HomeMy WebLinkAbout014-942-36-4401-LUP-2004-412 Application for Land Use Permit(*Non-shoreland*) o o •
County of Sawyer � ,
PO Box 676 -Hayward WI 54843 k
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. �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED.
.�. _�^ PRINT-USE BLACK INK OR PENCIL �
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Owner Builder N� �
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Mailing Address Mailing Address O �
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City, tate,Zip City,State,Zip �
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Daytime Phone Daytime Phone ��I
Additional Information: Zone District: C-�/F'—�
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Lot Dimensions: ���
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Date lot was created: Acres: �9�`/`� o
Is there wetland near the proposed structure?If yes,how far /.' �u --
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Building Land Use Floodptain-( j Yes O No `; �
( )New ( )Filling �
Dred in Drivewa access off of a(Check one): `D
)Addition ( ) g g Y ?4
�)Alteration O Grading O Pxivate Rd O Town Rd. o
( )Moving On ( ) ( )County Hwy (>)State Hwy „`'', �
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Primary Structure Accessory Building Addition � °
�Dwelling ( )Garage-attached/detached (�Q Deck W
( )Yeaz round ( )#of car stalls ( )Porch �
O Seasonal O Storage Building O Enclosed �
( )Frame built on site ( )Screenhouse ( )Living room �,
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen �.
( )Mobile/manufactwed ( )Other ( )Bedroom � �
O Other primary structure O O Relocate/enlarge �
� � � � ( )#of new � v+
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AdditionalInformation: � >
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Type of Construction: ^C „
(�}Frame ( )Log ( )Pole/metal ( )Block ( )Concrete � �-,
( )Other ,..,y .-3
Construction Cost:Primary Structure$ o �
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Accessory Building:$ Addition:$ /��ZOc� � �
Q�p 3i9�ios � '';
Deed:Vol �0� Pg g�/� Certified Soil Test# 92-z 7y °O z
CSM:Vol Pg Lot# Sanitary Permit# 9z-�9B o, %°
Plat Envelope Or: i�
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Condo Vo] Pg Year Installed: � �
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Aff of ex septic Vol Pg Owner When Installed:
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Previous office approvals/actions: 45� y�� —
Variance:# LUP:# 4z�3zy SP�# CUP:#
Inspection Report:# Change of Zone District: },jlc�
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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. !)i��+; #2. � , _ #3. �i�L #4.
Size �� f[. wide ft. wide ft. wide ft. wide
=�_ fr. long _ ft. long ft. long ft. long
Floor azea �� r sq. ft. �sq. ft. sq. ft. sq. ft.
Hgt.fmm gade_�_to peak > � ft. hgt. ft. hgt. fr. hgt.
Stories stories stories stories
# of bedrooms
Rear Lot Line
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Fire Number and Name of Road f ' � �- ���
1. Enter lot dimensions and indicate north by arrow. / Signatu�e of Owner or }horized Agent:
2. Indicate the location and size of the requested construction x
Signature
activities.
PnntName:�-/�r�U P t�'Y'v^i�l
3. Also, indicate the location and distance to the well, The above certifies that the�ist information and inteNions are
true antl correcL,that all work shall be pedortned in compliance
septic tank and drainfield, wetland areas, lot lines and to the with the 2quiremenis of�he sawyer co��ry zoo�o9 om��a�ce
and ihe laws and regula�ons of ihe State of Wisconsin, and if
CentCtllne Of the IOad. acting as owner(s)agent, has the permission of the owner(s)to
perfortn the work requested on Nis application. The above
personsls hereby give permission for atcess to ihe pmperty for
onsite inspection.
Permit fee: $ ��
At�gll�t_6-. 9004 �i �• • `1 6f�l��Q,c./ — ��1fL.D�in_�i�_
Issue Date Signature of Iss i g nt
August 6, 2005 50%Rule: Average Road Setback: _
Expiration Date
Office Comments:
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$CALE : l INCH = 400 FT.
Krr1 'T- 12.-17