HomeMy WebLinkAbout014-842-17-3201-LUP-2004-375 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 �:
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 ALL REQUIRED PERMITS HAVE BEEN ISSUED. —� `
�Q�� ` �� PRINT—USE BLACK INK OR PENCIL
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City, State, Zip City, State, Zip
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Daytime Phone Daytime Phone R
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Additional Information: Zone District: R 2`� �
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Lot Dimensions: S
Date lot was created: Acres: / 9 . d o �J
Is there wetland near the proposed structure?If yes, how far /(���� � �
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Building Land Use Floodptain:� j IFes (�(j No :� �
( )New ( ) Filling �
O Addition O Dredging Driveway access off of a(Check one): �,
(� Alteration ( ) Grading ( ) Private Rd � Town Rd. o
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy N �
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Primary Struc� e Accessory Building Addition � °
( ) Dwelling ( ) Garage-attached/detached ( ) Deck ,`;;
( ) Year round ( ) # of car stalls ( ) Porch �
( ) Seasonal ,t�+e� � Storage Building ( ) Enclosed �
O Frame built on site ( Screenhouse O Living room � v,
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen � �
( ) Mobile/manufactured ( ) Other ( ) Bedroom �.
( ) Other primary structure ( ) ( ) Relocate/enlarge ' A
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AdditionalInformation: �_ < < ` . ` .�
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Type of Construction: }�; --
� Frame ( ) Log ( ) Pole/metal ( ) Block (jQ Concrete Ca �
( ) Other ,�
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Construction Cost: Primary Structure $ �" � �
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Accessory B 5�ng: $ Z�����. �� Addition: $ � �
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Deed: Vol > �' Pg �5 f Certified Soil Test# �° z
CSM: Vol Pg Lot# Sanitary Permit# � 7�
Plat Envelope Or: �;
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Condo Vol Pg Year Installed: �
Aff of ex septic Vol Pg Owner When Installed: � �
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Previous office approvals/actions: �
Variance: # LUP: # SP: # CUP: # ` �
Inspection Report: # Change of Zone District: �\���
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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.
#L 5���� tiSe Shr�j� #2. #3. #4.
Size Zv ft, wide ft. wide ft. wide ft. wide
/ 5� ft. long ft. long ft. long ft. long
Floor area ��'�' sq. ft. sq. f[. sq. ft. sq. fr.
Hgt.from giade I y 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 / � S G' 2 N . S .m u r� s ��
1. Enter lot dimensions and indicate north by arrow. Si ature of Owner or Authorized Agent:
2. Indicate the location and size of the requested construction ��-P p'� ,���---
�� SignaNre
activities. ,7 u �, ( 7
PrintName: � .'7�tclF��Ju�)
3. A1S0, indicate the location and distance to the well, The above certifes ihat the listed intormation and intentions are
true and correct,ihat all work shall be performed in compliance
SephC t317�C anC� dralnfleld, wetl3rid 3Lea5, lot l(nes and to tlle wiN the requiremenLs ot the Sawyer County Zoning ordinance
and the laws and regula6ons of ihe SGte of Wisconsin, and if
C017YE711riC Of YtiC r0aC1. acfing as ownet(s)agent, has the permission of the owner(s)to
perfortn ihe work requested on this application. The above
personsls hereby give permission for aaess to the property for
onsite inspection.
Permit fee: $ ,s(`� , �, ��
July 26, 2004 �� � � �,Q(�� —_���U ,��_
Issue Date Signature ofIss ng ent ��
July 26, 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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NW—SW NE—SW
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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 . P��r s #2. �� ��` �'t.� ��r�` �.-t �: �, #3. #4.
Size /i� ft. wid� g � ft. wide ft. wide ft. wide
� ft. long � � ft. long ft. long ft. long
Floor area �6 � sq. ft. � t sq. ft. sq. ft. sq. ft.
Hgt. from grade � �v� to peak J y � ft. hgt. ft. hgt. ft. hgt.
Stories 1 stories stories stories
# of bedrooms �
Lot Line or Lake/River name:
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Fire Number and Name of Road � � .��' � ;'�,' °� �<��, ��� _. t�. �,;:, �,�'' � :�;Y ..« . ;, ti�.
1. Fill in lot dimensions and indicate north by arrow. Signature of Owner or Authorized Agent:
2. Indicate location and size of existing and new structures.
3. Indicate location of well, septic tank, drainfield. �� � � - -- - ._
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4. Indicate distance to existing structures, lot lines, septic system. !
5. Indicate distance to the ordinary high-water mark of any lake,
pond, river, stream, creek, and name the body of water. Print Name:
The above ceRifies that the listed information and intenGons are
6. Indicate any grading or clearing in excess of the construction site. �e and correct The above personsls hereby give permission for
access to the property for onsite inspection.
7. Indicate distance to any wetland. �
Permit Fee: � 7 �� �'�'
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Issue Date Signature of Issuing Agen
July 10 , 2004
Expiration Date
Office Comments:
Inspection Date: 50% Rule Applies: Avg. Setback: Within Reservation boundaries:
Restrictions and other information: