HomeMy WebLinkAbout014-842-29-1202-LUP-2004-529 Application for Land Use Permit(*Non-shoreland*) o o �
County of Sawyer � �
PO Box 676 -Hayward WI 54843 �
715/634-8288 ;�
*Property that is not located within 300'of a creek,river or stream ar within 1000'of a �
flowage,lake or pond or does not have any of the above waterbodies located within 9 �
the property's boundacies.
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CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. �
PRINT-USE BLACK INK OR PENCIL
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Owner Builder �'
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Mailing Address Mailing Address � �
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City,S ate,Zip City,State,Zip
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Daytime Phone Daytime Phone
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Addirional Information: �ne District: f� �°
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Lot Dimensions:
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Date lot was created: Acres:
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Is there wetland near the proposed structure?If yes,how far � �
Building Land Use Floodptain:( j Yes O No `� �
(�}New ( )Filling �
O Addition O Dredging Driveway access off of a(Check one): �
O Alteration O Grading O Private Rd O Town Rd o
( )Moving On ( ) ( )County Hwy ( )State Hwy ; �
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Primary Structure Accessory Building Addition � °
( )Dwelling ( )Garage-attached/detached ( )Deck "'
( )Year round ( )#of car stalls ( )Porch .'=�
O Seasonal O Storage Building O Enclosed �
O Frame built on site O Screenhouse O Living room � �
O Modulaz/manufactured O Greenhouse O Kitchen � C�
( )Mobile/manufactured ( )Other ( )Bedroom ,� �
( )Other primary structure ( )�`�,r r� ( )Relocate/enlarge +
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AdditionalInformation: � p
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Type of Construction: �,
( )Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �
( )Other ,� y
Construction Cost:Primary Structure$ � �
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Accessory Building:$�/ C�C- � Addition:$ �
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Deed:Vol 5,�� Pg�_ Certified Soil Test#9�i+-�7 b° z
CSM:Vol Pg Lot# Sanitary Permit# 4(� � 353 0� �
Plat Envelope �r� ti �
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Condo Vol Pg Year Installed: c�
Aff of ex septic Vol Pg Owner When Installed: " �
Previous office approvals/actions: g8 oy,� l_
Vaziance:# LUP:# 9(0'552 SP:# CUP:#
Inspection Report:# Change of Zone District: 1
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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. L�n., /„ #3. #4.
Size_L�ft. wide ,i� ft. wide ft. wide ft. wide
�3 C� ft. long ��� ft. long ft. long ft. long
Floor area� sq. ft. Y� sq. �. sq. ft. sq. fr.
Hgt.from gade �O to peak .',( c� ft. hgt. ft. hgt. ft. hgt.
Stories stories stories stories
# of bedrooms
Rear Lot Line
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Fire Number and Name of Road /� ��` ' / �'
1. Enter lot dimensions and indicate north by arrow. Signature of Oyrner r Au ize Agent:
2. Indicate the location and size of the requested construction `—"����r �zh
ignah�r
activities. �
Print Name: i 1�!, ,. �l ��rr��
3. AISO, 1ndlCate the IoCatlon and Q15tanCe to t}le well, The above ceRifes ihat the listed infortnation and intentions are
irue and cnrrecL,ihat all work shall be performetl in compliance
septic tank and drainfield, wetland areas, lot lines and to the wim �ne reQ��reme�� ot me sa�+�yer co�ory zo���9 ord'��a�ce
and the laws and reguiations of the Stzte of Wiscronsin, and i(
CORtCTI1riE Of tI1C T'03d. acting as ownet(s)agent, has the permission of the owner(s)to
peAortn the work requested on this application. The above
personsls hereby give permission for aceess to the property for
onsite inspectian.
Permit fee: $ /OG• "--�
September 23, 2004 gC� np� � gP � A/ -`�2���7�
Issue Date Si nature of Is m ent �—
September 23, 2005 50%Rule: AverageRoadSetback:
Expiration Date
Office Comments:
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