HomeMy WebLinkAbout020-103-00-3401-LUP-2004-295 Application for Land Use Permit (*Non-shoreland*) o o ,
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 Y C'
flowage, lake or pond or does not have any of the above waterbodies located within L � _
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 Y � p
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Daytime Phone Daytime Phone •
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Additional Information: Zone District: ��
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Lot Dimensions:
Date lot was created: 2 �l I ��I�� Acres: _ �7�� o
Is there wetland near the proposed structure? If yes, how far /�C� � .,�
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Building Land Use Flooctpfain:( j IFes O No �°
( )New ( ) Filling � p,
O Addition O Dredging Driveway access off of a(Check one): �, � -
( ) Alteration ( ) Grading ( ) Private Rd ( ) Town Rd. o
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy i;
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Primary Structure Accessory Building Addition � °
O Dwelling O Garage-attached/detached O Deck W w
( ) Year round ( ) # of car stalls ( ) Porch � —L-
( ) Seasonal �i� Storage Building ( ) Enclosed �
( ) Frame built on site ( ) Screenhouse ( ) Living room � �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen �
( ) Mobile/manufactured ( ) Other � ( ) Bedroom p
( ) Other primary structure ( ) l8' X !`rf CAr �r�" ( ) Relocate/enlarge , �
� � O O # ofnew a �
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AdditionalInformation: i A
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Type of Construction: �
( ) Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete
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(7� Other S•'���� 1-rA�'►� 1.�;��� \�,n� �� \ y
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Construction Cost: Primary Structure $ ,f1�,�-`� � �
Accessory B�ilding: $ �t� ��� Additi3n: � � U�
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Deed: Vol ��a Pg ��� Certified Soil Test# �(p — Ul� °Q Z
CSM: Vol�Pg �' �� Lot# ' Sanitary Permit# ��r `D�`� o, �
Plat Envelope �r� �� N
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Condo Vol Pg Year Installed: �
Aff of ex septic Vol Pg �pwner When Installed: �-' �
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Previous office approvals/actions: �
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Variance: # LUP: # ��l' t 32 SP: # CUP: # '�
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Ins ec tion Re o rt: # C h an g e o f Z o n e D i s t r i c t: � ����
P P �lN��
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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.
Size !�6 ft. wide ft. wide ft. wide ft. wide
J�' ft. long ft. long ft. long ft. long
Floor area 1�� sq. ft. sq. ft. sq• ft• Sq• ft• '
Hgt.from grade 6� 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 l�1'-1 �3 '���� L� .
1. Enter lot dimensions and indicate north by arrow. Signature of r A horized Agent:
2. Indicate the location and size of the requested construction `
ignature
activities.
Print Name:
3. Also, indicate the location and distance to the well, The above certifies that the listed information and intentions are
true and correct.,that all 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. aot��9 as ow�er�s�a9e�t, has the permission of the owner(s)to
perform the work requested on this application. The above
persons/s hereby give permission for access to the property for
onsite inspection.
Permit fee: $
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June 23, 2004 -
Issue Date Signa ure of Iss ng ent
June 23, 2005 50% Rule: Average Road Setback: _
Expiration Date
Office Comments:
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M/NK CQ P/ TA L SUR VE Y/NG, /NC. ;
MEDFORO,W�SCONSIN
SURVEYING SERVICES
s�eo�v�s�oHs
CERTIFIEO SURVEYS. �
PROPEHTY SURVEYS
TOPOGRAPHIC MAPPING
ROUTE LOCATIOHS
STREE7IMPROVEMENTS
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STATF Or WISCONSIN) `� �. �`�" +
�'' COUNTY OF SAWYER )SS � �
I � Charles Offerman , land surveyor o£ the State o£
isconsin . do Hereby c�rtify that on October 21 . 1976 , I surveyed the above
3escribed property sccordinP to official records an� that the accomnanyin�; map
is a true and correct representation of the exterior boundaries of the land surveyed
that all buildin�s and improvements lie wholly within �he boundary lines . and that no
encroachmeats by ad,jacent property owners annear from said s vey excep e i cated,
.�eQister'a OEfice 15 7 � ? 5
�>awyer County
ltec�eiv"ed for recotd Lie 19,r�doy o �e�istered Ia.nd Surveyor
. �'/�. A D 1�7G ct�'�p o c;ock
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