HomeMy WebLinkAbout020-638-08-5203-LUP-2004-507 ` Application for Land Use Permit(*Non-shoreland*) o o� �
County of Sawyer � -
PO Box 676 -Haywazd WI 5484 ��,"'>'-`�'r'��^�a,f �- •-,
715/634-8288 �` > _ � r�,4` �Y: 0 O
*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.
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. 1
PRINT-USE BLACK INK OR PENCIL �
1�N��L a�� +�S.biN �-�es�r�c� � �
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Owner Builder N' O
��a56 sr�rE �lw�/ ��-�a ��
Mailing Address Mailing Address � �
I'ld�c.l� 4t/-T � 602 :;
Ci State,Zip City,State,Zip �
71s- a66- �/o� z
Daytime Phone Daytime Phone m
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Additional Information: Zone District: �
Lot Dimensions: �.,n � 300� �
Date lot was created: Acres: `�'/ '7./Z o Z,•
Is there wetland near the proposed structure?If yes,how far G �
Building Land Use Floodplain:( j Yes (�No =R �
�New ( )Filling �
Addition O Dredging Driveway access off of a(Check one): �
O Alteration �Grading O Private Rd (�Q Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy �,"', �
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Primary Structure Accessory Building Addition � °
(xl Dwelling �Garage-attache etac e (�)Deck W �
(�{i Yeaz round O#of caz stalls (�Porch =
O Seasonal O Storage Building O Enclosed �
O Frame built on site O Screenhouse O Living room � �
( )Modular/manufactured ( )Greenhouse ( )Kitchen 0
( )Mobile/manufactured ( )Other ( )Bedroom � �
O Other primazy structure O O Relocate/enlazge Q
� � � � ( )#ofnew 5. �
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AdditionalInformation: o�' >
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Type of Construction: � �
( )Frame (�Log ( )Pole/metal ( )Block ( )Concrete �n
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( )Other �� .-�
Construction Cost:Primary Structure$ /:��b00 � �
:° �A1
Accessory Building:$ l�i��DO�'���` �''� Addition:$ �
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Deed:Vol 5 7 Z Pg 309 Certified Soil Test# �1�/— � �'� "� z
CSM:Vol Pg Lot# Sanitary Permit# ��5o�7B O t'_�y`p " %o
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Plat Envelope Or: N II��
Condo Vol Pg Year Installed: � �
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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: -' I'"'' �
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Describe the construction using these columns. List the dimensions of each structure in a separate
colum�p List each story, each addition, each alteration in a separate column.
#i. �tous� #z. �2�6E #3.�_ �,�xe� #a. �tl� .
Size � D f[. wide _.��ft. wide �oZ ft.�wide `/L �fr. wide
'� D ft. long �ft. long �,�,D ft. long �Z �a ft. long
Floor area /�yolJ sq. ft. 7�08 sq. ft. otY-(`� sq. ft. �y �_sq. ft.
Hgt.fium gcade a3 , to peak�ft. hgt. _�fr. hgt. � 1Q'_ft. hgt.
Stories o2 / stories _.�stories / stories
# of bedrooms � T
���� c � I y X ��> c-f�< � 11 r a �� (�
� Rear Lot Line �� }
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Fire Number and Name of Road K �Q R 01�1J
1. Enter lot dimensions and indicate north by azrow. � ture of Own r or Authorized Agent:
2. Indicate the location and size of the requested construction ��� �����i.�'��
—�gna�re -
activities.
Pont Name:
3. A150, 1nd1Cat0 the IoCatlOn and CI1StanCe t0 the We��, The a6ove certifes�hat the listed intortnation and intentions are
We and correct., that all work shall be peAormed in compliance
septic tank and drainfield, wetland azeas, lot lines and to the w�m cne requ�reme�r� or me sa�+yer co��ry zoo��9 om��a�ce
and the laws and regulations of ihe State of Wisconsin, and if
CCritCI'llri0 Of thC i0ad. acling as owner(s)agent has the permission of the owner(s)to
perform the work 2quested on this application. The above
personsls hereby give permission for access to ihe property for
onsite inspection.
Permit fee: $ � o� �, O 0
September 15 2004 �
Issue Date Signature ofIss g nt
September 15, 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments: ��c�t�OtQ �j �.tx� `��^�-�;�y� �a,,.,,�-��,
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