HomeMy WebLinkAbout022-638-22-3303-LUP-2004-146 Application for Land Use Permit(*Non-shoreland*) � o ,
County of Sawyer � � i�
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 �; f�
flowage,lake ar pond or does not have any of the above waterbodies located within c�; ��
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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p�� Builder �' �
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Mailing Address Mailing Address O �
�ac�.:��:�c��� �.1.,� ��1�b�1 �re�c,_�.a. , l.vL Sti��3 �; �
City,State,Zip City,State,Zip
�`�1 S -�'1�S--�-��k � `7 i S -�'t`l 3 - ��l S ��`%
Daytime Phone Daytime Phone �
Additional Information: Zone District !t-)
Lot Dimensions: 5�3` _�y C��r
4
Date lot was created: "7'a�`d y Acres: �� ,�__= n �
Is there wetland near the proposed structure?If yes,how far G �
Building Land Use Floodp}ain-( j Yes O No � :;
(j�New ( )Filling �
O Addition O Dredging Driveway access off of a(Check one): � 4
O Alteration O Grading O Private Rd (�Town Rd. o
( )Moving On ( ) ( )Counry Hwy ( )State Hwy i,"', �
� ) � ) o S
r
Primary Structure Accessory Buildin Addition �� °
(�Dwelling (�Garage attached/ etached (7c)Deck � "'
(�,Year round (�#of car stalls (>cj Parch �S �= �
O Seasonal (�c)Storage Building O Enclosed ��
O Frame built on site O Screenhouse O Living room � S,
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen p � �
( )Mobile/manufactured ( )Other ( )Bedroom � �? �
( )Other primary structure ( ) ( )Relocate/enlarge � �� '�' ��
� � ( � ( )#of new � �� � �
� � 1..
AdditionalInformarion: � � p >
�� eY�e '�s ��� tiws 6e:�� ��� o-�-� t�h� � � � F�,
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Type of Construction: UJ �
F,)Frame ( )Log ( )Pole/metal ( )Block ( )Concrete � � �
( )Other ,.ti ,�
Construction Cost:Primary Structure$ � �
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Accessory Building:$ i�' ,,c `�f Addition:$ �
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Deed:Vol�_Pg 3 ��' Certified Soil Test# (i� -(i(D� °Q z
CSM:Vol a S Pg �' `` Lot#_� Sanitary Permit#�C-k - (i�l,�i o� �
�,�,�t U.+Cur�. �
Plat Envelope �r� N
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Condo Vol Pg Year Installed: co
Aff of ex septic Vol Pg Owner When Installed: `-' �
Previous office approvals/actions: �
Variance:# LUP:# SP:# CUP:#
Inspection Report:# Change of Zone District: ��aq 1p�j
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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. c��.; #2. �Tu—,r�S�C� #3. �,k� c��� � �,f�� #4. �� .
Size . ft. wide ft. wide ��_ft. wide � � j H ft. wide
ft. long ft. long �� ft. long �U �� ft. long
Floor area d� sq. ft. I�U� sq. fr. (nc�� sq. ft. � �_„-� sq. ft.
Hgt from gade to peak 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 i '
1. Enter lot dimensions and indicate north by arrow. ��,of Owner or Authorized Agent:
2. Indicate the location and size of the requested construction �{„,.� �,�� `�
ig re
activities. � � �N
Pnnt Name: n n,_:�� �T�� �'�'
3. Also, lndicate the lOcation and distance to the well, The above certifes mat the listed iniormation and intentions are
hve and correct.,that all work shall be performed in compliance
Sept1C ta1llC anCl CiTalnfielCl, wetl3rid 87eas, lot lines and to tlle with the requiremenfs ot the Sawyer Counry Zoning Ordinance
and the laws and regulations of the Sfate of Wisconsin, and if
COritETIlIIO Of 1}1C I03C1. � acting as ownel(s)agent, has the pertnission of the owner(s)to
peAortn the work requestetl on ihis application. The above
personsls hereby give permission for awess to the property for
onsiteinspeclion.
Permit fee: $ ��� -}SQ �5�
May 5, 2004 + � � � -
Issue Date Signature of Issu' g A t `
May 5, 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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SCALE� I INCH=400 F
DRAWN BY:
COLON (�) INDICATES