HomeMy WebLinkAbout010-169-00-2200-LUP-2004-687 Application for Land Use Permit(*Non-shoreland*) o 0
County of Sawyer � � �
PO Box 676 -Hayward WI 54843 � � O
715/634-8288 `I� -
*Property that is not located within 300'of a creek,river or stream or within 1000'of a 1� �
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. W
�U,m� a�� PRINT-USEBLACKINKORPENCIL �
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Owner Builder �' �
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Mailing Address Mailing Address �J � �
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Cit�,State,Zip � City, tate,Zip � �` �
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Daytime Phone Daytime Phone �
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Additional Information: Zone District ��—I —.
Lot Dimensions ��
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Date lot was created: Acres: �s� . 7 0 �
Is there wetland near the proposed structure?If yes,how faz �i� � �
Building Land Use Floodgfain:�( j Yes O No =Y
( ) w ( )Filling �
Addition Dred m Drivewa access off of a Check one `D
(� � ) g� g Y � )� do
O Alterarion O Grading O Private Rd O Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy ti, �
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Primary Structure Accessory Building Addition � °
( )Dwelling ( )Garage-attached/detached ( )D ck „"',
( )Year round ( )#of car stalls (�rch �
O Seasonal O Storage Building O Enclosed �
O Frame built on site O Screenhouse O Living room ��
( )Modular/manufactured ( )Greenhouse ( )Kitchen � ' �y
� +
( )Mobile/manufactured ( )Other ( )Bedroom °'
( )Other primary structure ( ) ( )Relocate/enlarge ' '
( � ( ) ( )#ofnew � . �
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Additional Information: �� p
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Ty f Construction: � W
( Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �
( )Other �
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Construction Cost:Primary Structure$ /�Sz cL �
Accessory Building:$ Addition:$ — ,� �
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Deed:Vol�Pg 2 5� Certified Soil Test# �y c�!Z tlQ z
CSM:Vol Pg Lot# Sanitary Permit# 8`/ — C-`�� o, %h
Plat Envelope Or: �"�p ��`� ��z �;,
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Condo Vol Pg Year Installed: n x c,
Aff of ex septic Vol Pg Owner When Installed: ,r,�-.:; v, ,� •
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Previous office approvals/actions: �R �d r� � � I
Variance:# LUP:#�(p-�SP:# CUP:# �''� �"+
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Inspection Report:# Change of Zone District: � � � � � p�'
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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
i e
�_ft. long ft long ft. long ft. long
Floor area �� sq. ft. sq. ft. sq. ft. sq. fr.
Hgt.from gade /a to pealc ft. hgt. ft. hgt. ft. hgt.
Stories�_ stories stories stories
# of bedrooms i�
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Rear Lot Line
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Fire Number and Name of Road /5 �/51/ ( it v",'� / r•
1. Enter lot dimensions and indicate north by azrow. Si i t �re f n r�j��rized Agent:
2. Indicate the location and size of the requested construction �ri�J�� —
Signature /
activities. 1��� �G�� �Z rz��/ir�,
Print Name:
3. Also, 1ndlCate the loCatlon 211d d1StanCC to the Well, ihe above ceRifies ihat the listed information and intentions are
true and cortect,that all work shall be pedortned in compliance
septic tank and drainfield, wetland areas, lot lines and to the w�m me requirements or tne sawyer counry zonina ob'�nance
antl �te laws and regulalions of the State of Wisconsin, and if
Centerllne of tlle ToBd. acting as ownef(s)agent, has the permission of the owner(s)to
pedorm the work requested on this application. The above
personsls hereby give permission for access to the property for
ansite inspectian.
�%
Permit fee: $ 7� "
December 21, 2004 _
Issue Date Signature of sui Agent
December 21, 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
,. � � .
NOTE: CAPS �ND OVERLAPS ElfIST TMROUCFIWt MOST OF SECTION 33. THERE ,�T
ARE NUMEROUS CLOSURE ERRORS AND DEEDS 7FIAT HAVE VACUE POINT OF � �
BECINNINCS. R/W CALL$ ARE OFTEN MADE TO R/VYS h1AT HAVE BEEN
ALTEREO MHICH PFFECT HOW T1E PARCEL IS PLAGED. IT IS POSSIBLE h1AT A I
MANY OF THESE PROBLEMS DO NOT E%IST IN THE FIELA, BUT RAIHER IN THE lti
OESCRIPT10N5 THEMSElVES. A BEST-FIT ME7M00 WAS USEO BUIIAINC UPON i' �
THE MO57 RECENT C5AI�S FOR MAPPINC PURPOSES. MORE RESEARCH AND/OR ti' � I
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