HomeMy WebLinkAbout022-738-20-4205-LUP-2004-019 Application for Land Use Permit o �
County of Sawyer �
PO Box 668 -Hayward WI 54843 �
715/634-8288 v �
The undersigned hereby makes application for a Land Use Permit and agrees that all work '� �
shall be done in compliance with the requirements of the Sawyer County Zoning Ordinance v��
and the laws and regulations of the State of Wisconsin. a '
PRINT-USE BLACK INK OR PENCIL
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uwner Buiider v �
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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 1—
Building Land Use y� .
(��New O Filling Zone District /'C- �
( )Addition ( )Dredging � I �
O Alteration O Grading Lot Size 3 3� X l 3 3� �
( )Moving On ( ) � ��
( ) ( ) Acres ��� g
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Primary Structure Accessory Building -� Addition ;�
O Dwelling (�Garage-attache etached O Deck j ��,
O Yeaz round (�#of car stalls O Porch r�,,,
( )Seasonal (pt)Storage Building ( )Enclosed � ��
`?(�Frame built on site O Screenhouse O Living room �
( )Moduladmanufactured ( )Greenhouse ( )Kitchen �
( )Mobile/manufactured ( )Other ( )Bedroom �
,To
( )Other primary structure ( ) ( )Relocate/enlarge - �
( ) ( ) ( )#of new � '
l;J '`�� W
Type of Construction "1 �`��,
(y�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete : �
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( )Other � i.
d N F
Construction Cost$ �l��U��� ;� G �
�1 f�l r55 f !'e
Vol ���3 Pg 2G,� of Deed Certified Soil Test# i�3- ���� ! = v�
CSM Vol Pg Sanitary Permit#��-���a- � �� rn
cr� M
Plat Envelope Or: S tAt� �°f�,� tQ''� �T"17 fl Z`� z
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Condo Vol Pg Year Installed
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Aff of ex septic V P Owner When Installed:
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Application for Land Use Permit — Page 2
Describe Construction: List dimensions of each structure, story, addition, or alteration.
#1. #2. #3. #4.
Size �� ft. wide ft. wide fr. wide ft. wide
�� ft. long fr. long ft. long fr. long
Floor area��r?_sq. ft. sq. fr. sq. fr. sq. ft.
i
Hgt frnm grade�__to peak ft. hgt. fr. hgt. fr. hgt.
Stories �y2 (TTh3iN ;h af�iC. '�/us� stories stories stories
# of bedrooms U
reaz lot line or waterline of lake/river
In the box sketch in: 33 '
Location and size of all
existing and proposed structures.
Location of septic system. ��
�'�
Indicate distance to: "-
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Waterline p,i�� � ' C�
Road '� � ��
r-
Lot lines `^
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Septic system � � , �
Distance between structures. � o�a��,�,� �_`,�CX�_� �d�
Indicate North. ,�c� � � �;�w
�� 3d� �,�p � �
Fire Number: y �� _ �(���� a'�'9
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Signature of Owner \Nt:` � ` �
The above certifies that the listed '� /�� �
information and intentions are true and i �
wrrect. The above person/s/hereby
give permission for access[o the ,
property for onsite inspection. �^��------- centerline of 1A�e_ �T_�(� road-------S
IssueDate Februar� 5 , 2004 ExpireDate February 5 , 200�
Office Comments: ` ' �
Signature of n Adminis tor
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POLISH ROAD 42
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SGALE: IINCH=400 FEET FOR ASSESSMENT USE ONLY NOZ
DRAWN BY: DATE�7-18-84 INTENDED TO SHOW GONCLUSIVE
COLON (�) INDIGATES GOVT. LOT gp�NDARY�L CATIONS �P OR