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HomeMy WebLinkAbout012-640-09-4212-LUP-2004-347 � , "" _ , Application for Land Use Permit (*Non-shoreland*) o o� -- County of Sawyer � � 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 or pond or does not have any of the above waterbodies located within i v Z the property's boundaries. �1 ,� CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. �,J , PRINT—USE BLACK INK OR PENCIL 1 �n // � � � , �fJ�=�� � ,_ �/'i' � e `�� C('� E' ��C C� c(/�� 9 C�LJIl�_�G.:�, � ' _�. � � �Owner Builder �, �'y�b �VP�/��� �U,-� �c/ , � _ „ � o. � � Ma' in Address � � Mailing Address _ �c O � ��i/��,�a��/ �1��1 �;5��� �. „.�,�� �/ .� /�',- � � �� � � City, State, Zip City, State, Zip , �, , �� � , � �� � ; ; � �.�;�-� ; �: , � - ;��ir ; � Daytime Phone Daytime Phone , �� � Additional Information: Zone District: IQ K.�( � - ' �/ =_ i �` Lot Dimensions: _ `-' ' � � .,/ - � � � �� Date lot was created: � ��a ��`� Acres: �� S�7 0 � Is there wetland near the proposed structure? If yes, how far i�1 C--' � � � � Building Land Use Floadplain:( j 1'es (�No �° (�New ( ) Filling � Addition O Dredging Driveway access off of a(Check one): � �, O Alteration O Grading (?Q Private Rd O Town Rd. o � ( ) Moving On ( ) ( ) County Hwy ( ) State Hwy N � ( ) ( ) o S � r Primary Structure Accessory Building Addition � ° (� Dwelling ( ) Garage-attached/detached ( ) Deck W ( ) Year ro•.:nd ( ) # of car stalls ( ) Porch � � Seasonal ( ) Storage Building ( ) Enclosed � ( ) Frame built on site ( ) Screenhouse ( ) Living room � � (�j Modular/manufactured ( ) Greenhouse ( ) Kitchen cJ �-- ( ) Mobile/manufactured ( ) Other ( ) Bedroom � � ( ) Other primary structure ( ) ( ) Relocate/enlarge �: � � � ( ) # of new o � ( ) c- � � ; AdditionalInformation: .t A N � � � Type of Construction: � ( ) Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete �= � Other /�����'��' '' b y Construction Cost: Primary Structure $ ���; �`�' � � � � .: Accessory Building: $ Addition: $ *� ,-. c� cia Deed: Vol��Pg _5t! Certified �oil Test# D�-- /70 �, z �_ /l,��Lot# { Sanitary Permit# Dy � l��l o� � CSM: Vol Pg �— � Plat Envelope ��� �r� `�' N 1 Condo Vol Pg Year 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� 1 � 13��� c� 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 . ��rt�5� #2. #3. #4. ' Size� 7 ft. wide ft. wide ft. wide ft. wide '�- `� _ ft. long ft. long ft. long ft. long Floor area I .�� 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 �_ t Rear Lot Line ° S � j. 7a ' � � � � I� � , l��� �1 � � .;,F � �' � � ' / �� ; , , , � � �� �� , �, � ^�, ,�v / / - ' ,� � . . , �� `�'' �e-�r ^�� ��` � � (J!V�. , � � � � �.G,� � � ,� .� „ , Fire Number and Name of Road ���✓� ��� ��� �"� ^�` ` �� � '�, � �`%�� 1 . Enter lot dimensions and indicate north by arrow. Si nature of Own r orized Agent: . 2. Indicate the location and size of the requested construction Signature activities. G���``" PnntName: Crc�.'1 J�, I �.5�1/. �'fi.L'���5. 3. Also, indicate the location and distance to the well, The above certifies that the listed informa on and intentions 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. � a�t��s as ow�er�s� a9e�t, has the permission of the owner�s) to perfortn the work requested on this application. The above personsls hereby give permission for access to the property for onsite inspection. Permit fee: $ J Jul� 12� 2004 Issue Date Signature of Issuin Age July 12 , 2005 50% Rule: Average Road Setback: _ Expiration Date Office Comments: RapalMb OAI)B � ' Sewyer County a��.a t«�.�wa w.30'`'�r a 306797 ��=o�a, 2�DDo'clock M azd recaded in vd. .Z� ct CaNtred Surveys m Vape !O6-10� FaPaWr I-�n �ry SAWYER COUNN �. ` ��I ��'� ' �°� ' ��� �\ � 1536 � CERTIFIED SURVEY. � � sozw'is� S84'S2'S2'E 3�1,55� � LOGOED W THE NW 1/4SE I/4 S SW I/4SE 1/4 00 -yo.s�' SECTION 9,740N,RbW,TOWN Of HUMER �E 434 36 s�sc' SAWYERCOUMY.WLSCONSIN. �� a56'�fi �- --'--_ N"1 � �.�3a.o , s�'s3'szlrizf.ea• '�-u �F .�.� r �� 'f" �16y- \\ 'NJOWMC CE�Xp yLFVE1S E �JCN �.. ,.. r 15fi�6/ �M fASENEN! i0 C.i.E55 M'0 w So :�-�- �� N �,:�-�'`� ���`= o e ..�..m�^��Mj,,* �[�nco '� ���y. � M'ESf LINE E6�MOf-� // 'i i•\�OS�•W a IGCE55/J�� Mlliv �N �� �a4� D Q N III COR. n� FASt1Ewt �u. '\ ��n �B.LY. 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