HomeMy WebLinkAbout020-638-02-5506-LUP-2004-001 Application for Land Use Permit o o .
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 y �
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. ,
Kafhlrrn a PRINT—USE BLACK INK OR PENCIL
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Owner Builder ��
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Ma ing Address Mailmg Address �
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City,State,Zi ity,State,zip � �
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Daytime Phone D ime Phone ��
Additional Information: Zone District 1'(R'� �
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Lot Size '�' <� X �:�J �
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DaYe lot was created I �� j'�]- `7�� Acres � �� �-
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 far from the shoreline&water name: - . �-C irlb�/5
Is there wetland near the proposed structure?If yes,how far�/� � �
Building Land Use �"
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(�New ( )Filling Floodplain:( )Yes ( )No # ;;
( )Addition ( )Dredging � �
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( )Alteration ( )Grading Chippewa Flowage: ( )Yes (X)No , �
( )Moving On ( ) 0., r
� � ( ) Driveway:( )State (>�County ( )Town Rd.0 �
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Primary Structure Accessory Building Addition t��
�(Dwelling (�)Garage-attached/detached (��Deck a' -
( )Yeaz round ( )#of caz stalls ( )Porch
( )Seasonal ( )Storage Building ( )Enclosed
(r)Frame built on site O Screenhouse O Living room � „'
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen ��
( )Mobile/manufactured ( )Other ( )Bedroom
( )Other primary structure ( ) ( )Relocate/enlazge
� � ( ) ( )#ofnew >
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Additional Information: �
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Type of Co�struction � �
(�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �
( )Other �n ,
Construction Cost:Primary Structure$ - ~
Accessory Building:$ � - Addition:$ z
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+s r�: , s qy
CSVM Vol u Pg�r .4of Deed c�' p G Certified Soil Test# ��7 � /3/ �
CSM Vol Pg Lot# Sanitary Permit# o y-oo a
Plat Envelope Or: �
Condo Vol Pg Year Installed
Aff of ex septic Vol Pg Owner When Installed:
Gard Gazebo Vol Pg
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Previous Variance: LUP: Inspection Date:
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2a3(v 1
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. ' � �,� �,�e, #4.
Size � �� ft. wide � • ft. wide �ft. wide /�_ft. wide
��ft. long ft. long �:; ft. long ly' ft. long
Floor area `.� �_sq. ft. sq. ft. _�_sq. ft. -�;,7�sq. ft.
Hgt.from gade i, to peak � ft. hgt. ft. hgt. �ft. hgt.
Stories % stories stories / stories
# of bedrooms ' / � , �
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Lot Line or Lake/River name:
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Fire Number and Name of Road .�2�p..+� �
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 shuctures. � ,
3. Indicate location of well, septic tank, drainfield. �����G�"-����'� �
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4. Indicate distance to existing structures, lot lines, septic system. i
5. Indicate distance to the ordinary high-water mazk of any lake,
pond, river, stream, creek, and name the body of water. Tnet no�e c€�tifiesinai is�ed �n�r(na��o'nyana teneons are
6. Indicate any grading or clearing in excess of the construction site. aceess�io me P perty to�ons lersnspectioneby grve permission for
7. Indicate distance to any wetland. J � �
Permit Fee: � F��_,�
January 13 , 2004 - -
Issue Date Signature of n Agent
January 13 , 2005
Expiration Date
Office Comments:
Inspection Date: 50%Rule Applies: Avg. Setback: Within Reservation boundaries:
Restrictions and other information:
TOWN OF OJIB
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� S[1�'i:YCR� S C::RTIFI �ATE SnvyesCounry �' Gl
--.: � I , Robert L. Klein , si12j�� Registered Aeceivedforrecordthe /�J.�vdavat o
W'isco�sin Land Surveyer, do rereby certify ��G, AD14'�LN�:�fo�i«k
that by order of kobert. E. M,issling, !?/17!'c�.� ^�MandrecotdedinvoL�_
; i 'NiscoZsin . I have surveyed, divideed and � (7�,x;,d�,� onpaqe�-3�r
mappe � the lands herein de�cribed ���y � �0.,�- ;
accoriing to the information :urni:;he�, R.o;�tiH
that .�aid map is a correct representation
of th�� la�ds sur��e��ed and th:�t. I tnve un
fully co:nplied with the provivions of RECi:IVb'D FOP, RF:CORD ON Ti?" '
Chaptirr 236 .34 of th P;" ..co s�. uxes. .,: . . �AY OF , i ' -
Ap�roved for rec��frY�����`� � 2/�/�/l6 n � o' cl ..>ci: ��: a
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Zoning administratbr• � record<:d in `✓olume o '
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CERTIFIED SURVEY MAP
CERTIFIED SURVEY MAP N0. DOCUMF3dT N0.
Located in Government Lot 5 also Lot 3 of C.S.M. 861 Section 2 T38N 1�R�
Township of Ojibwa, S�w}�er County Wisconsin.
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� area lot .2 249.769.$$ $g,F: "'
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Z . I.088 acres
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