HomeMy WebLinkAbout020-638-14-4301-LUP-2004-095 Application for Land Use Permit(*Non-shoreland*) o o �
County of Sawyer � .
PO Box 676 -Haywazd WI 54843
715/634-8288 "�
*Property that is not located within 300'of a creek,river or stream or within 1000'of a LD
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 �
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City,State,Zip City,State,Zip
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Daytime Phone Daytime Phone 5`
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Additional Information: Zone District: �
A
Lot Dimensions:
Date lot was created: Acres: yo Ccc<�5 0 �
Is there wetland near the proposed structure?If yes,how far � �
Building Land Use FloodpYain:( j Yes (�No :° �
�New ( )Filling '�
Addition Dred m Drivewa access off of a Check one `D
� ) � ) g� g Y � )� da
O Alteration O Grading O Private Rd P9 Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy ; �
( ) ( ) o S
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Primary Shucture Accessory Building Addition � °
( )Dwelling ( )Garage-attached/detached ( )Deck W
( )Yeaz round ( )#of caz stalls ( )Porch �
O Seasonal QO Storage Building O Enclosed �
O Frame built on site O Screenhouse O Living room � 1/i
( )Modular/manufactured ( )Greenhouse ( )Kitchen � L
( )Mobile/manufactured ( )Other ( )Bedroom � �
( )Other primary structure ( ) ( )Relocate/enlarge � '
� � ( ) ( )#of new V'
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Additional Information: P
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Type of Construction: �^'
( )Frame ( )Log �Pole/metal ( )Block ( )Concrete � G ,L
( )Other � ,_„�
Construction Cost:Primary Structure$ � �
Accessory Building:$ �`L�G�%•��- '� Addition:$ �
80a l �'� � �
Deed:Vol t�70 Pg 1S`7 CertifiedSoilTest# ��'�`�1 , z
CSM:Vol Pg Lot# Sanitary Permit# �$' �� o, �
Plat Bnvelope �r� N �
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Condo Vol Pg Yeaz Installed: co �
Aff of ex sepric Vol Pg Owner When Installed: "
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Previous office approvals/actions:
Vaziance:# LUP:# °�-`�b� 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
column. Lis each story, each addition, each alteration in a separate column.
#1. 5�.2� �Q��e� #2. #3. #4.
Size a'�� fr. wide fr. wide ft. wide ft. wide
_3�_ ft. i ng� ft. long ft. long ft. long
Floor area�sq. ft. sq. ft. sq. ft. sq. ft.
Hgt. from grade�j'' �to peak ft. hgt. ft. hgt. ft. hgt.
Stories �' stories stories stories
# of bedrooms
Rear Lot Line
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Fire Number and Name of Road �"� 7�E y (��c� N�-.i �ZG'
1. Enter lot dimensions and indicate north by arrow. Sign ture of Own r or Authorized Agent:
2. Indicate the location and size of the requested construction ,�.,.�� /
�' ���gna ure h'
activities. ��� � S �1 I ��
PrintName: +
3. Also, indlc8te 1.�1e loc8tlon and dlstance to the well, The above ceAiFles that the liste information and intention are
6ve and coned., that all work shall be performed in compliance
septic tank and drainfield, wetland azeas, lot lines and to the with lhe requirements of ihe Savryer Counry Zoning Ordinance
and ihe laws and regulations of the St2te of Wiscronsin, and if
CCnteT'11riC Of Y.I1C T03d. ading as owner(s) agent has the permission of the owner(s) to
peAorm the work requested on this application. The above
personsls hereby give permission for atcess to ihe property for
onsiteinspectian.
Permit fee: $ ��•�`
April 27 , 2004 — -
Issue Date Signature of Iss "ng ent
Apri1 27 , 2005 50% Rule: AverageRoadSetback: _
Expiration Date
Office Comments:
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SCALE: I INCH= 400 FEET FOR ASSESSMENT USE ONLY NO�
DRAWN BY: D.M. E. DATE : 2 - 14- �9 7 g INTENDED TO SHOW GONCLUSIVS
COLON (:) INDIGATES GOVT. LOT EVIDENCE OF OWNERSHIP OR
80UNDARY LOCATIONS