HomeMy WebLinkAbout022-738-09-4401-LUP-2004-443 Application for Land Use Permit o o �
County of Sawyer � �
PO Box 676 -Hayward WI 54843 � �
715/634-8288
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
and the laws and regulations of the State of Wisconsin. �
NO CONSTRUCTION MAY BEGIN UNTIL ALL PERMTTS HAVE BEEN ISSUED. 1
PffiNT-USE BLACK INK OR PENCIL �y
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Owner Builder �
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Maili�n- ��'dress �
Mailing Address s- " �
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City State,Zip City,State,Zip
Daytime Phone Daytime Phone �
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Additional Information: Zone District /7 !
1
Lot Size ?
Acres �V
Is the property in a Shoreland District?(within 1000'of a lake or pond,within 300'of a river,
creek or stream) If yes,how far from the shoreline&water name: �
Is there wetland neaz the proposed structure?If yes,how far � � �
Building Land Use �
�,j NeW ( )Filling Floodplain:( ) es _(��)"No # ;;
Dred in �
( )Addition ( ) S S � o
l '/�lteralion ( )�Jrading Ch�ppewa Flo�:age: ( )�'Ps � )No � �
( )Moving On ( ) �
� � � � Driveway:( )State ( )County ( )Town Rd. , �
Primary Structure Accessory Building Addition
( )Dwelling ( )Garage-attached/detached ( )Deck � �,
( )Yeaz round ( )#of car stalls ( )Porch „ (��
( )Seasonal ( )Storage Building ( )Enclosed ?
( )Frame built on site ( )Screenhouse ( )Living room p"
( )Modular/manufactured ( )Greenhouse ( )Kitchen � �
( )Mobile/manufactured (i)Other , ( )Bedroom (� �
O Other primary structure O r O Relocate/enlarge A
� � � � ( )#of new �
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0
Additional Information: .,y
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Type of Construction � .-3
( )Frame ( )Log (���Pole/metal ( )Block ( )Conerete � �
( )Other W
Construction Cost:Primary Structure$ �'
Accessory Building:$ � /i C��' _ Addition:� z
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Vol �i%I n Pg�7� of Deed Certified Soil Test# �
CSM Vol Pg Lot# Sanitary Permit#
Plat Envelope Or: �
CondoVol Pg YearInstalled �t'�is-r' �� l�iLc�''
Aff of ex septic Vol Pg Owner When Installed:
Gazd Gazebo Vol Pg
Previous Variance:
LUp: �_`��'1 InspectionDate: �/��` ��
C.
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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. #4. ,
Size 3 � ft. wide ft. wide ft. wide ft. wide
�3b ft. long ft. long ft. long ft. long
Floor area ? C' sq. ft. sq. ft. sq. ft. sq. ft.
Hgt.from grade to peak ft. hgt. ft. hgt. ft. hgt.
Stories
stories stories stories
#of bedrooms
L�t Line or Lake/River name: �
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Fire Number and Name of Road � _ �
1. Fill in lot dimensions and indicate north by arrow. Signature of Owner or Authorized Agent:
2. Indicate location and size of existing and new structures.
� �` , � � .
3. Indicate location of well, septic tank, drainfield. ,, ,
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4. Indicate distance to existing structures, lot lines, septic system.
5. Indicate distance to the ordinary high-water mark of any lake,
pond, river, stream, creek, and name the body of water. P�"t Name:
The above certifies that the listed information and intentions are
true and correcL The above personsls hereby give permission for
6. Indicate any grading or clearing in excess of the construction site. a�cess to tne pro�erty tor o�s�ce��S��c�o�.
7. Indicate distance to any wetland.
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Permit Fee: ��(J
August 18 2004
Issue Date Signature of Iss � A ent
August 18, 2005 ,,
Expiration Date ',,
Office Comments: '
Inspection Date: 50%Rule Applies: Avg. Setback:
Restrictions and other information: ;
� 2.� �.�
3.1 .3.2 4.1 .4.2
14. .14.1 .13. 13.1
15.2 .15. 15. 15. .16.
.15.1 ,15. 15.6 15. ,
SGALE: I INCH=400 NaT
DRAWN BY: DATE:7-IB-84 INTENDED TO SHOW GONCLUSIVE
COLON (:) INDIGATES GOVT. LOT 80UNDARY�L CAT ONS IP OR