HomeMy WebLinkAbout016-637-07-2201-LUP-2004-041 Application for Land Use Permit(*Non-shoreland*) �
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County of Sawyer � �
PO Box 676 -Hayward WI 54843 O
715/634-8288 �
*Properiy 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.
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Mailing A dress l Mailing Address � �
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City,State,Zip Ciry,State,Zip �
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Daytime Phone Daytime Phone �
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Additional Information: Zone District:/y-� 6-
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Lot Dimensions ��
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Date lot was created: Acres: yy�y o �1
Is there wetland near the proposed structure?If yes,how faz �
Buil g Land Use FloodpYain:f� )�es (t No � =R
( ew ( )Fiiling �
Addition Dred m Drivewa access off o Check one CD
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O Alteration O Grading O Private Rd ( own Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy r,"', �
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Primary tructure Accessory Building Addition � °
O D elling O Garage-attached/detacbed O Deck �"'.,
( Year round O of car stalls O Porch =
( )Seasonal ( Storage Building ( )Enclosed `D
( )Frame built on site ( )Screenhouse ( )Living room � �
( )Modular/manufactured ( )Greenhouse ( )Kitchen � �
( )Mobile/manufactured ( )Other ( )Bedroom s
( )Other primary structure ( ) ( )Relocate/enlarge ' \
O O O#ofnew � �F
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Additiona/l�Infor/matiq�: �/o�q,e/>a.��n p, ��f J��E� �✓I,/✓���*�> ��ii_Y ed4�in�-;� a
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Type of Construction: Q�
( )Frame ( )Log ( Pole/metal ( )Block ( )Concrete �
( )Other � �
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Construction Cost:Primary Structure$ /_5 E�C> � �
Accessory Building:$ Addition:$ � �
'� 3�8393 � �
Deed:Vol Pg Certified Soil Test# tl0
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CSM:Vol Pg Lot# Sanitary Permit# o, 7y
Plat Envelope Or: N �
Condo Vol Pg Yeaz Installed:_ �
Aff of ex septic Vol Pg Owner When Installed: % �
Previous office approvals/actions: s
Variance:# LUP:# SP:# CUP:# �
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
colu�p List e ch ory, each addition, each alteration in a separate column.
#1. Y��e .s e<<- #2. #3. #4.
Size y� ' ft. wide ft. wide fr. wide ft. widc
6�, fr. long ft. long ft. long ft. long
Floor area o?�� �� sq. ft. sq. ft. sq. fr. sq. ft.
Hgt. from giade 1 LJ� to peak ft. hgt. fr. hgt. ft. hgt.
Stories stories stories stories '
# of bedrooms �
Rear Lot Line
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Fire Number and Name of Road �n �'✓�� �
1. Enter lot dimensions and indicate north by arrow. Signa�re of 0 er or horized Agent:
2. Indicate the location and size of the requested construction it;�2 ���Z.
SignaNre
activities. �
Pdnt Name: �G � .�7� � �� 't �-�
3. Also, indlcate the location and distance to the well, The above ceNfes that the listed information and intentions are
We and cortect., that all work shall be peAormed in crompliance
septic tank and drainfield, wetland areas, lot lines and to the wilh ihe requirements of the Sawyer County Zoning Ordinance
and the laws and regulations of the State of Wisconsin, and if
centerllne of the road. actinq as ownet(s) agent, has the permission of the owner(s) to
peAorm the work requested on ihis application. The above
personsls hereby give permission for access to Ihe property for
onsite inspection.
Permit fee: $ �� �� �� �
March 10 , 2004
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Issue Date Signature ofIssu A t
March 10 , 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments: �1� � �,� ��,�� � � r ,� ��
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