HomeMy WebLinkAbout014-842-15-4410-LUP-2004-219 Application far Land Use Permit(*Non-shoreland*) o o �
County of Sawyer v �
PO Box 676 -Hayward WI 54843��� �FF�CE rC�Pvi`.���.Nl
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 S �
the property's boundaries.
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. 1
�Q �„� �y� PRINT-USE BLACK INK OR PENCIL
�� ��� GRr �e�m� � a
Owner Builder �' �
7a`� � ���iQ� 133�0 � 5-{�I� � �� `
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Mailing Address Mailing Address O �
`���e ��Q.. �� �yX�K ��,�ey W�. 5�(�� � �
Ciry,State,Zip City,State,Zip �
�03�' S (UZ.. �' � �'
Daytime Phone Daytime Phone � `�
Additional Information: Zone District: �`�' � �'
Lot Dimensions: �
Date lot was created: lo��2 Acres: ��� o �
Is there wetland near the proposed structure?If yes,how faz G
Building Land Use Floodplain:f )Yes (�No :9
Q�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 N �
� ) � ) o `,�
C^
Primary Structure Accessory Building Addition � °
O Dwelling Q9 Garage-attache etached O Deck W
O Year round (�#of car stalls O Porch =
O Seasonal O Storage Building O Enclosed �
O Frame built on site O Screenhouse O Living room � �
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen '�
( )Mobile/manufactured ( )Other ( )Bedroom
( )Other primazy structure ( ) ( )Relocate/enlarge ' '
� � ( ) ( )#of new �V,
n
AdditionalInformation: p �
�1 �,
� g
Type of Construction: �
(�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete � `J1
( )Other ,ti ,.�
Construction Cost:Primary Structure$ �(9�.�. � �
� S
Accessory Building:$ Addition:$ � N
3[l�oco �
Deed:Vol Pg Certified Soil Test# C�a-�/� °O z
CSM:Vol �3 Pg����� Lot# a Sanitary Permit# G.�-�So o� �
P1atEnvelope ��Yy� Or: " Q(1
N
�
Condo Vol Pg Yeaz Installed: �o
� �
Aff of ex septic Vol Pg Owner When Installed:
�
Previous office approvals/actions: •
�
Variance:# LUP:# Cc��y�7 SP:# CUP:# O
Inspection Report:# Change of Zone District: �����
I co 888
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 2u ft. wide ft. wide ft. wide ft. wide
2JA— ft. long
ft. long
ft. long
ft. long
Floor area sq. ft.
sq. ft.
sq. ft.
sq. ft. , ,
Hgt. from grade g to peak
ft. hgt.
ft. hgt.
ft. hgt.
Stories ] `/2
stories
stories
stories
# of bedrooms U
Rear.Lot Line
aW
LOT 1 UNPLAPED LANDS
CSC �5a66 BY OWNER
.. rb
µ���o�o �ygA'43 31 E S81143'26"E it n
�6e,7sZ 1 E 108.2 213.09' z
jrll�f, ACCESx STING
S EASEMENT N
To C.I.H. 00
M
N
MARSH 3
all pp� LOT 2 0�
94374s.f. S
2.17 ACt o 0
ro ro
� N n
3� LOT
L07 1 a 6688
992895.f. 1.53
e 2.28 ACt
cr t
?. N
rn
SAWMILL $
UNPIATTEO LANDS
Fire Number and Name of Road d
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.
er or Authorized Agent:
Print Name:
The above certifies that the listed information and intentions 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.
Permit fee: $ /00
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GRAPHIC SCALE TAX ASSESSMENT PURPO�
aoo a zao 40o soo ieoa Information contained on this
advisory. Map accuracy is lim
quality of the public records
was prepared. It is not intenc
( IN FEET ) substitute for an accurate fie
1 inch = 400 ft.