HomeMy WebLinkAbout012-640-05-4203-LUP-2004-686 Application for Land Use Permit(*Non-shoreland*) o o��
County of Sawyer � �
PO Box 676 -Hayward WI 54843
715/634-8288 �
*Properiy 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 REQU]RED PERMITS HAVE BEEN ISSUED. �
� INT-USE BLACK INK OR PENCIL
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Owner Builder <� �
9�s.��.,,/ C'�Y. ��. '� �vs�' �vl Gr�� D. 3 �� �
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Ma,il)'ng Address Maili��Address O
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City,State,Zip City,StaYe,Zip
'7/S�" 'SrG�f� �1l�'7!J �/ri' ���"- -9�/�O F.
Daytime Phone Daytime Phone �
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Additional Information: '-`Lone District: � �' � ^
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Lot Dimensions: �.G� X � �!X���(�'
Date lot was created: /9 C/� Acres: �c� � o� �
Is there wetland near the proposed structure?If yes,how far '�-� . � �
Building Land Use Flooctplain:� j Yes (7�j No :;
( )New ( )Filling �
�Addition O Dredging Driveway access off of a(Check one): "
ci�c
O Alteration O Grading O Private Rd O Town Rd. o
( )Moving On ( ) �CounTy Hwy ( )State Hvvy �,"', �
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��_ N O
Primary Structure Accessory Building Addition �o
�Dwelling ( )Garage-attached/detached ec W
� �Year round ( )#of caz stalls ( )Porch � � �
( )Seasonal ( )Storage Building (�c}Enclosed,.Z'S�X.3(v ::
(Xj'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: ��,
(�)Frame 1 ( )Log ( )Pole/metal ( )Block (j�Concrete ���
( )Other _-� ro �
Construction Cost:Primary Structure$ ^�� � �
:?
Accessory Building:$ Addition:$ -;�(!, (5�JC% � �
r//3, 2,0 �
Deed:Vol�(��Pg�',�� Certified Soil Test# �(„— �'�J.j "�Q z
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CSM:Vol Pg Lot# Sanitary Permit# 7� ' 3� o,
Plat Envelope Or: �, �
Condo Vol Pg Year Installed:�_Cf cf �i,r �
Aff of ex septic Vol Pg Own�en Installed: � �
s��:��2�.v ;;,1
Previous office approvals/actions: 9 g_�,�5 `��
Variance:# LUP:# 9(�,-�9(�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
colu n. List each story, each addition, each alteration in a separate column.
#1. � #4.
Size_ ft. wide ft. wide ft. wide ft. wide
3 ft. long ft. long
Floor area O sq. ft. sq. ft.
Hgt. from grade e� � to peak ft. hgt.
Stories 7Y To stories
# of bedrooms
f yk__ Q
Fire Number and Name of Road
ft. long
ft. long
sq. ft.
sq. ft.
ft. hgt.
ft. hgt.
stories
stories
1. Enter lot dimensions and indicate north by arrow.
2. Indicate the location and size of the requested construction
activities.
3. Also, indicate the location and distance to the well,
septic tank and drainfield, wetland areas, lot lines and to the
centerline of the road.
Permit fee: $ � to 0
Sijn-*--�e of ❑ er horized Agent:
net
Print Name LY 5 -�
The above certifies that the listed in rmatlon and intentlod are
true and correct., that all work shall be performed in compliance
with the requirements of the Sawyer County Zoning Ordinance
and the laws and regulations of the State of Wisconsin, and if
acting as owner(s) agent, 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.
)F HUNTER �
-O N. R. b W. ,
32
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