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HomeMy WebLinkAbout014-160-00-0500-LUP-2004-535 � Application for Land Use Permit �*Non-shoreland*) o o v 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 or within 1000' of a \ . /� flowage, lake or pond or does not have any of the above waterbodies located within I � the property's boundaries. � CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. � PRINT—USE BLACK INK OR PENCIL S�Z.a,�n a.nd v� � �-��-. � � �v�v�" (y�vr, '�°�1 �cu�.x.'v�.7 �. Owner Builder c: ;�� �• ` ���'l � C��/y 1�:� � �- � Mailing Address Mailing Address � (,�%N i T� /���° G�K� Gii .�/ 5��I � c.� ' ,� � City, State, Zip City, State, Zip S t�i I � ,� -- ���='S�"��� - c' Daytime Phone Daytime Phone �� r � Additional Information: Zone District: �/��/ � � , , � Lot Dimensions:=a'�'c% x ��=�lC'Cr� � � Date lot was created: � a�a 2�`�� Acres: ���3 o V' Is there wetland near the proposed structure? If yes, how far ��,TS T =��S � � � � Building Land Use Floadp�ain:( j �es ('X j No ' � (�c)New ( ) Filling � � ( ) Addition ( ) Dredging Driveway access off of a(Check one): �, ( )Alteration ( ) Grading � Private Rd ( ) Town Rd. � � 0 ( ) Moving On ( ) ( ) County Hwy ( ) State Hwy ,W � ) � ) o ° � r Primary Structure Accessory Building Addition � ° (X} Dwelling �) Garage-attached/ tached Q� Deck W QG) Year round (� # of car stalls � ( ) Porch � ( ) Seasonal ( ) Storage Building ( ) Enclosed � (�c}.Fxame built on site ( ) Screenhouse ( ) Living room � ( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen ' ( ) Mobile/manufactured ( ) Other ( ) Bedroom � � ( ) Other primary structure ( ) ( ) Relocate/enlarge � � � � ( � ( ) # ofnew 0 � Additional Information: A , � � � � � Type of Construction: �Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete ( ) Other � � ~� � �,��% � � Construction Cost: Primary Structure $ � ���, � Accessory Building: $ Addition: $ � � ,-, . � Deed: ti oi (} �g 2 38 Certified Soil Test# O�/_-33�oa QZ Z3�/' �" �z CSM: Vol Pg Lot# Sanitary Permit# C�y- 3 72 0� � Plat Envelope �r� N � Condo Vol Pg Year Installed: c� Aff of ex septic Vol Pg Owner When Installed: `-' � 1 s� Previous office approvals/actions: � Variance: # LUP: # SP: # CUP: # Inspection Report: # Change of Zone District: �- 1 l�-,l c�l iS�S I 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. k�u..�,� #2. ,u�-u � #3. Da�k� ��-r� #4. Size a3' ft.wide �� ft.wide ��` ft.wide ft.wide �:�� ft.long a`� ft.long ��� ft.long ft.long Floor area 1,�7,� sq.ft. y�G sq,ft, sq.ft. sq.ft. i Hgt from gade aS to peak �°I ft.hgt. ft.hgt. ft.hgt. � Stories� stories stories staries #of bedrooms .3 Rear Lot Line ,��. �� �,, Fire Number and Name of Road �I/�p {,�ea�h s✓ �'�u C. L Enter lot dimensions and indicate north by arrow. Sign�[e o�Owner or Authorized Agent: 2. Indicate the location and size of the requested construction � _ � Signature activities. Pdnt Name:��b/'.i;��n.�F�i ���i,r./ 3. Also,indicate the location and distance to the well, rne e�o�e cert�fies mec me r5tea mro��a�a m�em�o�s a�e hue and correct,ihat all work shall be performetl in compliance S2pt1C taT11C 3T1C�dr3lnfield,wetlan(1 3T'C1S,lot Ilnes and to tl'le with the requiremenis oi the Sawyer County Zoning Ortlinance and the laws and regulations of the State of Wisconsin,antl if centerline of the road. actinq as owner(s)agent,has the permission of the owner(s)to perfortn the work requested on this application. The above personsls hereby give permission for access to the proper.ry for onsite inspection. Permit fee:$ ,�. �u a a S Issue ate Signature ofIss ng ent September 28, 2005 50%Rule: Average Road Setback: _ Expiration Date Office Comments: /`���:»�:� � Suz�.t�J %17�u� �1/F'/-s�J%-s,ce J3 -�y.�i✓-�'8 c.v • �!�� �.la�a� �� �.���r � , �l��= � , L��_,�.�;��,� �i✓ ssii� , �, � � , > / ���.n�,�s \ � � � / � \ �"' � / � �`� `�� � , .� � � � �/ , � � � i / , �� 3 I - � � �\ �! � � ���, 1��� �' _ � � �„f.,.�� ' � � � �i�/� � \\ % .` � � I � j � Q , � �//� iT ��07- � �� ' �JJt",Lrr//�%/�i�'/ Nfi� �J a.�'F �v'7 0 i � -sa - �6ho,� �:�:��'��.���.�,�-F✓u?o- -s � `�5c,� � y�,� 1�+04 3 � ��.Jc�s�.�l/iC� �o.A��i�/=� ' l{ao�0 �� � 'cJ�II ( _ �� �C J�/o.✓,,�• -i�i� r � ��� t7 .�.l �o�.� s �'�r� .�cP� I' � =5!9 � sC`�//_F' \ _ `! ( i� I . 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