HomeMy WebLinkAbout014-842-28-2204-LUP-2004-374 Application for Land Use Permit(*Non-shoreland*) r �
County of Sawyer � �� '� �
PO Box 676 -Haywazd WI 54843 O
715/634-8288 ��
*Property that is not located within 300'of a creek,river or stream or within 1000'of a Z
flowage,lake or pond or does not have any of the above waterbodies located within �, �
the property's boundaries. i ,
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 ��/8'� O �
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City,State,Zip City,State,Zip �
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Daytime Phone Daytime Phone
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Additional Information:� Zone District:
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Po Qsc d96 �'
Lot Dimensions: �
�qyU,19�0�6Ji �'i�N3
Date lot was created: Acres: Jr.0�( o Z
Is there wetland near the proposed structure?If yes,how faz � 3
Building Land Use Floodptain:� j Yes (�No =; ?
(�)New ( )Filling � �
O Addition O Dredging Driveway access off of a(Check one): � fi
O Alteration O Grading O Private Rd O Town Rd. o
( )Moving On ( ) ( )County Hwy (v)'State Hwy c,"', �
O O o S
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Primary Structure Accessory Building Addition � °
( )Dwelling ( )Garage-attached/detached ( )Deck W
( )Yeaz round ( )#of caz stalls ( )Porch �
O Seasonal O Storage Building O Enclosed �
O Frame built on site O Screenhouse (-)Living room � �
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen � �
( )Mobile/manufactured ( )Other ( )Bedroom 4 �
( )Other primary struct�re ( ) ( )Relocate/enlarge .� `�
(�) C`�5.���C,^� C �i��c: ( ) ( )#of new � Z-
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Additional Information: <
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Type of Construction: t�-
( )Frame ( )Log (✓�Pole/metal ( )Block ( )Concrete 'f'
( )Other „d �
Construction Cost:Primary Structure$ � �
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Accessory Building:$ Addition:$ x�
#13�y�d'7 � y`'
Deed:Vol Pg Certified Soil Test# °Q z
CSM:Vol Pg Lot# Sanitary Permit# o, �
Plat Envelope �r� N �
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Condo Vol Pg Year Installed: �o
Aff of ex septic Vol Pg Owner When Installed: " �
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Previous office approvals/actions:
Vaziance:# LUP:# SP:# CUP:#
Inspection Report:# Change of Zone District:
�I���°y
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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. #2. #3. #4.
Size ft. wide ft. wide ft. wide ft. wide
ft. long ft. long ft. long ft. long
Floor azea sq. ft. sq. ft. sq. fr. sq. ft.
Hgt.from giade to peak ft. hgt. ft. hgt. ft. hgt.
Stories stories stories stories
# of bedrooms
Rear Lot Line !`�' ' '��� ��` � ` � �
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Fire Number and Name of Road /o2d'3G./�/ � S Mw' y � 3 !�E'2Tt+
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1. Enter lot dimensions and indicate north by arrow. Signature of Owner��ut�te,(ized Agent:
2. Indicate the location and size of the requested construction ��_:— �-
� Signatu2
activities. /� 1
PnntName: �:rtC�"YirT �'� �\��C �.�%�.
3. Also, indicate the location and distance to the well, rne a�ove�emres mat t ed mrormac�o� a�d �oiaoso�5 a�e
true and cortect.,that all work shall be performed in compllance
septic tank and drainfield, wetland areas, lot lines and to the with lhe requirements of the Sawyer Cowry Zoning Ordinance
and the laws and regulations of the S�ate of Wisconsin, and if
COriYCTI1riC Of t110 IO2d. acting as owner(s)agent, has the pertnission of the owner(s)to
peAortn the work requestetl on this application. The above
personsls hereby give permission for access to the propeRy for
onsite inspeQion.
Permit fee: $ J��
July 26, 2004 a ,��J o �p D�-�� _
Issue Date Signature ofI �n gent
July 26, 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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/ / "THANNUM FIRE LN"
SHOWN AS 66' N1DTH FOR
/ MApPiNG PURPCSES.
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