HomeMy WebLinkAbout022-638-26-1401-LUP-2004-485 Application for Land Use Permit(*Non-shoreland*) o
County of Sawyer � ��
PO Box 676 -Haywazd 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 REQUII2ED PERMITS HAVE BEEN ISSUED. � 1
PRINT-USE BLACK INK OR PENCIL
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Owner Builder �� �
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Mailing Address Mailing Address O
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Ciry,�State,Zip City,State,Zip �
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Daytime Phone Daytime Phone �_ ^
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Additional Information: Zone District: - �-� ,,,� ,
Lot Dimensions: L'�
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Date lot was created: Acres: ' r n "�y
Is there wetland near the proposed structure?If yes,how faz ti-� G /
Building Land Use FloodpYain:� )Yes O No =R �
(�New � ( )Filling �
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O Addition O Dredging Driveway access off of a(Check one): �, �
( )Alteration ( )Grading ( )Private Rd (;C}Town Rd. `b•
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( )Moving On (�) � � ( )CounTy Hwy ( )State Hwy i,`'',
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Primary Structure Accessory Building Addition � °
( )Dwelling ( )Garage-attached/deCached ( )Deck W
( )Yeaz round ( )#of car stalls ( )Porch .=
( )Seasonal (,�Storage Building ( )Enclosed �
O Frame built on site ��Screenhouse O Living room
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( )Modulaz/manufactured ( )Greenhouse ( )Kitchen 1�
( )Mobile/manufactured ( )Other ( )Bedroom � �
. ( )Other primazy structure ( ) ( )Relocate/enlazge � �
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AdditionalInformation: � p
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Type of Construction: ` $�
( )Frame ( )Log �Pole/metal ( )Block ( )Concrete � ��
( )Other ,.ti .�
Construction Cost:Primary Structwe$ ��,�3�J '� � �
Accessory Building:$ Addition:$ � ry��
m Fy�03
Deed:Vol �lgl Pg �yG Certified Soil Test# °Q z
CSM:Vol Pg Lot# Sanitary Permit# o� �
Plat Envelope Or: !�' r4111�_
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Condo Vol Pg Year Installed: � �
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Aff of ex septic Vol Pg Owner When Installed:
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Previous office approvals/actions:
Variance:# LUP:# SP:# �UP:#
Inspection 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. #4.
Size._3 C � �• w�de ft. wide ft. wide ft. wide �
� s
. long fr. long ft. long ft. long
Floor area �.� S'o sq. ft. sq. fr. sq. fr. sq. fr.
Hgt.from g�ade IS' 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 ' - � �
1. Enter lot dimensions and indicate north by arrow. Sig eture of Owner or Authorized Agent:
2. Indicate the location and size of the requested construction �l � 4 � . �
Sgnannnlure
aCtiVltlCS. PontName:y_✓d ��� ' v � � �� �1 �''n
3. Also, 1ndlcate the lOcation and distaIlce to the well, The above ceN9es that the listed intormation and intentions are
hue and conect.,that all work shall be performed in compliance
septic tank and drainfield, wetland azeas, lot lines and to the with lhe requirements of the Sawyer County Zoning Ordinance
and ihe laws and regulations of the Shate of Wiscronsin, and if
COnteLllne Of t}le IO2d. ading as ovmet�s)agent has the permission of the owner(s)to
perform the wo�C requested on this application. The above
personsls hereby give permission for aoxss to ihe property for
onsite inspection.
Permit fee: $
1 C� . ��o
September 7� 2004 �/i�'��"'C' ��ta��
Issue Date Signature of Issuing Agent
September 7, 2005 50%Rule: AverageRoadSetback:
Expiration Date
Office Comments:
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