HomeMy WebLinkAbout010-941-26-4408-LUP-2004-674 Application for Land Use Permit(*Non-shoreland*) o 0
County of Sawyer � �
PO Box 676 -Hayward WI 54843 �
715/634-8288 O
*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 2 ,
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Owner —� Builder <'
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M iling Address Maili Address O �
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�ity State,Zip City, te,Zip
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Daytime Phone Daytime Phone
Additional Information: Zone District: 1��
Lot Dimensions:
Date lot was created: Acres: 3.92 n
Is there wetland near the proposed structure?If yes,how faz � Q
Building Land Use Floodplain:� )Yes O No `;
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( )New ( )Filling
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O Addition O Dredging Driveway access off of a(Check one): �
( )Alteration ( )Grading ( )Private Rd ( )Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy c.`", '
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Primary Structure Accessory Building Addition � °
( )Dwelling ( )Gazage-attached/detached ( )Deck W
( )Yeaz round ( )#of caz stalls ( )Porch �
O Seasonal (�j Storage Building O Enclosed �
O Frame built on site O Screenhouse O Living room
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen � �
( )Mobile/manufactured ( )Other ( )Bedroom �. ��
( )Other primary structure ( ) ( )Relocate/enlazge .
� � � � ( )#of new � �
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Additional Information: >
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Type of Construction: �
(�(j Frame ( )Log ( )Pole/metal ( )Block ( )Concrete � �
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( )Other ..3
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Construction Cost:Primary Structure$ ��� o �
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Accessory Building:$ Addition:$ � �
Deed:Vol Q,3.5 Pg 5Z`J Certified Soil Test# °Q
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CSM:Vol�Pg ��a Lot# � Sanitary Permit# o� '�
Plat Envelope a �O9 �r� N �p
Condo Vol � Pg=,r. Yeaz Installed: � �
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Aff of ex septic Vol Pg� Owner When Installed:
Previous office approvals/actions:
�
Variance:# LUP:# SP:# CUP:# �
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.
#1. #2. #3. #4. �
Size ft. wide ft. wide ft. wide ft. wide •
/�_ ft. long ft. long ft. long ft. long
Floor area _ � z� _ sq. ft. 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 / �/ �7 / ��� �� tt � �� �
1 . Enter lot dimensions and indicate north by arrow. ture of Owner�r Authorized Agent:
2. Indicate the location and size of the requested construction �:.'''�o,� .� ;�'�`'`�: . . � � �'� . .�
�Signature . � ,s.. �
activities. /�
PrintNama!"iq�1l'' � � '�' �rr�1Ji'"'�.�^i
3. Also, indicate the location and distance to the well, The above certifies that the listed information and IAtentions are
true and correct., that all work shall be performed in compliance
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 road. act�n9 as owner�s� a9ent, has the permission of the owner(s) to
perform the work requested on this application. The above
personsls hereby give permission for access to the property for
onsite inspection.
Permit fee: $ , l�'�
_--
November 30 2004
Issue Date Signature of Iss ing ent
November 30 , 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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170,680 5�. FT. �
3.92 nCRES '
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I s�ic�O SCALE: 1' - 100'
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/�'� �"" . SOIAq OBSERVATIONS OETERMINE THE
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9��SUR`�O AUGUST 9,1989
CERTIFIED SURVEY MAP LEGEND HEART OF THE NORTH
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GRAPHIC SCALE TAX ASSESSMENT PURPOSES �NLY
o zoo <oo eoo �eoo Information contained on this map is
advisory. Map accuracy is limited by the
quolity of the public records from which it
was prepared. It is not intended as a
( IN FEET ) substitute for an- accurate field survey.
1 inch = 400 ft.