HomeMy WebLinkAbout010-941-13-3301-LUP-2004-698 Application for Land Use Permit(*Non-shoreland*) � o �'
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 boundazies.
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. ,
PRINT-USE BLACK INK OR PENCIL �
5�1,,�y�'lz- �d ' �4r5 G� 1�G=��. a
Owner Builder i—@`��� �' �
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Mailing Address Mailing Address O �
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City, tate,Zip City,State,Z��
��s �3¢ �7�a
Daytiine Phone Daytime Phone
Additional Information: Zone District: ��f ���
Lot Dimensions: �p� ib CD �
Date lot was created: (S �`7 Acres: '/J n
0
Is there wetland near the proposed structure?If yes,how faz �� G
Building Land Use Floodptain:�( j Yes O No � :;
�New ( )Filling �
Addition Dred in l Drivewa access off of a Check one fD
� ) � ) g B Y � )� ao
O Alteration O Grading O Private Rd O Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy N �
� ) � ) o `,�
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Primary Structure Accessory Building Addition � �
( )Dwelling ( )Garage-attached/detached ( )Deck W
( )Year round ( )#of caz stalls ( )Porch .=
O Seasonal O Storage Building O Enclosed �
O Frame built on site O Screenhouse O Living room �
( )Modular/manufactured ( )Greenhouse ( )Kitchen O �
( )Mobile/manufactured ( )Other ( )Bedroom p
O Other primary structure (�}.�ra n7� O Relocate/enlazge � '
� � () ( )#of new � �
AdditionalInformation: W p
i �
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(�ype of Construction: t,t
}.F'rame ( )Log ( )Pole/metal ( )Block ( )Concrete � �
( )Other
�✓ b �
Construction Cost:Primary Structure$ k ��J, �� G� �
:? �
Accessory Building:$ Addition:$ � �
�
D e e d:V o l�P g 5/o C e rt i f i e d S o i l T e s t# tlQ
z
CSM:Vol�Pg �� Lot# / Sanitary Permit# - � 7y
Plat Envelope Or: N �
Condo Vol Pg Yeaz Installed: �
Aff of ex septic Vol Pg Owner When Installed: � �
Previous office approvals/actions: �
Variance:# LUP:# SP:# CUP:#
Inspection Report:# Change of Zone District: ` ,}\o I
tX\,:
tao iq
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 _ S C� ft. wide ft. wide ft. wide ft. wide
S�% ft. long ft. long ft. long ft. long ' •
Floor area�_�sq. ft. sq. ft. sq. ft. sq. ft.
Hgt. from gade to peak ft. hgt. ft. hgt. fr. hgt.
Stories stories stories stories
# of bedrooms
Rear Lot Line
;� cl��
� E � �
Fire Number and Name of Road Air ort Road
1. Enter lot dimensions and indicate north by arrow. ign re o w r Authorized Agent:
2. Indicate the location and size of the requested construction
ture
activities. � �R�� G �A � �G_zC 2
PnntName
3. Also, inC�lcate the IoCatlon and d15tanCe t0 the Well, The above certifes that the listed iniormation and intentions are
We and correct., that all work shall be peAormed in compliance
septic tank and drainfield, wetland areas, lot lines and to the wilh ihe requirements of lhe Sawyer County Zoning Ordinance
and the laws and regulafions of lhe St2te of Wiscronsin, and if
centerline of the road. acting as owner(s) agent, has the permission of the owner(s) to
perform the work requesled on lhis application. The above
� personsls hereby give permission for access to the property for
onsite inspection.
Permit fee: $ .��
December 30 , 2004 ���n�����lL%%��y�Ll,ayi _
Issue Date Signature of Issuing Agent
December 30 , 2005 50% Rule: Average Road Setback:
Expiration Date
O£fice Comments:
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Located in the SW 1/4 of the SW 1/9 of Section 13,
T. 41 N., R. 9 W., tin the Town of Haywa.rd,
/ Sawyer County, Wisconsin.
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u' LOT 1 IS A SUBSTANDA'2D LOT WHICH HAS
� RA�/ / S BEEN CREAiED BY SAMI�'ER COUNTI' FOR
� / / o ?� 65�7445��� IEASE AS AN AIRCRAfT HANGQ2 SITE.
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SURVEY Scale: One inch = 30 feet.
IARRY T. ELSO 10 �1276
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