HomeMy WebLinkAbout010-941-33-4405-LUP-2004-582 Application for Land Use Permit(*Non-shoreland*) o 0
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. �
�' �'1
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED.
���n � PRINT-USE BLACK INK OR PENCIL r
` � ��DticRT �•tDE� OwU�=e� a
Owner Builder �' �,\
I 5 9►J (.t�. .1 t N►J�( LA�II= o. �J ii)
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Mailing Address Mailing Address �
I-�AY WaRl7 4 W l ��F S"4�3 �
City,State,Zip City,State,Zip �
"�►S L3�1 od2�
Daytime Phone Daytime Phone
Additional Information: Zone District: 12'�
Lot Dimensions:
Date lot was created: Acres: Z �`���`� o
Is there wetland near the proposed structure?If yes,how far �
Building Land Use FloodpYain�� )Yes (�No
� �
�-)New ( )Filling �
O Addition O Dredging Driveway access off of a(Check one): � �
O Alteration O Grading Private Rd O Town Rd. o
( )Moving On ( ) �County Hwy ( )State Hwy �,"', �
� ) � ) o S
r
Primary Structure Accessory Building Addition � °
( )Dwelling ( )Gazage-attached/detached ( )Deck "'
( )Year round ( )#of caz stalls ( )Porch �
( )Seasonal �Storage Building ( )Enclosed �
O Frame built on site O Screenhouse O Living room �
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen . �
( )Mobile/manufactured ( )Other ( )Bedroom r� �
( )Other primary structure ( ) ( )Relocate/enlarge
� � ( � ( )#of new � �
AdditionalInformation: u p
U' �
�
`` �
Type of Construction: �•
(�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �� �
��
( )Other ti y
Construction Cost:Primary Structure$ � �
�
Accessory Building:$ �D�.b' Addition:$ x�
rn
Deed:Vol 7(c`I Pg 3 ic' Certified Soil Test#�,;" tl0 z
CSM:Voi •�� Pg %'S Lot# � Sanitary Permit# _ � �;1-'� � '�
�
Plat Envelope
t1 Cr�S S Or: i;,
Condo Vol Pg Yeaz Installed: � �
� �
Aff of ex septic Vol Pg Owner When Installed:
Previous office approvals/actions: �
Vaziance:# LUP:# � � SP:# CUP:# �,
Inspection Report:# Change of Zone District: '��\
�C�
13319
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.S�ra=r.;= 3.�c. #2. #3. #4.
Size i l. ft. wide ft. wide , ft. wide ft. wide
Z4 ft. long fr. long fr. long ft. long
Floor azea 'µflo sq. ft. sq. ft. sq. fr. sq. fr.
Hgt.from grade �`�` to peak fr. hgt. fr. hgt. fr. hgt.
Stories I stories stories stories
# of bedrooms o
Rear Lot Line
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Fire Number and Name of Road �S`(� � '� �1�'�'�" �U'=
1. Enter lot dimensions and indicate north by arrow. Signature f er or Authorized Agent:
2. Indicate the location and size of the requested construction
Signature
activities.
Pnnt Name: SE'�i Y D
3. Also, indicate the location and distance to the well, The above cedifes that the listed information and intentions are
We and correct. that all work shall be performed in compliance
septic tank and drainfield, wetland azeas, lot lines and to the with ihe requirements of the Sawyer County Zoning Ordinance
and the laws and regulations of lhe S�ate of Wiscronsin, and if
C0ritC2'11IIC Of t110 T08d. acting as owner(s)agent has the permission of the owner(s)to
pedortn ihe work requested on this application. The above
personsls hereby give permission for access to the property for
ansite inspectian.
Permit fee: $ 7�`��� �� �':
October 14, 2004 -
Issue Date Signatwe of I s in gent
October 14, 2005 50% Rule: AverageRoadSetback: _
Expiration Date
Office Comments:
� . .
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GRAPHIC SCALE -rAx ASSESSMENT Pui
aoo o zoo 40o aoo �8� Information contained on
advisory. Map accuracy i
quality of the public rec
was prepared. It is not
( IN FEET ) substitute far an accura
1 inch = 400 ft.