HomeMy WebLinkAbout020-638-01-3201-LUP-2004-646 a.- �a..-
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
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. '
PRINT-USE BLACK INK OR PENCIL
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l '���L /�L-y� s� I !�N��� ���`���� �f ��� ��� �
Owner ' T Builder �— �:
15�75 �-7�`�� S�r /S�7 S'S� 7C�lj �/ r �.
Mailin Address Mailing Address O
(D G�//IZZ�r �� �7�,� ���ll► �'r [-cJ.�. �5�7.�'s/ �
City, State, Zip City, State, Zip
'7/s - ��'(��� �� 7/S'� S-�d''- .�.� 7� �,
Daytime Phone Daytime Phone '
�io �a ?c�.sonu w�cL,
Additional Information: Zone District: � 02
y3r� � Vl�trBS�
Lot Dimensions:
Date lot was created: Acres: �r j � c^ n
o � ,,,
Is there wetland near the proposed structure? If yes, how far �
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Building Land Use Floadptain:( j Yes ( j No � '
(,�New ( ) Filling �
( ) Addition ( ) Dredging Driveway access off of a(Check one): �,
( ) Alteration ( ) Grading ( ) Private Rd ( ) Town Rd. o
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy ti, �
� ) � � o �
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Primary Structure Accessory Building Addition � °
� Dwelling 'Garage-attached/detached ( ) Deck W
�� Porch '�
( ) Year round ) # of car stalls ( ) �
( ) Seasonal ( ) Storage Building ( ) Enclosed �
( ) Frame built on site ( ) Screenhouse ( ) Living room � �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen �
( ) Mobile/manufactured ( ) Other ( ) Bedroom
( ) Other primary structure ( ) ( ) Relocate/enlarge i �
� � � � O # ofnew , '
� �
AdditionalInformation: �; A
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Type of Construction: �+
(�'Frame ( ) Log ( ) Pole/metal ( ) Block ,(�') Concrete��-j
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( ) Other �
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Construction Cost: Primary Structure $ � � C��'o �
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Accessory Building: $ ' �ek�' Addition: $ � W
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Deed: Vol Pg Certified Soil Test# �"
z
CSM: Vol P Lot# Sanitary Pertnit# O y .3 7 y � �
g °�
Plat Envelope Or: N �
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Condo Vol Pg Year Installed: �? �
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Aff of ex septic Vol Pg Owner When Installed: `-'
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0
Previous office approvals/actions: �
Variance: # LUP: # SP: # CUP: #
Inspection Report: # Change of Zone District: a�,�Ib�
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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.
#i. yb�,i #2._ '�� #3. #a. ,
Size fr.wide�' 2O fr.wide ft.wide fr.wide •
�ft.long,36� �ft.long ft.long ft.long , ,
Floor azea 9.3(c sq.ft. y�� sq.ft. sq.ft. sq.ft.
Hgt.from gc-ade�to peak fr.hgt. ft.hgt. ft.hgt.
Stories_� stories stories stories �
#of bedrooms�_ �
4
�`'� Rear Lot Line '
�_— —
/ �
13�, �°� ���
�d,�y � k �
�T�h�' 'L C � �, _
✓ ��� ` , �-
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Fire Number and Name of Road�����_� �(^�f't��� � ��'����
1. Enter lot dimensions and indicate north by arrow. Signature n r thorized Agent:
2. Indicate the location and size of the requested construction
Signaty�
activities.
Pont Name:
3. Also,indicate the location and distance to the well, The above certifies mat the listed iniormation and intentions are
We and correct.,Nat all work shall be peAormed in compliance
Sept1C tari1C 2Tld drfllnfleld,wetland azeas,lot�1nes 321d to the with the requiremenLs ot the Sawyer County Zoning ordinance
and Ne Iaws and regulations of the Sta�e of Wisconsin,and if
centerline of the road. acting as ownet(s)agent,has the permission ot tne owner(s)to
pedortn the work requestetl on ihis application. The above
personsls hereby give permission for aaess to the property for
onsite inspedion.
Permit fee:$ /�S `�5� --- �� �
November 10 2004 —
Issue Date Signature of Iss � g g nt
November 10 2005 50%Rule: Average Road Setback:
Expiration Date �
( ���ti. V�,2-e-P � �,`Y`ry� u�.- `
Office Comments: 10 l9 � ��� u ,,,,�,Q,� C�>�
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