HomeMy WebLinkAbout010-941-21-2309-LUP-2004-518 ,�
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�ppiication for Land Use Permit (*Non-shoreland*) �'
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County of Sawyer � � � -
PO Box 676 - Hayward WI 54843
715/634-8288 _1`
*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 ¢'
lb���c l�-� l�f �/���' �-� �:
Mailing Address Mailing Address � `
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City, St�, Zip City, State, Zip �
CC � �c� � rf � r� Da ime Phone �
Daytime Phone Yt� �
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Additional Information: Zone District: �"(
Wc���' c�-��! — t�88$ �
Lot Dimensions:
Date lot was created: Acres: . $ n �
Is there wetland near the proposed structure? If yes, how far �1 O � �
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Building Land Use Floadplain:( j Yes (�No �° �
( )New ( ) Filling �
(� Addition O Dredging Driveway access off of a(Check one): �,
( ) Alteration ( ) Grading ( ) Private Rd Q� Town Rd. o
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy N �
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Primary Structure Accessory Building Ad��!ition � °
� i D�V��ill� � ) Garage�uttached,'detached � Derk w
( � Year round ( ) # of car stalls ( ) Porch �
( ) Seasonal ( ) Storage Building ( ) Enclosed �
O Frame built on site O Screenhouse 4Q Living room Fr�m�L� � �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen �
( ) Mobile/manufactured ( ) Other ( ) Bedroom Ci
( ) Other primary structure ( ) ( ) Relocate/enlarge � '
( � O O # ofnew �^ �
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AdditionalInformation: , .�
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Type of Construction: `� ��
(�j Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete
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( ) Other ��
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Construction Cost: Primary Structure $ � �
Accessory Building: $ Addition: $� b��.o�) � f�
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Deed: Vol 5fs 3 _Pg_,3 9b _ Certified Soil Test#_ _ �" ,y —"
CSM: Vol � Pg ,�I:� Lot#_� Sanitary Permit# � 7�
Plat Envelope # ��? Or: i;
Condo Vol Pg Year Installed: �
Aff of ex septic Vol Pg Owner When Installed: � �
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Previous office approvals/actions: '
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Variance: # LUP: # SP: # CUP: # "'
Inspection Report: # Change of Zone District: t �
,��,ola
�a3"IS �'Y
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. �t� #2. #3. #4.
Size ft. wide 9 ft. wide ft. wide ft. wide
�_ft. long �_ft. long ft. long ft. long
Floor area_����-sq. ft. 252 sq. ft. sq. ft. 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 �b ,�.� � �� �`-�U � �'-- �-�
1. Enter lot dimensions and indicate north by arrow. Si nature of Owner or Authorized Agent:
2. Indicate the location and size of the requested construction �- , ;. .� ,�' � � �-;� < <.:� .�
Signature
activities. �' -�
Pnnt Name: O 12.b A{ . !
3. Also, indicate the location and distance to the well, The above certifies that the list d information and intention a�e
true and correct.,that all work sha�i be performed in comp i nce
�,,� septic tank and drainfield, wetland areas, lot lines and to the with the requirements of the Sawyer County Zoning Ordinance
-� and the laws and regulations of the State of Wisconsin, and if
centerline of the ro1Cl. acting as owner(s)agent, has the permission of the owner(s)to
perform the work requested on this application. The above
persons/s hereby give permission for access to the property for
onsite inspection.
Permit fee: $ ��L� �� ��
September 17, 2004 _
Issue Date Signature of Iss 'ng g nt
September 17, 2005 a
50/o Rule: Average Road Setback:
Expiration Date
Office Comments:
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