HomeMy WebLinkAbout020-638-07-5301-LUP-2004-032 �- .
Application for Land Use Permit(*Non-shoreland*) o 0
County of Sawyer �XO
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 �_�j �
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. ,
PRINT—USE BLACK INK OR PENCIL
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Owner Builder �� �
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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: �}�- �
LotDimensions: � � '��--
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Date lot was created: Acres: :�/ •a 6 0
Is there wetland near the proposed structure?If yes,how faz h o G
Building Land Use Floodplain-( J Yes O No =°
(�)New ( )Filling �
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O Addition O Dredging Driveway access off of a(Check one): �, �
( )Alteration ( )Grading ( )Private Rd ( )Town Rd. o ,
( )Moving On ( ) ( )County Hwy (�j State Hwy ;
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Primary Structure Accessory Building Addition � °
O Dwelling O Garage-attached/detached O Deck W I-
O Yeaz round O#of car stalls O Porch = J�
Stora e Buildin ( )Enclosed =°
( )Seasonal (}f) g g �
O Frame built on site O Screenhouse O Living room � �
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen � r4',
( )Mobile/manufactured ( )Other ( )Bedroom r �
( )Other primazy structure ( ) ( )Relocate/enlarge ^
� ) � ) ( )#of new ;S� �n
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Additional Information: A
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Type of Construction: ' ^ �
( )Frame ( )Log (X)Pole/metal ( )Block ( )Concrete �.l
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( )Other .d �-]
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Construction Cost:Primary Structure$ �i ��'O o
:? I"
Accessory Building:$ Addition:$ �
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Certified Soil Test# C-� '��'� °Q z
Deed:Vo1�Pg / �
CSM:Vol Pg Lot# Sanitary Permit# ��� -���5 0� �
Plat Envelope Or: ^ N �
Condo Vol Pg Year Installed: :3�u� �
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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:#
Chan e of Zone District: \��
Inspection Report:# B �\�-a�
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abs�s
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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. #3. #4. w.
Size � v ft. wide ft. wide ft. wide _T_i't. wide
_`j `� ft. long ft. long fr. long ft. long
Floor azea o1 v sq. ft. sq. ft. sq. ft. sq. ft.
Hgt.from grade i 7 � to pealc ft. hgt. ft. hgt. f'f'. hgt.
Stories � stories stories stories
# of bedrooms� ..
Rear Lot Line
/V
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Fire Number and Name of Road Y 7✓� '"w j-�W y � �
1. Enter lot dimensions and indicate north by anow. Signature of pwn r or Authorized Agent:
2. Indicate the location and size of the requested construction ������-1��"`�-� —
SignaNre
activities. s-
Print Name: �'� ��� s�� "-��Sh'
3. Also, 1ndlC8te tlle IOCatlOn and d15tanCe t0 the well, The above ceRifies that the listed intormalion and intentions are
We and correct., that all work shall be peAormed in compliance
septic tank and drainfield, wetland azeas, lot lines and to the w�m me requiremenLs of the Sawyer County Zoning Ordinance
and the Wws and regulaUons of the SYete of Wisconsin, and if
CCnteI'line of tlle I08d. acUng as ovmer(s)agent,has the peimission of the owner(s)�o
pedortn the work requested on this application. The above
personsls hereby give permission for access to ihe property for
��,.
onsite inspedion.
Permitfee: $ -��
February 24, 2004 -
Issue Date Signature of Iss �n ent
February 24, 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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REF : AERIAL PHoTO K14 C6-5 - t9 � o) SCALE : 1 INCH = 40o FEET
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