HomeMy WebLinkAbout014-842-07-1401-LUP-2004-508 Application for Land Use Permit(*Non-shoreland*) � o
County of Sawyer �, �_ '
PO Box 676 -Haywazd WI 54843
715/634-8288
*Property that is not located within 300'of a creek,iiver or stream or within 1000'of a �
flowage,lake or pond or does not have any of the above waterbodies located within J
the property's boundaries. '7
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. 4 �
PRINT-USE BLACK INK OR PENCIL
� i ��, r� G �r� u„ si�tt��.� a � i
Owner Builder <� �
� b� �� ��
ailing Address� Mailing Address / O
L� w� r // � �l.�.hrd t.v,S �
City, tate,Zip City,St te,Zip
� (�s � `E'g`T3 )
Daytime P1�/one Daytime Phone
���i lP���3Z1'J � - I �
Additional Information: Zone District:
Lot Dimensions: �
;�
Date lot was cxeated: Acres: C��"tS o �
Is there wetland near the proposed structure?If yes,how faz�;t (7 � �
Building Land Use Floodptain-( j Yes �No fD
( )New ( )Filling �
(�,Addition O Dredging Driveway access off of a(Check one): fD
ac
O Alteration O Grading O Private Rd �Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy ti, �
O O o S
r
Primary Structure Accessory Building Addition � °
( )Dwelling ( )Garage-attached/detached (f(")Deck `^
( )Yeaz round ( )#of caz stalls ( )Porch �
Stora e Buildin (�Enclosed "
( )Seasonal ( ) g g �
O Frame built on site O Screenhouse O Living room �
O Modulaz/manufactured O Greenhouse O Kitchen C' r
( )Mobile/manufactured ( )Other ( )Bedroom .-� �
( )Other primary structure ( ) ( )Relocate/enlazge ' �'r
� � ( � ( )#of new � I V'
N Ijy
AdditionalInformation: �., Ar
� �
� �
Type of Construction: ��, =� �
(`�}Frame ( )Log ( )Pole/metal ( )Block ( )Concrete � _
( )Other y
ro �
Construction Cost:Primary Structure$ �� �
p �
Accessory Building:$ Addition:$ 0��oC � �,
!' �
Deed:Vol�Pg�� Certified Soil Test# (���'�{"�5 °Q z
CSM:Vol Pg Lot# Sanitary Permit# (7���� �5� o� �
Plat Envelope �r� N �
Condo Vol Pg Yeaz Installed: � �
o �
Aff of ex septic V ol Pg Owner When Installed:
�
Previous office approvals/actions: �
Variance:# LUP:#��a=_SP:# CUP:#
Inspection Report:# Change of Zone District:
`l i�3�{`/
I
I1�53(
Describe the construction using these columns. List the dimensions of each structure in a separate
column. List each story, each addition, eacj alteration in a separate column.
(
#4.
#1. #2. �
#3. 40
Size 1 --k ft. wide r - ft. wide_
ft. wide
ft. wide
l 2- ft. long y ft. long
a a ft. long
ft. long
Floor area Jqq sq. ft. _ 5 sq. ft.
17 sq. ft.
sq. ft.
Hgt from grade to peak ft. hgt.
ft. hgt.
ft. hgt.
Stories stories
stories
stories
# of bedrooms
Lot Line or Lake/R.
D
fit (Ito
}
Iva �
, ;
� / rw�i
CV
ADD
�. ScNcri-J i— r0of'c� A�c� 0
SiM(?lC v/5{4 -Cck
Fire Number and Name of Road 13 q r�7 kpr 4 0 C'
1. Enter lot dimensions and indicate north by arrow.
2. Indicate the location and size of the requested construction
activities.
3. Also, indicate the location and distance to the well,
septic tank and drainfield, wetland areas, lot lines and to the
centerline of the road.
&a-�k
'P
S' r"f OrnerorA�u�thorized Agent:
Signature
Print Name: TA &n-&S i� m orl-Z
The above certifies that the listed information and intentions are
true and correct., that all work shall be performed in compliance
with the requirements of the Sawyer County Zoning Ordinance
and the laws and regulations of the State of Wisconsin, and if
acting as owner(s) agent, has the permission of the owner(s) to
perform the work requested on this application. The above
personsls hereby give permission for access to the property for
onsite Inspection.
Permit fee: $
!'I
�,
��
� 'SEELY FlRE LN' : , �' . _—
\
� ' 910NN AS 66'MiDtM FOR I
\` NAP�NG PIMFOSES. _�___ � l
�
1204
,zo,
NW NE , NE—NE
W � 1202 1]03 ���� I
'z� I
SE—NE I
SW—NE ,w,
N ,�, �
� €
�
�I ��
0
I ��
�I
NE—SE
NW—SE •;a,
.zo,
I
�,
SE—SE
SW—SE • ���
�
4501 �w] N/�P
• I I �
I
aW2 L—____
�406 aM
{�05 1101 I �
I �