HomeMy WebLinkAbout022-738-25-1201-LUP-2004-642 Application for Land Use Permit(*Non-shoreland*) o o �,,�
County of Sawyer � � '
PO Box 676 -Ha ward WI 54843 � �
715/634-8288 ����`4��O�ME�y �
*Properly 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
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Owner ��r Builder �'
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Mailing Address Mailing Address �
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City,State,Zip City,State,Zip �
�'�/`� 1'�S � �l C1�a 's
Daytime Phone Daytime Phone �
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Additional Information: �Zone District �y � �
Lot Dimensions:
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Date lot was created: Acres: .�-��J o �
Is there wetland neaz the proposed structure?If yes,how faz G
Building Land Use Floodp}ain:{ )Yes (�No `;
�New ( )Filling �
O Addition O Dredging Driveway access off of a(Check one): �,
O Alteration O Grading O Private Rd (�f Town Rd. o
( )Moving On ( ) ( )CounTy Hwy ( )State Hwy �,`'', �
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Primary Structure Accessory Building Addition � °
( )Dwelling ( )Garage-attached/detached ( )Deck W
( )Yeaz round ( )#of caz stalls ( )Porch �
O Seasonal O Storage Building O Enclosed �
O Frame built on site O Screenhouse O Living room � �
( )Modular/manufactured ( )Greenhouse ( )Kitchen � C
(�Mobile/manufactured ( )Other ( )Bedroom �� �
( )Other primazy structure ( ) ( )Relocate/enlarge �
� � ( ) ( )#ofnew �
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Additional Information: ����;�,_�{ �jY E� �-� ` /y�t`` 7�f���' �� p
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Type of Construction:
QQ Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �^_�.
( )Other \ ,�
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Construction Cost:Primary Structure$ �S! �•'r`� � �
:? �
Accessory Building:$ Addition:$ �
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Deed:Vol 5ti Pg i z� Certified Soil Test# /�2 °•'° z
CSM:Vol Pg Lot# Sanitary Permit# p�/-S/Sz o, �
Plat Envelope �r� N �
Condo Vol Pg Year Installed: o
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Aff of ex septic Vol Pg Owner When Installed:
Previous office approvals/actions: _
Variance:# LUP:# SP:# CUP:#
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 Cv fr. wide ft. wide ft. wide ft. wide
�ft. long ft. long ft. long ft. long
Floor azea �� " � sq. ft. sq. ft. sq. ft. sq. ft.
Hgt.from gade %�! � to peak ft. hgt. ft. hgt. ft. hgt.
Stories / stories stories stories
# of bedrooms�_
Rear Lot Line
.A�z at�e.�..'0
Fire Number and Name of Road Q���` l� f�/�S'�/�L��� /���z�
1. Enter lot dimensions and indicate north by arrow. Signature of Owner or Au orized Agen)t
2. Indicate the location and size of the requested construction '�r" �.�u-c- �����,✓
Signat
activities. -
Pnnt Name:�7'Jo�»�,z- .�- �,c'2��t.f'i
3. Also, 1ndlCate tlle loCatlon and CI1StanCe to tlle well, The above ceitifles that the listed Informafion and Intentions are
true and conect.,that all work shall be performed in compliance
septic tank and drainfield, wetland areas, lot lines and to the wun me re�mreme�� or me sawyer co��ry zoo�o9 om��ance
and ihe laws and regulations of the State of Wisconsin, and if
C0rit0LI1RC Of YI1C TOaCl. acting as owner(s)agenC has the permission of the owner(s)b
peAortn the work requesled on this appiication. The above
personsls hereby give permission for aceess to the property for
onsite inspedian.
Permit fee: $
November 8, 2004 _
Issue Date Signature ofI uin gent
November 8, 2005 50% Rule: AverageRoadSetback:
Expiration Date
Office Comments: �X� ��� r.� q m o�i l2. `4}Om�2 '�"c� �e- �'�°'n�`�-�-`-� �
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