HomeMy WebLinkAbout014-942-36-3105-LUP-2004-383 Application for Land Use Permit(*Non-shoreland*) o 0
County of Sawyer �
PO Box 676 -Haywazd 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. -> �
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CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. T �
PRINT-USE BLACK INK OR PENCIL ��
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Owner Builder �' �
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Mailing Address Mailing Address Lt,t.ct� , � �
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City, tate,Zip City, te,Zip
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Daytime Phone c Daytime Phone
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Additional Information: Zone District: L P,�/o a ��
S 3 6�i 4 Z/�. Oq � Lot Dimensions:
Date lot was created: Acres: �� n
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Is there wetland near the proposed structure?If yes,how faz � �'
Building Land Use Floodp}ain:O Yes O No �/� =°
( )N w ( )Filling � �
(�dition O Dredging Driveway access off of a(Check one): `D
aa �
O Alteration O Grading O Private Rd O Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy N �
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Primary Structure Accessory Building Addition � °
��Dwelling ( )Garage-attached/detached ( )Deck W
( )Year round ( )#of car stalls (j�Porch =
O Seasonal O Storage Building K )Enclosed �
O Frame built on site O Screenhouse O Living room � �
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen � ,
( )Mobile/manufactured ( )Other ( )Bedroom L �
( )Other primazy structure ( ) ( )Relocate/enlarge .p
� � ( ) ( )#ofnew � �
AdditionalInformation: �_ P
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Type Construction: '� �
�e ( )Log ( )Pole/metal ( )Block ( )Concrete ��
N
( )Other ,�
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Construction Cost:Primary Structure$ '������ � �
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Accessory Building:$ Addition:$ � .�
Deed:Vol�`7'-7 Pg 3�� Certified Soil Test# `�lr.-!3� °Q z
CSM:Vol Pg Lot# Sanitary Permit# 9�� D 15 0, 7'
Plat Envelope Or: �
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Condo Vol Pg Year Installed: rn I�
Aff of ex septic Vol Pg Owner When Installed: `-'
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Previous office approvals/actions: �r/-�5'�� �
Variance:# LUP:# ��Z�/`� SP:# CUP:#
Inspection Report:# Change of Zone District:
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I 88�1'1 L
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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 '' - fr. wide ft. wide ft. wide fr. wide
x�� ft. long ft. long ft. long ft. long
Floor azea 2R'B sq. ft. sq. ft. sq. ft. sq. ft.
Hgt.from gade Z to peak fr. hgt. fr. hgt. fr. hgt.
Stories stories stories stories
# of bedrooms
Rear Lot Line
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Fire Number and Name of Road 1 y q-7 S lJ ����SD� �-u
1. Enter lot dimensions and indicate north by arrow. Signature S�f Owner o� hor' d Agent:
2. Indicate the location and size of the requested construction �
SignaNre
activities.
Pri t Name: ���T T ��
3. Also, lndicate the locatlon and distance to the well, The above certifes tnat Ne listed information an entions are
hue and coned.,that ail work shall be performed in compliance
SCpt1C tari1C anCl QTalnfleld, wetland 3Teas, lot Ilnes anCl to the with ihe requiremenGs ot the Savryer County Zoning Ordinance
and the laws and regula6ons of ihe S�ate of Wisconsin, and if
Centerline of ttle ioad. acting as ownet(s)agent, has the permission of the owner(s)to
pedorm Me work requested on this application. The above
personsls hereby give permission for ao:zss lo ihe property for
� �� onsiteinspection.
Permit fee: $ �
July 27 2004 - -
Issue Date Signature of I i Agent
T„1� 77 7n05 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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2 � REF. : AERIAL PHOTO D4
U.S. G.S. HAYWARD QuAD 1971