HomeMy WebLinkAbout014-842-17-4101-LUP-2004-321 ,� `
Application for Land Use Permit (*Non-shoreland*) r `` � '
County of Sawyer ° � .
PO Box 676 - Hayward WI 54843 � �
715/634-8288 r.
*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 Z
the property's boundaries. �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. �,
PRINT—USE BLACK INK OR PENCIL '
. � �
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Owner Builder �•
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Mailing Address Mailing Address � p
it✓�,✓�r��u u: ; �Xyy3 ��4w�� u�rtS �y8k3 �
City, State, Zip City, State, Zip �' `
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Daytime Phone Daytime Phone �
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Additional Information: Zone District: !�� �
1
Lot Dimensions: �
Date lot was created: �� � � Acres: ��► o
Is there wetland near the proposed structure? If yes, how far .� .�,�-
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Building Land Use Floadptain:� j I�es ( j No �_ � Z �
�New ( ) Filling � C-
O Addition O redging Driveway access off of a(Check one): CD �
c�c, G
( ) Alteration Grading ( ) Private Rd ( ) Town Rd. o j
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy N � -�•
( ) ( ) .� � �
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Prirpary Structure Accessory Building Addition � o �
Q(f Dwelling ( ) Garage-attached/detached ( ) Deck W .�
�Year round ( ) # of car stalls ( ) Porch � ,v
( ) Seasonal ( ) Storage Building ( ) Enclosed � %
( ) Frame built on site ( ) Screenhouse ( ) Living room � 7 �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen � � r
�
( ) Mobile/manufactured ( ) Other ( ) Bedroom s ',
( ) Other primary structure ( ) ( ) Relocate/enlarge � A q
� �K-} SC.rN Pv�c,� ( ) ( ) # of new �s,, m �
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AdditionalInformation: .-� �
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�Ty of Construction: —
rame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete
( ) Other
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Construction Cost: Primary Structure $ 225�c)CO3 c�(, � �
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Accessory Building: $ Addition: $ �
38� z� �
Deed: Vol ' .Z 9�Pg (rr`�Z-G�`J,3 Certified Soil Test# �jy ._3yg °Q z
CSM: Vol Pg Lot# Sanitary Permit# 7 q - ��{3 � �
Plat Envelope Or: �,
Condo Vol Pg Year Installed: �
Aff of ex septic Vol Pg Owner When Installed: � �
Previous office approvals/actions:
9 7- �axA
Variance: # LUP: # q� -� SP: # CUP: #
Inspection Report: # Change of Zone District:
Describe the construction using these columns.List the dimensions of each structure in a separate �
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column.List each story,each addition,each alteration in a separate column.
#1. pwe,lLin,4 #2.�p�.,����4n� _ ��Ft #3. S(,rN Porc,1, Qec.K #4. (.yUeYtb Pc�rc,1�
Size�wift de 2 ft.wide �lo ft.wide �( _�fr.wide '
��fr.long 12. fr.long \lp fr.long 5(p I 8 ft.lon , '
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Floor azea_�I l(p sq.ft. 2� sq.fr. 350 25l¢ sq.ft. 331e 10 sq.ft.
Hgt.from grade�to peak N A ft,hgt. 20 ft.hgt. N� ZD ft.hgt.
Stories�_ ./+� stories �stories n/q __�stories
#of bedrooms� .��.�L �Zoo s��FI� 1550 s9 Fi- " c
Rear Lot Line `
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Fire Number and Name of Road 1349 Z N 4.Rr S2rU I�c� (/ L�iv�
1. Enter lot dimensions and indicate north by arrow.
Signature Owr or E ed Agent:
2. Indicate the location and size of the requested construction � C
activities. / ,C� ��
ignature
PnntName: ✓�iPC!('ric/� l� �Y'/1T'NZ—
3. Also,1ndlCate flle loCatlon 3nd dlStanCe t0 the Well, The above c rtifes that the listed information and intentions are
hue and covect.,that all work shall be perfortned in compliance
septic tank and drainfield,wetland areas,lot lines and to the w�m me����reme�cs ot me sawyer co��ry zoo��9 om��a�ce
and the laws and regulations of the State of Wisconsin,and i(
Centetllne Of tlle t08d. acting as owner(s)agent has ihe permission ot the owner(s)to
pedortn the work requested on this application. The above
personsls hereby give permission for aceess to Ne property for
onsite inspection.
Permit fee:$
July 2, 2004 ������,�^� ��� �
Issue Date Signature of Issuing Agent
July 2, 2005 50%Rule: Average Road Setback:
Expiration Date
Office Comments:^��o n��o�y�,Q,x (�f.f.9�.Q��`Gt�� ' • C.t-o�
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GRAPHIC SCALE
TAX ASSESSMENI
•� o zoo 40o eoo isoo Information contain�
advisory. Mop accu
quality of the publi
was prepared. It is
( IN FEET ) substitute for on a
1 inch = 400 ft.