HomeMy WebLinkAbout014-941-03-4404-LUP-2004-150 Application for Land Use Permit(*Non-shoreland*) o o _ ,�.
County of Sawyer � j
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 � Ce
flowage,lake or pond or does not have any of the above waterbodies located within � �-
the property's boundaries. a �
CONSTRUCTION SHALL NOT BEGIN UNTIL AL�.REQUIRED PERMITS HAVE BEEN ISSOED. �
PRINT-USE BLACK INK OR PENCIL y �
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�«haRr�$���zab�rh �yft`e�,'lv� � N����' ou�.��,� �
Owner Builder < �
lss�� w �eo�s Rd ' �� ��1
Mailing Address Mailing Address �
%�aXw�RA �� SH��3 :° -<
City,State,Zip City,State,Zip �
��s- �3�- is9 � �
Daytime Phone Daytime Phone �
Additional Information: Zone District: �'`a ��
Lot Dimensions: �'
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Date lot was created: fJc T �/ z�L 1 Acres: S.o� n �`
o Cr
Is there wetland near the proposed structure?If yes,how faz G �
Building Land Use FloodpYain:� j Yes (� j�No ���° �
(�)New ( )Filling � �
O Addition O Dredging Driveway access off of a(Check one): � '�
O Alteration O Grading O Private Rd O Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy ti, �
� ) � ) � o
t"
Primary Structure Accessory Building Addition � °
O Dwelling (xL Garage-attache detached' O Deck W
( )Year round ( )#of car stalls ( )Porch =
O Seasonal O Storage Building O Enclosed �
O Frame built on site O Screenhouse O Living room �- �
( )Modular/manufactured ( )Greenhouse ( )Kitchen � �
( )Mobile/manufactured ( )Other ( )Bedroom -z �
( )Other primazy structure ( ) ( )Relocate/enlarge '� '�
� � ( ) ( )#of new � �°
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AdditionalInformation: �' A
s �
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Type of Construction: � C,�
( )Frame ( )Log ( )Pole/metal ( )Block ( )Concrete
( )Other
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Construcrion Cost:Primary Structure$ ��i�o v �
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Accessory Building:$ Addition:$ � -�
� �
Deed:Vol 7 7 Pg� Certified Soil Test# v�-�7`� tlQ z
CSM:Vol J'3 Pg 7 7 Lot# Sanitary Permit# O:2 -�"7 j o, 7�
Plat Envelope �r� N "`�
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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: I�/a�
�
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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. ��"��� v� #2. #3. #4.
Size �? ft. wide ft. wide ft. wide ft. wide
� � ft. long ft. long fr. long ft. long
Floor area 7a o sq. ft. sq. ft. sq• fr• S9� fr•
Hgt. from gade �j to peak ft. hgt. ft. hgt. fr. hgt.
Stories _�_ � stories stories stories
# of bedrooms
Rear Lot Line
,t �
�pM E 3b
�.��ti � �7-'JF � _-^--� ��' � H rH�E �
- -,- - - - ;30
hl�ir/ ���-` yS � .-� 1/ti"�
�� /75 '
, ,
333 " � -S"
Fire Number and Name of Road � s S 36 �� � ��� ' S �d �n�S f?c/
1. Enter lot dimensions and indicate north by arrow. Sig�tur of Owner or Authorized A�nt;
2. Indicate the location and size of the requested construction /��,,� (,(1y �,� �--c,/v
sig aNre
activities. h7 i` h �r, � 4 � �� ��ti� � �
Pnnt Name:
3. Also, 1nC�1c3te tlle IoCatlon anC� d1St211Ce to the Well, The above certiAes that the listed intortnatlon d iNentions are
true and cortect., ihat all work shall be performed in compliance
septic tank and drainfield, wetland areas, lot lines and to the w�tn tne aqui�eme�� ot me sawyer coun�y zonin9 ominance
antl lhe laws and regulalions of the Stzte of Wisconsin, and if
C0nte711ne Of tlle Toad. acting as owner�s) agent, has the permission of the owner(s) b
peAortn the work requested on this application. The above
personsls hereby give permission for access lo ihe property for
onsite inspedian.
Permit fee: $
May 6 , 2004 y.� � - � - �ti �`�-
Issue Date Signature of Issu A e t "
May 6 , 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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SCALE � l INCH = 400 FT.
KM 5- 10-77