HomeMy WebLinkAbout010-941-20-1405-LUP-2004-540 Application far Land Use Permit(*Non-shoreland*) � o
County of Sawyer �
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-USEBLACKINK����CIL ��1z,�
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Owner�.— { Builder ��
�O 7( 5� ✓�. h/�`�,�( �,tL• ��J jSr x� �'ci �. �
Mailing Address �— Mailing Address �
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Ci State,Zip City,State,Zip
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Daytime Phone Daytime Phone r
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Additional Information: Zone District: f�`�
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Lot Dimensions: •�j
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Date lot was created: Acres: .-5� o �
Is there wetland near the proposed structure?If yes,how faz 1�v G �
Building Land Use Floodplain:( j Yes �No =°
'�New ( )Filling �
O Addition (�Dredging Driveway access off of a(Check one): �
O Alteration �Grading O Private Rd (xj Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy i,"', �
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Frimary Struc e Accessory Building Addition � °
( ) welling (�Garage-attached/detached ( )Deck W
(� ar r und (3)#of car stalls O Porch =
O Sea al O Storage Building O Enclosed �
�Fr uilt on site O Screenhouse O Living room � rn
( Mo ular anufactured O Greenhouse O Kitchen O
( ) bileJ anufactured ( )Other ( )Bedroom � �
( )O primary structure ( ) ( )Relocate/enlazge � �
� � � � ( )#ofnew -D �
AdditionalInformation: , �
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Type of Construction: -�. �
(�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete � 0
( )Other ,.`� .-�
Construction Cost:Primary Structure$ /v o 0o m � �
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` Accessory Building:$ /�l aoo�J Addition:$ ^ -,�C
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Deed:Vol 75`I Pg /5�{ Certified Soil Test# 95-S 3 9 °Q z
CSM:Vol I�I Pg 41 Lot#�_ Sanitary Permit# F.rj- �/'7`� o, �
Plat Envelope �3�� Or: N �
Condo Vol Pg Yeaz Installed: c �
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Aff of ex septic Vol Pg Owner When Installed:
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Previous office approvals/actions:
Vaziance:# LUP:# `-f5=�(ol9 SP�# CUP:#
Inspection Report:# Change of Zone District: /)I Z�"� •
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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.�( R��. #2. #3. #4. �
Size�_ft. wide fr. wide ft. wide ft. wide
_�_ft. long ft. long ft. lon
g ft. long
Floor area R yo sq. ft. sq. ft. sq. ft. s fr.
�,,,j�. 4�
Hgk from gade 1$ ' `�"o peak ft. hgt. ft. hb�t• ft. hgt.
Stories � stories stories stories
# of bedrooms c'�
Rear Lot Line
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Fire Number and Name of Road ���P 5 ' � /�
I. Enter ot dimensions and indicate north by arrow.
ig re of�� � er Auth�rized Agent:
2. Indicate the location and size of the requested construction
activities. �"�
Pnnt Name:
3. Also, 1ncllC3te tlle loCatlOn and d1StanCe t0 t}le Well, The above ceA�es ihat the listed information and intentions are
true and covect.,that ali work shall be pedormed in compliance
septic tank and drainfield, wetland azeas, lot lines and to the with ihe requiremenfs of the Sawyer County Zoning Ortlinance
and ihe laws and regulations of the S�ate of Wisconsin, and if
CCntei�lne of the i08d. acGng as owner(s)agent, has the permission of the owner(s)to
peAorm the work requested on this application. The above
personsls hereby give permission for access to the property for
v G onsite inspection.
Permit fee: $ �Q�,1
September 29, 2004
Issue Date Signature of sui Agent
September 29, 2005
50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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RONALD L. PETEFi40N
S-0803
SEPTEMBER f0. 1992
CEATIFIED SURVEY HAP EGENO HEART OF THE NORTH
PARi OF THE SE-NE, SEC. 20. FOUNO 3/1' Al M/CAP SURVEYS INC. SEPT. f0, 1992
T41N, R9M, TO�M OF HAYMAF�, FOUND il/�' IRON PIPE pT. 10, 80X 251 5125-75
SANYEA COUNTY, MISCONSIN. SET 1'x24' IP KT��,33 LB/FT �YMAHD, MISC. 51813
715-63�-2�12 PAGE 1 OF 2
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