HomeMy WebLinkAbout014-842-29-1207-LUP-2004-419 ✓
Application for Land Use Permit(*Non-shoreland*) o 0
County of Sawyer �, � -
PO Box 676 -Hayward WI 54843
715/634-8288 0
*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 REQIDRED PERMITS HAVE BEEN ISSUED.
PRINT-USE BLACK INK OR PENCIL '
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d-�jf.r��yn � `�
%�'r � f- G'/S�irl ./�.t.Q1 � �
O er Builder <'
I y�23 �,� f�l,���• �� �,,,�.
Mailing Address Mailing Address O �
�rti�,,,� � ������3 �
City,State,Zip Ciry,State,Zip �
7%5 G3Y Go«� �./ ��i5 Gq�'�iGsS in
Daytime Phone Daytime Phone ��
Additional Information: ZoneDistrict: /��l'� C�rz���'�
Lot Dimensions: /G`� 1 3 j�' �
Date lot was created:��,�:u���-/ Acres: /*� �`-'--5.��i'�� o �
Is there wetland neaz the proposed structure?If yes,how faz /'C � �5l
Building Land Use Floodp}ain:O Yes O No � '
( )New ( )Filling �
Dred in Drivewa access off of a(Check one): fD
( )Addition ( ) g� g Y �
O Alteration O Grading O Private Rd �Town Rd. o
(�Moving On O O County Hwy O State Hwy h, �
O O o S
r
Primary Structure Accessory Building Addition � °
(I)Dwelling (�j Gazage-attac�detached `(/ De�k W
(i)Year round O#of car staLls �Porch.� �
O Seasonal (�)Storage Building O Enclosed �
O Frame built on site O Screenhouse (!)Living room �
( )Modulaz/manufactured ( )Greenhouse )Kitchen
( )Mobile/manufactured ( )Other ��j Bedroom ` �
(1)Other primazy structure ( ) ( )Relocate/enlazge '^
� � ( � ( )#of new � �
Additional Information: 1�' p
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Type of Construction: y�
(�)Frame ( )Log ( )Pole/metal ( )Block ( )Concrete
( )Other `"
vti7 �-1
Construction Cost:Primary Structure$���JC�C) � �
:? �
Accessory Building:$ Addition:$ x�
:# 3;tC'7k9 �
Deed:Vol Pg Certified Soil Test# Q y-�9 tl4 z
CSM:Vol a�o Pg Lot#�_ Sanitary Permit# O y-193 � '�
Plat Envelope ' �r� N �
Condo Vol Pg Yeaz Installed: � ������
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Aff of ex septic Vol Pg Owner When Installed:
i
Previous office approvals/actions: -
Variance:# LUP:# SP:# CUP:#
Inspection Report:# Change of Zone District: �I ��Q�
C:�
1
Describe the wnstruction using these columns. List the dimensions of each structure in a separate
column. List each story, each addition, each alteration in a separate column. �,,a 1-`='
#1. j7�c��,,� #2. y� ��-�-- #3. �-�=�di�J � #4. .5l.�c,%
Size z` ft. wide 'L�/ ��f�t�. wide i/ ft. wide �� (G ft. wide
�� fr. long < v ft. long rL'' ft. long �� �f- ft. long
Floor area ��i 0 sq. ft. a�/`D sq. ft. �_."�sq. ft. Y54 sq. ft.
Hgk from giade `�to peak •��� ft. hgt. ��ft. hgt. /�%� ft. hgt.
Stories ' ( stories �_stories �_stories
# of bedrooms�_
Rear Lot Line
�/-y� ����c��i
Fire Number and Name of Road /.� �-5 `� ,.�� �."� -�-" ��r'
1. Enter lot dimensions and indicate north by arrow. Signature of Owner or Authori�ed A ent:
2. Indicate the location and size of the requested construction ����' L�,� � ��f�.L�r�j�vv-„
�' Sign ure A
activities. � � / 1,.
PnntName:lf��n �`: Ctily�., „��!O/�l��A� � -'�,n �
3. AISO, 1nd1C3te tl'le IOCatlon and d15tanCe to the Well, The above ceRi ies that the Ilsted information an intentlors are
true and correct,that all work shall be pedormed in compliance
septic tank and drainfield, wetland areas, lot lines and to the w�tn me r���remeot9 ot me sawyer co��ry zo�ios om��aoce
antl the laws antl regulations of the State o(Wisconsin, antl If
C0rit0Lllne Of th0 TOad. acting as owner(s)agent, has the permission of the owner(s)to
pedorm the work reques�etl on this application. The above
personsls hereby give permission for access to the propeRy for
G� onsite inspection.
Permit fee: $ / 75 •
August 10 2004 -
Issue Date Signature of Is u ng A ent
Augsut 10, 2005 50% Rule: Average Road Setback: _
Expiration Date
Office Comments:
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