HomeMy WebLinkAbout010-841-22-5116-LUP-2004-658 Application for Land Use Permit(*Non-shoreland*) ��
Coun of Sa � �
ty wyer �
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 ar pond or does not have any of the above waterbodies located within h�% �_
the property's boundaries. ,4j �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. ~
T—USE BLACK INK OR PENCIL � �
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Mailing Address Mailmg Address � �
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City,State,Zip � ��-1
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Dayhme/Phone Daytime Phone
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Additional Information: Zone District: �Z�-' �
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14q osX 13�-1 e��C yJ7 x -� 1
Lot Dimensions: 300 �a X s4 id X 311 d '
DatelotwascreaTed: L4� �' U���`��10�oy �r7 � ��
Acres: n
Is there wetland near the proposed structure?If yes,how far r.'�c � '- -
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Building Land Use Floodptain:� -j�'es (✓)No �
(f)New ( )Filling � ���
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Addition O Dredging Driveway access off of a(Check one): ° �
( )Alterarion ( )Grading (JjPrivate Rd ( )Town Rd. �
� �Moving On � � ( )County Hwy ( )State Hwy N �
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A f�
Primary Structure Accessory Building Addition N o
(�Dwelling (�Garage-attache etache> ( )Deck �
(�Year round (2)#of car stalls ( )Porch � �
( )Seasonal ( )Storage Building ( )Enclosed �
(✓�Frame built on site O Screenhouse �
( )Living room �
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen p
( )Mobile/manufactured ( )Other ( )Bedroom
( )Other primazy structure ( ) c �
� � � � ( )Relocate/enlazge ,
( )#of new � ��
Additional Information:
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T e of Construction: �
(✓�Frame ( )Log ( )pole/metal ( )Block ( )Concrete � �'
( )Other � '
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Construction Cost:Primary Structure$ ��i�, 90�o�v �
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Accesso Buildin $ "
rY g: fU i�%� � � Addition:$ �CD-
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Deed:Vo13a�1� pg Certified Soi1 Test# o d�o �
y— 3 7�/— z
CSM:Vol_�pg�_Lot# � Sanitary Permit# ��i�(- '�(�I � �y
�'�850 °`
Plat Envelope Or: •
N X1,
Condo Vol Pg Yeaz Installed: �^
Aff of ex septic Vol Pg Owner When Installed: ", �
.X�;'�l ,a�t'�.. r.,
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Previous office approvals/actions: .�
Variance:# LUP:# � SP:# CUP:# �'; ��
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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.
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#1 � --�_Ci, �T(��i�4 �- n�,1� #2. �5` t ��(�r� #3. ' - � t #4.���in�� ,_ .
Size , iz ft. wide _a�ft. wide dS ft. wide �/o , wide
`i `t ft. long � � ft. long `1`l ft. long ?� ft. long
Floor area I�� ` sq. ft. � 1 U sq. ft. � �I �� sq. fr. , I _�=` sq. ft.
Hgt.from gade to peak ft. hgt. ft. hgt. ft. hgt.
Stories -% � stories stories � stories
# of bedrooms �'
` � = � � Rear Lot Line
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l,^ . K- e 7' `/ � `'� I .
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Fire Number and Name of Road �k r s �,�� I�`i 3 G� '� - � � 4
1. Enter lot dimensions and indicate north by arrow. Signature of Owner or Authorized Agent:
2. Indicate the location and size of the requested constnzction �-�r-----�
Sgnature
activities. �r;� ���V
Print Name:
3. Also, indicate the location and distance to the well, The above certifes ihat the listed information and imentions are
� We and covect.,that all work shall be peAormetl in compliance
septic tank and drainfield, wetland areas, lot lines and to the w�m me req��reme�r� or me sawyer co�ory zo���9 om'��aoce
and Ne laws and regulations of the State of Wiscronsin, and if
CCRtCillrie Of tl'1C I03d. actlng as ownel�s)agent,has the permission of Ne owner(s)to
pedorm the work requested on this applicalion. The above
personsls hereby give permission for access to ihe property(or
onsite inspection.
Permit fee: $ o� � � � E'��
November 15 , 2004 �� � � i ,� �, � 1 nc,(���_
Issue Date Signature ofIss g ent
November 15, 2005 50% Rule: Average Road Setback:
Expiration Date
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Office Comments: F � � ��J �/�'.`�. - - ��" `� -'
enuu cxissea � �
SAWYER COUNTY� WI , -
REGISTER OF DEE�S �
325070
09/16/2004 12:15 PM
� RECOROZNG £EE 13.00
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SURVEYING
13614WindroseIme,Suite330 eages 2
�Yw'e�d R'I 54843
715-6343435 Feu:715-9342739
SAWYER COUNTY CERTIFIED SURVEY
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