HomeMy WebLinkAbout022-738-36-4401-LUP-2004-291 Application for Land Use Permit(*Non-shoreland*) o o �
County of Sawyer �
PO Box 676 -Hayward WI 54843
715/634-8288 � 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. �
PRINT-USE BLACK INK OR PENCIL
Sv�CG.rI (�d c
l/�G�iii i 5 ���f-� a �
Owner Builder N' �
��s'��/3 ,r/ �,��TC u,✓� /i'Q �:
Mailing Address Mailing Address O
��<13��'�/ �� �S 5/5°�=� � �
City,State,Zip City,State,Zip �
i� li,.�=�r�1,3 -:1��` 73 �,.
Daytime Phone Daytime Phone
Additional Information: Zone District ���
.n.
Lot Dimensions:
Date lot was created: �t/��%'3D -�3 Acres: y�.� o �
Is there wetland near the proposed structure?If yes,how far � ��
Building Land Use Floodp}ain:� )Yes O No `� �
( )New ( )Filling �
� �•
O Addition O Dredging Driveway access off of a(Check one): �
O Alteration O Grading O Private Rd (�Town Rd. o
(�)Moving On O O County Hwy O State Hv✓y N �
� ) � ) o `�
r
Primary Structure Accessory Building Addition � °
( )Dwelling ( )Garage-attached/detached ( )Deck W
�jy)Year round O#of car stalls (s�Porch :
( )Seasonal ( )Storage Building ( )Enclosed � �
O Frame built on site O Screenhouse O Living room ; �
( )Modular/manufactured ( )Greenhouse ( )Kitchen
(�j Mobile/manufactured ( )Other ( )Bedroom �� �
O Other primary structure O O Relocate/enlarge i
� � ( ) ( )#of new � �
Additional Information: p
� �
� �
Type of Construction: � �
�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete a
( )Other � ,�
Construction Cost:Primary Structure$ `�;c'�L", �C� � �
Accessory Building:$ Addition:$ � �
�'318t`15 �°
Deed:Vol Pg Certified Soi]Test# "•° Z
CSM:Vol Pg Lot# Sanitary Permit# �'�/ -.C�'C� � �
Plat Envelope Or: N �
Condo Vol Pg Year Installed: �
Aff of ex septic Vol Pg Owner When Installed: � �
�
Previous office approvals/actions: %
Variance:# LUP:# SP:# CUP:#
Inspection Report:# Change of Zone District: ��l
�.3b1�1
sC��`� `�c,�.
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 T � ft. wide ft. wide fr. wide ft. wide
�I�% ft. long ft. long ft. long ft. long
Floor azea ��J sq. ft. sq. ft. sq. ft. sq. ft.
Hgt.from gade to peak ft. hgt. ft. hgt. fr. hgt.
Stories stories stories stories
# of bedrooms
Rear Lot Line
1
�Gp h�r SCr//5��'I / �
��
� ,
� \'�"" C?
c �F� � �y��
1/ � ``
� 2 5'O �� �
Ll °�- :�
J �CQ-�� . � /�_ �,,
Fire Number and Name of Road
1. Enter lot dimensions and indicate north by arrow. Signature of Owner or Authorized Agent:
2. Indicate the location and size of the requested construction ���,�2 ��u��'—
SignaNre
activities.
PnntName:
3. Also, lndicate the location and distaTlce to the well, The above certifes that me listed information and intentions are
true and conect.,that ali work shall be pedortned in compliance
SeptiC tank and dIalnfield, Wetlanc�areas, lot Ilnes and to the with the requirements of the Savryer Counry Zoning Ordinance
and the laws and regulations of the Shate of Wiscronsin, antl If
CCC1tCI�lIlO Of th0 203a. acting as owner(s)agent,has the pertnission of the owner(s)to
peAorm ihe work requested on this application. The above
personsls hereby give pertnission for aceess to Ue property for
onsite inspection.
Permit fee: $
.TnnP 77 , 7004 -
Issue Date Signatwe of Iss ing ent
June 22, 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
2. 1 I .I
3.1 4.1
� 14. I 13.1
15.1 16.1
SCALE: I INCH=q�p FEET FOR ASSESSMENT USE ONLY NOT
DRAWN BY: DATE :7/24/ 84 INTENDED TO SHOW CONCLUSIVE
COLON (:) INDIGATES GOVT. LOT EVIDENCE OF OWNERSHIP OR
BOUNDARY LOGATIONS