HomeMy WebLinkAbout020-639-35-5201-LUP-2004-421 Application for Land Use Permit (*Shoreland*) o o �
County of Sawyer � �� o o � �'
PO Box 676 - Hayward WI 54843 �
715/634-8288
*Property that is located within 300' of a creek, river or stream or within 1000' of a "
flowage.; lak� or pond �r has any of the above;-✓ate:b�uies locuted;��i�hin
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 �
SY�7� �st' ST ST. �:
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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:
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Lot�imensions: ,z,bfvD X ,`��5 �f''/�'I� T
Date lot was created: Acres: 5�9
Is there wetland near the proposed structure? If yes, how far � 3� � o
Building Land Use Floodplain: ( ) Yes (X)No �
( )New ( ) Filling Chippewa Flowage: ( ) Yes � No �
( ) Addition ( ) Dredging Driveway access off of a(Check one): ^ ��
( ) Alteration ( ) Grading ( ) Private Rd Q�j Town Rd. �
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy "�
q�')��STi�vG ( ) � �.
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Primary Structure Accessory Building Addition o 0
( ) Dwelling ( ) Garage-attached/detached ( ) Deck �
O Year round O # of car stalls O Porch W
( ) Seasonal ( ) Storage Building (�1 Enclosed �
�Q Frame built on site O Screenhouse O Li��in;roer:. � �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen �
( ) Mobile/manufactured ( ) Other ( ) Bedroom O A
( ) Other primary structure ( ) ( ) Relocate/enlarge \
� � O O # ofnew '
AdditionalInformation: � ;
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Type of Construction: W W
Q�lr Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete � o a o
( ) Other y
Construction Cost: Primary Structure $ Z�[�C5 �' ,.,d �
Accessory Building: $ Addition: $ �2�� � (,�
5a,4- rnl� (�3? �?,.2.5 �° �o
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Leed: �c,1_��rg 3G15 Certified Soil Test# ._�,.Q � 'Z
00
CSM: Vol Pg Lot# Sanitary Permit# O`� ' Dz 3 � � 7�
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Plat Envelope Or: o, �
Condo Vol Pg Year Installed: �,
"Loads and Flows": Vol Pg Owner When Installed: � �
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F'revious office approvals/actions: \ ^ jv
� Variance: # LUP:# SP: #_ CUP: # ! c " O�
Inspection Report: # Change of Zone District: `
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a� � 83
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 Zo ft.wide ft.wide ft.wide ft.wide
�ft.1or.g ft.!ong ft.ioag ft.ton�
Floor area�sq.ft. sq.ft. sq.ft. sq.ft.
Hgt from grade 1�� to peak ft.hgt. ft.hgt. ft.hgt.
Stories � stories stories stories
#of bedrooms O �
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Lake/Pond/Flowa e/River/Stream Name , � N
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Fire Number and Name of Road 17oQ SCNY��
1. Enter lot dimensions and indicate north by arrow. Sign e of Own or uthor'i;ed Agent:
2. Indicate the location and size of the requested construction �
SignaWre
activiries. /�.,�.rl�.
Print Name:��'�S • C.io7R/`'���
3. Also,1ndiCate tlle IoCatlon and dlstance to tlle well, The a6ove cedifes that ihe listetl information and intentions are
We and conect.,that ail wo�c shall be pertortned in compliance
Septic t3S1�C 211d dPalnf eld,wetland azeBS,lot llnes, with tha requirements of the Sawyer CounTy Zoning Ordinance
and the laws and regulations of the State of Wisconsin,and if
centerline of the road and waterbodies. a�r�A a5 ow�,er�s>a9eoi,nas me Pe��55�00 or me ow�er�s�io
perform the work requestetl on this application. The above
personsls hereby give permission for aceess to the property for
ansite inspection.
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Permit fee:$ �7J��-
Total land azea within 300'of the waterbody:(A)?����,_
Tatal i.^.:pe^.;cus sE:;:ace 2seu[inc:ndii.g this p:oject](B) '->;i, ��' '.f
(B)/(A)x 100=%Used � ����(Shall not exceed 15%[or 25%with a conditionai use permit].)
Shoreline Vegetation Protection Area:Mitigation Required?O Yes (�No
August 11, 2004 - _
Issue Date Signa ure ofIss i g A nt
August ll, 2005 50%Rule: AverageRoadSetback:
Expiration Date
Office Comments:
Please Print
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SCALE: I INCH= 40o FEET FOR ASSESSMENT USE ONLY NOT
DRAWN BY: D. M.E. DATE : ! 1 - 25- 19 77 INTENDED TO SHOW CONCLUSIVE
COLON (:) INDICATES GOVT. LOT EVIDENCE OF OWNERSHIP OR
80kJNDARY LOCATIONS