HomeMy WebLinkAbout014-842-21-1110-LUP-2004-515 Application for Land Use Permit(*Non-shoreland*) o o �"
County of Sawyer �
PO Box 676 -Hayward WI 54843 V �,
715/634-8288 �, 'h 0
*Property that is not located within 300'of a creek,rivec or stream or within 1000'of a �
flowage,lake or pond or does not have any of the above waterbodies located within � �
��S +Q� the property's boundaries. �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. �'
PRINT-USE BLACK INK OR PENCIL -� 1
��ct�ie- ��arna �r�c�cve,a� fi�di� �un��3.�'�r] � �
Owner /
Builder <
�"7(0 �u�'� �'a� �3ne� �7(0 �UrY' �c�� l�anC� �� `
Mailing Address Mailing Address � �
��5cn �� i S�o i G� �/(,c SG�� G(�I J`-�O /� �,
City,State,Zip City,State,Zip (�l
7/5���� (c 5�`l 7/5��.�`�- G�S�`� `�
Daytime Phone Daytime Phone �
Additional Information: Zone District:�� A
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Lot Dimensions: �s� X Z Z 3:�� �
Date lot was created: �Z � / Acres: ' 7� o �
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Is there wetland near the proposed structure?If yes,how faz /v J � �
�mg Land Use Floodptain:( j�`es (�No � `
ew ( )Filling � �
O Addition O Dredging Driveway access off of a(Check one): � S
O Alteration O Grading rivate Rd �Town Rd. o
O Moving On O )County Hwy O State Hwy i,"', �
O O � S
o r
ri Structure cc sory Building Addition � ° �
welling ��j�arage-attached/detached �Deck w �
ear round #of car stalls O Porch = �
)Seasonal ( )Storage Building ( )Enclosed � � �
O Frame built on site O Screenhouse O Living room p � ��
( )Modular/manufactured ( )Greenhouse ( )Kitchen
( )Mobile/manufactured ( )Other ( )Bedroom -C � �
( )Other primazy structure ( ) ( )Relocate/enlazge � '� �� l�
� � ( ) ( )#ofnew � � '�'S �
� �
Additional Information: �' A � �
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�Ty e of Construction: G �j � �
rame ( )Log ( )Pole/metal ( )Block ( )Concrete � a, �(
( )Other ro ,� �' �
Construction Cost:Primary Structure$ �///) -y��,''° � �
� �
Accessory Building:$ � Addition:$ ,� �
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Deed:Vol�Pg_ ��v Certified Soil Test# a�����% °Q z
CSM:Vol_.�_Pg.l,"1�, Lot#� Sanitary Permit# �� �.3 b•1 � 7y
Plat Envelope Or: r;, �
Condo Vol Pg Yeaz Installed: �
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Aff of ex septic Vol Pg Owner When Installed:
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Previous office approvals/actions: G
Variance:# LUP:# SP:# CUP:#
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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
colum List each story,each addition,each alteration in a separate col,u'�
#1. f�u5� #2.��/,,,���ztr��c- #3.�lro�z%; #4. �
Size�_ft.wide ��fr.wide > ' ft.wide ft.wide
3�- ft.long �! _ft.long /�� ft.long _ ft.long
Floor area 7/�'G' sq.ft. �sq.ft. /�-/�sq.f[. _ sq.ft.
Hgk from grade /7 to peak_1Z_ft.hgt. {� ft.hgt. ft.hgt.
Stories�� / stories / stories stories
#of bedrooms ,,L � I
.. ... .__. ...._. . .... . �'�p . . y ...�.
Rear Lot Line �I
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� Fire Number and Name of Road ��l Y K G' �%✓ f
1. Enter lot dimensions and indicate north by arrow. Signat�fe of Owne r Authorized Agent:
2. Indicate the location and size of the requested conshuction ��,(.����� —
SignaN
activities.
Pnnt Name:���i e- L(Y)���I�L✓L
3. Also,1ndlCate tlle loC3tlon and dlstance to the Well, The above cedifies that the listed intormation a inten�ions are
We and correct,that all work shall be performed in compliance
Septic tanlc ancl dralnfielcl,wetland areas,lot lines and to the with ihe requirements ot the Sawyer Counry 2oning ordinance
and the laws and regulations of the State of Wisconsin,and if
CentBtllne of the Toad. acting as owner(s)agent has the permission ot the owner(s)to
perform ihe work requested on this applicalion. The above
personsls hereby give permission for access to the propedy for
onsite inspection.
/M �
Permit fee:$ / /'S
September 16, 2004
Issue Date Signature of Is uing gent
September 16, 2005 50%Rule: Average Road Setback: _
Expirarion Date
Office Comments:
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PROCEDURE NAS BFFN
-ST"�` �- TOWN OF LENROOT
a�c. SHOWN AS 66'w�oni FOR J
1203 MAPPING PURPOSES.
_ ... __.__ .. 1105 � �— .
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5����. LEGEND
, ---�— Approximate Parcel Line
�� Approximate Recorded Parcel Line(Not shown on this map)
4.46AG/ �� „�� � �� — — — Approximate Surveyed Lot Line �
� � 6.;M�. 1270A� --------- Center Line of road(Appoximated data)
� '� Deeded Right of way(Approximated data)
� — Right of way(Approximated data)
/ �� Water Feature(Approximated data)
� � Island or Marsh Feature( roximated data
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SW—N E S E—N E Water less than 15'+-in width(Appoximated data) '
Meander line from recorded document
107 Possible gap in adjacent recorded documents
16.36AC. ��2
• Possible overlap in adjacent recorded documents
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0�+8+22�(XxxX) Parcel Mapped ID Number(4302) I
5 CSM 5/343 Recorded Mapped document(Not shown on this map) � �
"` 36.37 AC Mapped Acreage of parcel j
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