HomeMy WebLinkAbout016-637-07-2102-LUP-2004-100 ``-
Application for Land Use Permit r y '.
County of Sawyer � � ,�
PO Box 676 -Haywazd WI 54843 ;� �
715/634-8288 �.
The undersigned hereby makes application for a Land Use Permit and agrees that all work
shall be done in compliance with the requirements of the Sawyer County Zoning Ordinance -
and the laws and regulations of the State of Wisconsin. �
NO CONSTRUCTION MAY BEGIN UNTIL ALL PERMITS HAVE BEEN ISSUED. -
4�/ � PRINT-USE BLACK INK OR PENCIL ' �
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�o na /G� �UG/�i1G i l ,.- 1
Owner Builder °'
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G'J�%� `lf v�/N"lr���r.�-4�l � �
Mailing Address Mailing Address �
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City,State,Zip City,State,Zip _,
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Daytime Phone Daytime Phone
Additiona]Information: Zone District � � �
Lot Size
Date lot was created Acres �h�:: �
Is the property in a Shoreland Dishict?(within 1000'of a lake or pond,within 300'of a river,
creek or stream) If yes,how faz from the shoreline&water name: 'Y��
Is there wetland near the proposed structure?If yes,how far �'Lf} �
Building Land Use G
jx-New �Filiing Floodplain:� )Yes �No # ;;
( )Addition ( )Dredging � L�
O Alteration O Grading Chippewa Flowage: O Yes �,}�.,No I� °
( )Moving On ( ) � o
( ) ( ) Driveway:( )State ( )County ( )Town Rd. �
Primary Structure Accessory Building Addition �
( )Dwelling ( )Garage-attached/detached ( )Deck .J
( )Yeaz round ( )#of car stalls ( )Porch � Z
( )Seasonal ( )Storage Building ( )Enclosed O �
O Frame built on site O Screenhouse O Living room J �
( )Modular/manufactured ( )Greenhouse ( )Kitchen � -�
( )Mobile/manufactured �Other ( )Bedroom � ��
( )Other primary structure ( ) o ( )Relocate/enlarge � �
� � ( ) ( )#of new p
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Additional Information: �
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Type of Construction �
( )Frame � ( )Log ,�LPole/metal ( )Block ( )Concrete � �
( )Other �
Construction Cost:Primary Structure$ � y
Accessory Building:$ Addition:$ • Z
� 7y
Vol �{I Pg N86 ofDeed CertifiedSoilTest# 9!o'/(n�/ �
CSM Vol Pg Lot# Sanitary Permit# 9!�-/3a 9E3'3/D
Plat Envelope Or: �
Condo Vol Pg Year Installed
Aff of ex septic Vol Pg Owner When Installed:
Gazd Gazebo Vol Pg
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Previous Variance: 48�7a- LiJP: �B�077 Inspection Date: ��,
�g98Y
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. #3. #4.
Size�fr.wide ft.wide _ fr.wide ft.wide
�_ft.long ft.long ft.long ft.long
Floor area� (�sq.ft. sq.ft. sq.ft. sq.fr.
Hgt.from gade to peak ft.hgt. fr.hgt. ft.hgt.
Stories stories stories stoiies
#of bedrooms
Lot Line or Lake/River name:
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Fire Number and Name of Road��i 9 � b✓ �Yl�'"2. �j{rl 1'S
1.Fill in lot dimensions and indicate north by arrow. Signature of Owner or Authorized Agent:
2.Indicate location and size of existing and new structures.
3.Indicate location of well,septic tank,drainfield. /
4.Indicate distance to existing structures,lot lines,septic system. ��,y.�,�,tc� r����.»
5.Indicate distance to the ordinary high-water mazk of any lake,
pond,river,stream,creek,and name the body of water. ann�Name: R o nG l a 13 ti c%c i;�/! -L
The above certifes Nat the listed in(ormation and intentions are
6.Indicate any grading or clearing in excess of the construction site. we a�d correcc Tna ato�e Persoosis nereby y��e verm�s5�o�,ror
I aceess to ine pmperty tor onsite inspeclion. (
7.Indicate distance to any wetland.
Pernut Fee: � pa
April 27, 2004
Issue Date Signature ofI uin gent
April 27, 2005
Expiration Date
Office Comments:
Inspection Date: 50%Rule Applies: Avg.Setback: Within Reservation boundaries:
Restrictions and other information:
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TOWI� O � MEAL �
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