HomeMy WebLinkAbout014-941-01-3106-LUP-2004-547 Application far Land Use Permit(*Non-shoreland*) o 0
County of Sawyer �, � ��� '
PO Box 676 -Haywazd 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 .� �
the property's boundaries. �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUiRED PERMITS HAVE BEEN ISSUED. i 1
' " PRINT-USE BLACK INK OR PENCIL �
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Owner Builder N�
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Mailing Address Mailing Address O �
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City,State,Zip City,State,Zip �
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Daytime Phone Daytime Phone
Additional Information: Zone District: ' ��>
Lot Dimensions: �
Date lot was created: Acres: ' � °�" n
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Is there wetland near the proposed structure?If yes,how far � ' _
Building Land Use Floodplain-( j Yes (kj No `;
( )New ( )Filling �
Addition Dred in Drivewa access off of a Check one `D
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O Alteration O Grading O Private Rd O Town Rd. o
pO Moving on O O co,mty xwy O state xwy N �
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Primary Structure Accessory Building Addition � °
( )Dwelling ( )Garage-attached/detached ( )Deck "'
( )Year round ( )#of car stalls ( )Porch =
O Seasonal (�j Storage Building O Enclosed �
O Frame built on site O Screenhouse O Living room �-- t-
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen ; �
( )Mobile/manufactured ( )Other ( )Bedroom S _
( )Other primazy structure ( ) ( )Relocate/enlarge \
� � ( ) ( )#of new ���' ��
AdditionalInformation: �' p
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Type of Construction: `
( )Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �� � —
(�Other fkpV� o+.l-- Woop 5f�a.i�
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Construction Cost:Primary Structure$ — � �
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Accessory Building:$ — �� Addition:$ � �
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Deed:Vol 7 5� Pg �,�'1� Certified Soil Test# � ! �/ � tl0 z
CSM:Vol Pg Lot# Sanitary Permit# O( '3 d D � 7y
Plat Envelope Or: �;, �
Condo Vol Pg Yeaz Installed: �
Aff of ex septic Vol Pg Owner When Installed:
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Previous office approvals/actions: �
Variance:# LUP:# '';(-`�3 L� SP:# CUP:# �Y \�
Inspection Report:# Change of Zone District: � \ Q
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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. S}�{''C(� #2. #3. #4.
Size�ft. wide ft. wide ft. wide ft. wide
I�' ft. long ft. long ft. long ft. long
Floor azea_�__ sq. R. sq. ft. sq. ft. sq. fr.
Hgt.from grade � � to peak 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 � � 8 �- 'M {-�1.K( �Q3
1. Enter lot dimensions and indicate north by arrow. Signetur�bf Owner or A}�thorized Agent:
2. Indicate the location and size of the requested consriuction {!l � ; . (
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�� SignbNre -
activities. �
Print Name: i ��� � �• �
3. Also, 1nd1C3te tlle IoCatlOn and d15tanCe to the well, The above ceRifies ihat the listed information and intembns are
We and correct.,that all work shall be perfortned in compliance
septic tank and drainfield, wetland azeas, lot lines and to the with the requirements of the Savryer County Zoning Ordinance
and the Iaws and regula6ons of ihe Sfate of Wisconsin, and if
Centerline of the io8d. acling as ownef(s)agent has the peimission of the owner(s)to
perfortn the work requested on this application. The above
� personsls hereby give permission for aaess to the property for
onsite inspection.
Permit fee: $ ��
September 30, 2004 ' _ �-
Issue Date Signature ofIssuin ge
September 30, 2005
50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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