinkAbout010-941-20-4204-LUP-2004-504 .�
Application for Land Use Permit(*Non-shoreland*) 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. �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED.
PRINT—USE BLACK INK OR PENCIL .S 1
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Owner Builder N'
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M�iling Address Mailing Address O
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City, a ,Zip City,State,Zip
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Daytime Phone Daytime Phone �
Additional Information: Zone District: �'� �
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Lot Dimensions: _
Date lot was created: Acres: 3/ Z n -�
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Is there wetland near the proposed structure?If yes,how faz N D G .�
Building Land Use Floodptain:O Yes �No =° �
{MNew ( )Filling � �
Addition Dred in Drivewa access off of a Check one fD �
� ) � ) g g Y � )� ac �
( )Alteration ( )Grading ( )Private Rd ��'I'own Rd. o --�
( )Moving On ( ) ( )County Hwy ( )State Hwy �,`'; �
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Primary Structure A cessory Building Addition � °
( )Dwelling �,Gazage-attache etached ( )Deck W
O Yeaz round #of car stalls Z O Porch .-
( )Seasonal (�Storage Building ( )Enclosed �
O Frame built on site O Screenhouse O Living room �-
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen _ �
( )Mobile/manufactured ( )Other ( )Bedroom �'
( )Other primary structure ( ) ( )Relocate/enlazge '� �
� � ( ) ( )#of new �' �
AdditionalInformation: 1 p
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Ty e of Construction:
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�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete C Q
( )Other
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Construction Cost:Primary Structure$ � �
C7 c �c
Accessory Building:$ c7�(�(��� Addition:$ � �
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Deed:Vol �`� Pg 7�`I Certified Soil Test# �(p- 1 loq 04 z
CSM:Vol Pg Lot# Sanitary Permit# �(n- 19 0 0, 7y
Plat Envelope Or: ^, �
Condo Vol Pg Year Installed: rn
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: /
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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. Q 4.i #2. #3. #4. "
Size_�ft.wide ft.wide ft.wide ft.wide
.�_ft.long ft.long ft.long ft.long
Floor area �2 32- sq.ft. sq.ft. sq.ft. sq.ft.
Hgt from g�ade �3�� to peak ft.hgt. ft.hgt. fr.hgt.
Stories � stories stories stories
#of bedrooms O
Rear Lot Line
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Fire Number and Name of Road �f�(C�� CY" � � ��'f.�
1. Enter lot dimensions and indicate north by arrow. Sigr�ature of Owner d Age�
2. Indicate the location and size of the requested construction ��� ���---a�
S re
activities. /
RurhName:� `«ne �/�✓:t �J�,�/.
3. Also,lndicate the location and distance to the well, The above cedifes lhat the listed informalion and intentions are
hve and correct.,that all work shall be perfortned in compliance
septic tank and drainfield,wetland azeas,lot lines and to the with ihe requiremenLs of the Sawyer County Zoning Ordinance
and the laws and regulations of the State of Wisconsin,and if
centerllne Of tlle road. acting as owneY(s)agent,has the pertnission ot the owner(s)to
perform the work 2quested on this applicafion. The above
personsls here6y give pertnission for access to the property for
onsite inspeclion.
Permit fee:$ /GO��
September 15, 2004 - 7j�—
Issue Date Signature ofIssu' A nt
September 15, 2005 50%Rule: Average Road Setback:
Expiration Date
Office Comments:
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010-947-20 4201 010-947-20 4101
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REFERENCE DEED 666/417. �
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IF SECTION 20�, ETC. �
JTO SMALLER PARCELS G�
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0 3401 Q10-941-20 4301 010-941-20 4401
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NMPINO PIJNPOSES AIAPPING PU�3.
GRAPHIC SCALE Tax ASSESSMENT P
400 0 20o aoo soo �e� Information contained
advisory. Map accurac�
quality of the public r
was prepared . It is nc
( IN FEET ) substitute for an accu
1 inch = 400 ft.