HomeMy WebLinkAbout020-639-11-5214-LUP-2004-147 Application for Land Use Permit(*Non-shoreland*) o 0
County of Sawyer �, � -
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 L� �
flowage,lake or pond or does not have any of the above waterbodies located within ( �
the property's boundazies.
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PF,RMITS HAVE BEEN ISSUED.
PffiNT-USE BLACK INK OR PENCIL �L �
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Owner Builder �' �
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Mailing Address Mailing Address O
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C:ty,SYate,Zip r City,State,Zip
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Additional Information: Zone District: �''-JS^� �R' R R� a � <♦i'
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Lot Dimensions: �'
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Date lot was created: Acres: � `l� � o �
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Is there wetland neaz the proposed structure?If yes,how faz G
Building Land Use Floodptain:� j Yes�/f No �
,(�'New ( )Filling �
�( )Addition O Dredging Driveway access off of a(Check one): �
O Alteration O Grading {�Private Rd O Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy i,"', �
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Primary Structure Accessory Building Addition �
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(�Dwelling J iazage-attached/detached ( )Deck "' Ic�,
O Yeaz round (i)#of caz stalls O Porch � f
XjSeasonal O Storage Building O Enclosed � �
O Frame built on site O Screenhouse O Living room
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen �i
( )Mobile/manufactured ( )Other ( )Bedroom � �
( )Other primary structure ( ) ( )Relocate/enlarge �
� � ( ) ( )#of new U�
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AdditionalInformation: = A
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3-7 0
Type of Construction: '�' ��- G �
,(/�Frame ( )Log (xPole/metal ( )Biock ( )Concrete
( )Other ro ,�
Construction Cost:Primary Structure$��� � �
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Accessory Building:' � Addition:$ � ,�
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Deed:Vol_�__Pg_ Certified Soil Test#_ _.,______��y .: y_
CSM:Vol � I Pg ScJ;;� Lot# �J Sanitary Permit# f/�Ut�l'S� o, �
Plat Envelope c 1N`� '�!''� �sy� � ��� c� �
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Condo Vol Pg Yeaz Installed: co
Aff of es septic Vol Pg Owner When Installed: " �
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Previous office approvals/actions: —
Variance:# LUP:# SP:# CUP:#- �'
Inspection Report:# Change of Zone District: ���}i I��
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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. � o�r` #3. ',,, -; #4.
Size �o ft. wide � � ft. wide ft. wide ft. wide
J� ft. long � �, ft. long � ft. long ft. long
Floor area `�60 sq. ft. l�; �, sq. ft. � sq. ft. sq. ft.
Hgt. from grade �O F�r �I� ft. hgt. � � ft. hgt. ft. hgt.
Stories � �r=i� stories 1 stories � � stories
# of bedrooms � � _ , ' _' 1��
/�o-�- ���'���
� I/ I Rear Lot Line
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Fire umber and Name of Road {�,1:vr,�' / �;` ��-�z: �_ , : � , '
1. ter lo dimensions and indicate north by arrow. Signature ner or thorized Agent:
2. Indicate the location and size of the requested construction
Signature
activities. ./',�
Print Name: /Yti� '�� �/O/�l�
3. Also, indicate the location and distance to the well, The above certifies that the listed infortnation and intentions are
true and correct., that ali work shall be performed in compliance
septic tank and drainfield, wetland areas, lot lines and to the with the requirements of the Sawyer County Zoning Ordinance
and the laws and regulations of the State of Wisconsin, and if
centerline of the road. act�ng as owner�s> a9ent, has the permission of the owner(s) to
perform the work requested on this application. The above
personsls hereby give permission for access to the property for
onsite inspection.
Permit fee: $ �v(� "=--
May 5 , 2004 -
Issue Date Signature of Issu' g A nt
May 5 , 2005 50% Rule: Average Road Setback: _
Expiration Date
Office Comments:
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