HomeMy WebLinkAbout014-942-28-3305-LUP-2004-284 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 r
flowage,lake or pond or does not have any of tbe above waterbodies located within pQ
the property's boundaries. � �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. �
H�S�}C'r PRINT-USE BLACK INK OR PENCIL n
�K►2i� E ToA�J .t3��r�r��� dv'��C.�rt!Sil�� f�c�,f�s � '' �
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o,�er Builder P.a 'r3�x ��
��I03a7 � .S'JLBE�f'L2_L�K�k� `�,�?5 1i1,�. ��C�fLI.AN �50 0�
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Mailing Address Mailing Address �
!�/i�c-i�� , ���j�e_. S�SSsr MRRSrFFiEu� ;c�JY� 5���9 �
City,State,Zip City,State,Zip �
7/5�339- �s�s'� '�1.7-38� -d l(�l �
Daytime Phone Daytime Phone ��
R'i
Additional Information: Zone District: �� �—z _
Lot Dimensions: /�� + X `�'�� , �
Date lot was created:�p ���000 Acres: � y�� � ��,,
Is there wetland near the proposed structure?If yes,how far ti�G � cW
�. �
Building Land Use Floodptain:�� ��)I`es� ��No ��=° �
(Xj New ( )Filling � (,
O Addition O Dredging Driveway access off of a(Check one): � �
( )Alteration ( )Grading ( )Private Rd ( )Town Rd. o �'ti�
O Moving On O ikl County Hwy O State Hwy ; ��
� ) � ) o `�+
t�
Px mary Structure Accessory Building Addition � °
(7�Dwelling OC)Garage- ttache /detached �Deck �"'„
�}Q Year round (�#of caz stalls O Porch :
( )Seasonal ( )Storage Building ( )Enclosed �
O Frame built on site O Screenhouse O Living room `-'
(�Modular/manufactured ( )Greenhouse ( )Kitchen � �
( )Mobile/manufactured ( )Other ( )Bedroom � �
( )Other primary structure ( ) ( )Relocate/enlarge '�
� � � � ( )#of new � �11
�.
Additional Information: �
�
�, �
is�
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Type of Construction: � �,
�j Frame ( )Log ( )Pole/metal ( )Block ( )Concrete o0
( )Other y
c�c w �
Constnzction Cost:Primary Structure$ ��C) ��'�'• o
��C c�? :°
Accessory Building:$ � �.'�.�� Addition:$ ���j L�= � `�
A- 3 r`7�o`�/ � �
Deed:Vol Pg Certified Soil Test# (�y— /6� . z
CSM:Vol ,�� Pg �3 Lot# � Sanitary Permit# ��'��� o. 7'
Plat Envelope � �'���a' Or: N �
I �Y�S�S v,
Condo Vol Pg ,��Sc�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:
5��,��b 1
��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. t}OuSt #2. _iy��¢y�t�y? #3. #4.
Size ?� ft. wide ��de ft. wide ft. wide
(p(p ft. long .�� fr. long ft. long ft. long
Floor area ��(� sq. ft. 78� S9. ft• Sq_ ft. Sq• ft.
Hgt.from gade to peak_.L(�ft. hgt. fr. hgt. ft. hgt.
Stories � stories stories sCories�
# of bedrooms 3
Rear Lot Line
pr,� / �' �
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Fire Number and Name of Road .1�' � Q �'1Y L � � !�-`'t �
1. Enter lot dimensions and indicate north by arrow. na re of Own r Aut ' � Agent:
2. Indicate the location and size of the requested construction
gnature
aCt1VlY1CS. PriniName: �/���� ��/ /C�!/��
3. Also, indlCate the IoCatlon and d15tanCe to the Well, The above ceRifes that the listed information and intentions are
true and conect.,that all work shall be peAortnetl in compliance
septic tank and drainfield, wetland azeas, lot lines and to the w�m me �q���eme�� ot me sawye� coo�ry zoom9 oro��a��
and Ne laws and regulations of�he State of Wlsconsin, and if
Ceritei�iri0 Of the iO3d. acting as owner�s)agent, has the permission of the owner(s)to
perfortn ihe work requested on this applicafion. The above
personsls hereby give pertnission for aaess to the property for
{� onsiteinspection.
Permit fee: $ ���/ � �
June 22 2004 '
Issue Date Signature of I suin Agent
June 22, 2005 50% Rule: Average Road Setback: _
Expiration Date
Office Comments:
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RE��ERENGES : SAWYER CO. DEED RECORDS SCALE: I INCH— 400 FEE
U. S. G.S. — HAYWARD AND pRAWN BY: KM [
STANBERRY EAST COLON (:) INDIGATES G(
AERIAL PHOTO 83
FaPEX
5 U a v e V i H G P.O.BOX 607 - NAY'NAR�,WI 51847
SAWYER COUNTY CERTIFIED SURVEY MAP
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