HomeMy WebLinkAbout014-842-16-2107-LUP-2004-628/ .
, Application for Land Use Permit(*Non-shoreland*) o 0
County of Sawyer � ;� °�
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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 �( =
the property's boundaries. �'
CO1��JCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. � ,
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�RIN'F—USE'�tiACK INK OR PENCIL �
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Owner Builder �'
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Mailing Address Mailing Address s O
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Cit ,State,Zip City,State,Zip �-l� y�-i c _
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Daytime Phone Daytime Phone �
Additional Information: �one District: ��'� %` '�
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Lot Dimensions: = b
Date lot was created: Acres: -�-`��C n 1
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Is there wetland near the proposed structure?If yes,how faz � q
Building Land Use Floodptain:�� )I�es (��No � =; �
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(x)New ( )Filling
O Addition O Dredging Driveway access off of a(Check one): ti`D,
( )Alteration ( )Grading ( )Private Rd ( )Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy i.''', �
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Primary Structure Accessory Building Addition � �
(x(Dwelling ( )Garage-attached/detached ( )Deck w �
( )Yeaz round ( )#of car stalls ( )Porch � �= �'�
( )Seasonal ( )Storage Building ( )Enclosed ��-' �
O Frame built on site O Screenhouse O Living room � �
( )Modular/manufactured ( )Greenhouse ( )Kitchen '{ �
( )Mobile/manufactured ( )Other ( )Bedroom � L. �
( )Other primary structure ( ) ( )Relocate/enlazge � �
� � � � ( )#of new � °n �
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AdditionalInformation: � � _
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Type of Construction: Y-� � �
( )Frame (�Log ( )Po1e/metal ( )Block ( )Concrete �' �
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( )Other � .�
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Construction Cost:Primary Structure$ �k�"'L�' �
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Accessory Building:$ Addition:$ � �
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Deed:Vol �������g� Certified Soil Test# �y- �j`j tl0 z
CSM:Vol �L!' Pg�Lot# � Sanitary Permit# Qy-�Zt 8 0� �
Plat Envelope �r� N '�
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Condo Vol Pg Year Installed: cc �
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Aff of ex septic Vol Pg Owner When Installed:
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Previous office approvals/actions:
Variance:# LUP:# SP:# CUP:# �
Inspection Report:# Change of Zone District: O 3 - a a a �1�� 0
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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 . ���- #2. � ���-��1 S�: , � � #3 . #4. ,
Size ,� ft. wide � ft. wide ft. wide ft. wide •
,3 � ft. long � � ft. long ft. long ft. long .
Floor area � G sq. ft. �- r"� � sq. ft. sq. ft. sq. ft.
Hgt from grade to peak ft. hgt. ft. hgt. ft. hgt. • . = '
Stories ��' stories stories stories �` �t
# of bedrooms 3 1
,�� � �/L'�� Rear Lot Line °', '
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Fire Number and Name of Road � � , • - Y'� � Gt =' � � Li� � �
1 . nter lot dimensions and indicate north by arrow. Si tuT�of 0 o Authorized Agent:
2. Indicate the location and size of the requested construction
Signature
activities. -- �,' / /'
Print Na�� _ �L�S� `�
3 . Also, indicate the location and distance to the well, The above certifie that the listed information and intentions are
true and correct., that all work shall be performed in compliance
septic tank and drainfield, wetland areas, lot lines and to the with the requirements of the Sawyer Counry zoning ordinance
and the laws and regulations of the State of Wisconsin, and if
centerline of the road. a�t��9 as ow�er�s� a9e�r, 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.
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Permit fee: $ �i [) "' .�v � �-
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November 3 , 2004 - z� —
Issue Date Signature of Iss ng ent
November 3 , 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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