HomeMy WebLinkAbout020-638-05-1102-LUP-2004-425 / � .
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Application for Land Use Permit (*Non-shoreland*) o 0
County of Sawyer � � ,!% -
PO Box 676 - Hayward WI 54843
71 Si634-8288 ,
*Property that is not located within 300' of a creek, river or stream or within 1000' of a � �
flowage, lake or pond or does not have any of the above waterbodies located within
the property's boundaries. � i
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. �
PRINT-USE BLACK INK OR PENCIL �
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Owner Builder c
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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 �
Additional Information: Zone District: /�f�r� �.
Lot Dimensions: 3�01 �-- /;30� C'� � ,
Date lot was created: � -�.5�-a�f Acres: /'O n �
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Is there wetland near the proposed structure? If yes, how far 75 � �
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Building Land Use Floodptain:� j IFes (�(�j No �°
�()New ( ) Filling �
( ) Addition ( ) Dredging Driveway access off of a(Check one): �
( ) Alteration ( ) Grading ( ) Private Rd (�Q Town Rd. o
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy N �
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P 'mary Structure Accessory Building Addition � °
�Dwelling ( ) Garage-attached/detached ( ) Deck W
( ) Year round ( )# of car stalls (�Q Porch �
QQ Seasonal ( ) Storage Building ( ) Enclosed �
O Frame built on site O Screenhouse � ) Living mom � �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen � �
( ) Mobile/manufactured ( ) Other ( ) Bedroom •
( ) Other primary structure ( ) ( ) Relocate/enlarge � �
� � ( ) ( )# ofnew
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Additional Information: .�
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Type of Construction:
( )Frame ( ) Log Q� Pole/metal ( ) Block ( ) Concrete
( ) Other � ,,.�
Construction Cost: Primary Structure $ `/�;Op[>, F;� � �
Accessory Building: $ Addition: $ �
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Deed: Vol _P�_�______ Certified Soil Test#, �'�1 _2_�__ "Q �
---- �
CSM: Vol Pg Lot# Sanitary Permit# � y-� 70 0� �
Plat Envelope �r� N
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Condo Vol Pg Year Installed: c�
Aff of ex septic Vol Pg Owner When Installed: �-' �
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Previous office approvals/actions: �
Variance: # LUP: # SP: # CUP: # �
Inspection Report: # Change of Zone District: � �Iq/
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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_�ft. wide ft. wide ft. wide ft. wide
�.5�ft. long ft. long ft. long ft. long
Floor area 'f/ SO sq. ft. sq. ft. sq. ft. sq. fr.
Hgt from gade�to pealc 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 '# �9�9 � O L-/5
1. Enter lot dimensions and indicate north by arrow. Signa re of Owqer r Authori d Agent:
2. Indicate the location and size of the requested construction O
Signature
&Ct1V1t185. PnntName: E / ' -E'
3. AlSO, inQlCBte tlle loCatlon and d15tanCe to tlle well, The above ce�es Nat the listed information an intention re
We and cortect.,that all work shall be performed in compliance
Septic t2ri1C and d7alnfleld, wetland 2Leas, lot 11nes 1lld to tlle with the requiremenis ot ihe Savryer Counry Zoning Ordlnance
and ihe laws and reguWlions of ihe State of Wiscronsin, and if
centCrline of 1.Ile ioad. acting as ovmer(s)agent has the permission ot the owneQs)to
peAorm the work 2quested on this application. The above
personsls hereby give permission for access to Me property for
onsite inspecUon.
Permit fee: $
August 11, 2004 � � � �'����'
Issue Date Signal e of Iss ng ent U
August 11, 2005 50% Rule: AverageRoadSetback:
Expiration Date
Office Comments:
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