HomeMy WebLinkAbout022-738-20-4204-LUP-2004-428 Application for Land Use Permit(*Non-shoreland*) o o �/
County of Sawyer ti, � �
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. ]�
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Mailing Address Mailing Address �
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City,State,Zip ity, tate,Zip i
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Daytime Phone Daytime Phone
Additional Information: Zone District: �"r �^
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Lot Dimensions: �
- C Acres: ��'i �L-� E� 5,0 0 �
Date lot was created: � `�
Is there wetland near the proposed structure?If yes,how far � `-
Building Land Use Floodptain:� j Yes O No � \
(`�,l New ( )Filling
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O Addition O Dredging Driveway access off of a(Check one): �
O Alteration O Grading O Private Rd �Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy N �
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Primary Structure Accessory Building Addition � °
(�)Dwelling (,�Garage-attachecUdetached (')Deck �
O Yeaz round (Ji)#of car s�alrs (h)Porch 'J
Stora e Buildin O Enclosed CD
�_j Seasonal ( ) B B �
Qti')Frame built on site O ScYeenl�ouse (xj Living toom
( )Modulaz/manufactured ( )Greenhouse (�)Kitchen � �
( )Mobile/manufactured ( )Other (�)Bedroom � p
( )Other primazy structure ( ) ( )Relocate/enlarge yJ �
� � � � ( )#of new � �
AdditionalInformation: � A
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Type of Construction: � �
�7 Frame ( )Log ( )Pole/metal ( )Block ( )Concrete -� �
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( )Other � �
Construction Cost:Prunary Structure$ � 'c"•�'�- `�� �
Accessory Building:$ ddition:$ � ✓�
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Certified Soil fest# "°
Deed:Vol�Pg�._ " z
CSM:Vol 'Pg Lot# Sanitary Permit# O�/ -z� b, �
Plat Envelope Or: N j�
Yeaz Installed: '° � I
Condo Vol Pg g �
Aff of ex septic Vol Pg �Owner When Installed: �
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Previous office approvals/actions:
Variance:# LUP:# �� SP:# CUP:# �
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Inspecrion Report:# Change of Zone District: �\�
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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. #2.�� #3. �e�!( #4.
Size ��� ft. wide �zo ft. wide /� ft. wide ft. wide
U ft. long ��� fr. long k0 ft. long fr. long
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Floor azea %�I sq. ft. (� sq. ft. �sq. fr. sq. fr.
Hgt.from gade;'�� to peak fr. hgt. ft. hgt. fr. hgt.
Stories�_ stories stories stories
# of bedrooms �
��� 7��zZ � ��i Rear Lot Line
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Fire Number and Name of Road {��/i 2 C� �iR l f� I
1. Enter lot dimensions and indicate north by arrow. ,
Signature of 0 ner ar Authorized Agent:
2. Indicate the location and size of the requested construction � � , ���_� � � , ,��
" Sgnature
activities. ,
PnntName:/�lI ��Ic(.l L�} �-j•; ,. �i"/ %�
3. A�SO, indicate the location and distance to the well, The above certifes that the listed information and intentions are
true antl cronect.,that all work shall be peAormed in crompliance
septic tank and drainfield, wetland azeas, lot lines and to the with the requiremenfs of the Sawyer County Zoning O�dinance
and the laws and regulations of the Sfate of Wiscronsin, and if
CCriY0111riC Of t}10 L03d. acting as ovmer(s)agent, has the permission of the owner(s)to
perfortn the work requested on this application. The a6ove
persons/s hereby give pertnission for access to ihe property for
onsite inspedion.
Permit fee: $ �C:C�
Aug ic �., 2004 -
Issue Date Signature of Iss ng ent
August 13, 2005 50% Rule: Average Road Setback:
Expiration Date
OfficeComments: rnU.,Qb,,,.,Q �a�y_ ��,�,...� C-eU_� ��3/ y _ � /i,.��,tiZc�,��
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SCALE: I INCH-400 FEET FOR ASSESSMENT USE ONLY NO?
DRAWN BY: DATE :7-18-84 INTEN�ED TO SHOW CONCLUSIVE
COLON (�) INDIGATES GOVT. LOT EVIDENCE OF OWNERSHIP OR
BOUNDARY LOGATIONS