HomeMy WebLinkAbout014-941-07-1103-LUP-2004-009 Application far Land Use Permit ��F S �UR�3�/�
County of Sawyer � �
PO Box 676 -Hayward WI 54843 �
715/634-8288 O
The undersigned hereby makes application for a Land Use Permit and agrees that all work i
shall be done in compliance with the requirements of the Sawyer County Zoning Ordinance �
and the laws and regulations of the State of Wisconsin. �' �
NO CONSTRUCTION MAY BEGIN UNTIL ALL PERMITS HAVE BEEN ISSUED. `„�"
PRINT—USE BLACK INK OR PENCIL � ,
�GIG!t��CQu/-!t���/�� �iGK�/�C'l/�� a O
Owner Builder Y�
�lE�.� �/, C�,�,o��v �k. 1���1 l��'X 7/�{ o� o
Mailing Address �� Mailing Address � �
����,�E,r�� G�..Z S�/��/3 i����tvur�l�� .�y��/3 �
City,State,Zip City, taS p n,
d.�y- 8�s`s—� 6�'�- �/y�� �
Daytime Phone Daytime Phone
Additional Information: Zone District !
I Lot Size �/�C�' X/-/�5
Date lot was created Acres .�`
Is the property in a Shoreland District?(within 1000'of a lake or pond,within 300'of a river,
creek or stream) If yes,how faz from the shoreline&water name:
Is there wetland near the proposed structure?If yes,how far o
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Building Land Use �
( )New ( )Filling � Floodplain:( )Yes ( )No # �
(Xj Addition �t 12 O Dredging � o
(�Alteration O Grading Chippewa Flowage: O Yes O No � �,
( )Moving On ( ) r"'
( ) ( ) Driveway:( )State ( )Counry (�Town Rd. � �
,
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Primary Structure Accessory Building Addition "t
(�Dwelling ( )Garage-attached/detached ( )Deck '
( )Yeaz round ( )#of car stalls ( )Porch J ==
( )Seasonal ( )Storage Building ( )Enclosed � �
(�Frame built on site O Screenhouse O Living room p'"
( )Modular/manufactured ( )Greenhouse ( )Kitchen
( )Mobile/manufactured ( )Other ( )Bedroom �=
( )Other primazy struchzre ( ) ( )Relocate/enlarge =�
( ) ( ) ( )#ofnew A
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Additional Information: "
4ktZ {�dd-����.:;. �2�,�odv� 1'(z �1�-,-� i���o�.� ��.tiU Z >4�.. .�
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Type of Co�struction �
(�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �
( )Other �
Construction Cost:Prunary Structure$ /�� � '�'a( <==-�
Accessory Building:$ C% Addition:$ ��� ���-r� ca�a��r Z
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Vol ��,R3 Pg /$7 ofDeed CertifiedSoilTest# 90-0l7
CSM Vol Pg Lot# Sanitary Permit# q�^Cb(e �
Plat Envelope Or: �
Condo Vol Pg Year Installed %5 9�'
Aff of ex septic Vol Pg Owner When Installed:
Gard Gazebo Vol Pg 7;�r s � r�`�;�- C,-f�., ,ba
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Previous Variance: LUP: Inspection Date:
I�(��y
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. At{di�Fron #3.aY1d5{O(�ll�l�• #4.
Size L`��y � ft.wide � ft.wide � ft,wide ft.wide
3'� .long ��ft.long l a ft.long ft.long
Floor az a '���C sq.ft. �sq.ft. �sq.ft. sq.ft. �
Hgk fivm e 21o� to peak ac� ft.hgt.TO�Q..F ft.hgt. ft.hgt.
Stori �_ stories �_stories stories
#o edrooms �3 > l InaYQt��
�3 ���jC`,C..c�� ivlc.l4�,nc� l-'.�,�c—��:fKl `1
Lot Line or Lake/River name:
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Fire Number and Name of Road //6'y.�/�i� �in �/� L-< e ��`�
1.Fill in lot dimensions and indicate north by arrow. Sign ture of Owner or Auth�Agent:
2.Indicate location and size of existing and new structures. �
3.Indicate location of well,septic tank,drainfield.
4.Indicate distance to existing structures,lot lines,septic system.
5.Indicate distance to the ordinary high-water mazk of any lake,
pond,river,stream,creek,and name the body of water. P""�Name: ��`�"'�� e` K��y�r
The above cer6fes lhat Ne listed information and intentions are
6.Indicate any grading or clearing in excess of the construction site. We a"d�o�recc Tne a�o�e Persoos�s ne�eby 9�ve Pe��se�o�ro�
access to ihe properry for onsite inspedion.
7.Indicate distance to any wetland.
Permit Fee:
`` .. I,S %c c`i - �
Issue Date Signature of Issu' g g nt
5 �.
Expiration D te
Office Comments:
Inspection Date: 50%Rule Applies: Avg.Setback: Within Reservation boundaries:
Restrictions and other information:
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