HomeMy WebLinkAbout010-133-00-0600-LUP-2004-638/
Application for Land Use Permit .����-J��kC�y� r ,� -�I.�
County of Sawyer � �
PO Box 676 -Haywazd WI 54843 � O
715/634-8288
T h e u n d e r s i gn e d h e r e b y m a k e s a p p l i c a t i o n f o r a L a n d U s e P e r m i t an d a g r e e s t h a t a l l w o r k ��
shall be done in compliance with the requirements of the Sawyer County Zoning Ordinance
and the laws and regulations of the State of Wisconsin. �
NO CONSTRUCTION MAY BEGIN UNTIL ALL PERMITS H�1VE BEEN ISSUED. � �
PRINT-USE BLACK INK OR PENCIL �
O� I ���-ef' C�C � -��C'ff�sT(�(� �vn�5 a �
O�n"/� I �v 1`^-4-� ��� Bu�✓I J W�f7 0�
Maili g Address (� Mailing ddress � �
C��C�1/w��c��(,�.)� � T�3 �5 � � � �
City,Stat ,Zip City, tate,Zi ,
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Daytime Phone Daytime hone �(S_��j -Sg9� 'b
Additional Information: Zone District �'� � �
Lot Size Q �
Date lot was created , `- ��� Acres l�7 � � �
Is the property in a Shore and District?(within 1000'of a lake or pond,within 300'of a river, � �
creek or stream) If yes,how far from the shoreline&water name: �
Is there wetland near the proposed structure?If yes,how far � n
�B Iding Land Use �
New ( )Filling Floodplain:( )Yes (�}No # ;;
Addition ( )Dredging � a
� 1 Atreratinn ( 1 Gradins Chippewa Flowage: O Yes Q�No I �
�`I Moving On ( ) � r`
( ) ( ) Driveway:( )State �County ( )Town Rd. � �
Primary Structure Accessory Building Addition I
QC)Dwelling OC)Garage-attache ache O Deck �
(X)Yeaz round (2)#of car stalls ( )Porch m
( )Seasonal ( )Storage Building ( )Enclosed
( )Frame built on site ( )Screenhouse ( )Living room � �
(�(}Modular/manufactured ( )Greenhouse ( )Kitchen �
( )Mobile/manufactured ( )Other ( )Bedroom �
( )Other primary structure ( ) ( )Relocate/enlazge
( ) ( ) ( )#ofnew >
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Additional I�formation: �.�,
ro �
�� �
�T e of Co�ishuction x�
Frame � ( )Log ( )Pole/metal ( )Block ( )Concrete �
( )Other
Construction Cost:Prunary Structure$ r/��(���� I �
CN ��`
AccessoryBuilding:$ ���C1D�� Addition:$ U1} �\
� :�4�! # 3.Z57Z5 �j 7y
Vol �? Pg_F�of Deed / Certified Soil Test# O�!-�l1S �
CSM Vol Pg Lot# �F' Sanitary Permit# C�y-�/
Plat Envelope � Or: �
Condo Vol Pg Year Installed
Aff of ex septic Vol Pg Owner When Installed:
a
Gard Gazebo Vol Pg �
0`�
Previous Variance: LUP: Inspection Date: \�\��
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q'1')0
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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. House #2. G r°�l. #3. #4.
Size �� ft.wide �i�.wide ft.wide ft.wide
oj O ft.long _�ft.long ft.long ft.long
Floar azea ��`�� sq.ft. �I20 sq.ft. sq.ft. sq.ft.
Hgk from gade �� to peak i I ft.hgt. ft.hgt. ft.hgt.
Stories v2 � stories stories stories
#of bedrooms
1�OC Lot Line or Lake/River name:
300' nI
�IV
QD
15�
� °f �al�°'v4-
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'�o, � 28 x 50 — — �
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Fire Number and Name of Road
1.Fill in lot dimensions and indicate north by arrow. Signature of Owner or Authorized Agent:
2.Indicate location and size of existing and new structures. �
3.Indicate location of well,septic tank,drainfield. �/
l
4.Indicate distance to existing structures,lot lines,septic system.
5.Indicate distance to the ordinary high-water mazk of any lake, ,�/ /
pond,river,stream,creek,and name the body of water. ad��Name: j„ /���T 7����
The above cerG�ea'rha[the listed information and inten�ons are
6.Indicate any grading or clearing in excess of the construction site. +Ne a�d�o��Tne abo�e Perso��5 nereby 9��a per��s5�o�ror
aceess to Ne pmperty(oronsite inspedion.
7.Indicate distance to any wetland.
Permit Fee: ��=
November 8, 2004
Issue Date Signature ofIs uin gent
November 8, 2005
Expiration Date
Office Comments:
Inspection Date: 50%Rule Applies: Avg.Setback: Within Reservation boundaries:
Restrictions and other information:
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""' -�`���""--_ MAPPINC PURPOSES ONLY.
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