HomeMy WebLinkAbout022-738-35-5201-LUP-2004-677 Application for Land Use Permit(*Shoreland*) r ' .�
County of Sawyer � �
PO Box 676 -Hayward WI 54843 �
715/634-8288
*Property that is located within 300'of a creek,river or stream or within 1000'of a � �
flowage,lake or pond or has any of the above waterbodies located within � So
the property's boundaries. � 1
CONSTRIICTION SHALL NOT BEGIN UNTIL ALL REQUIIiED PERMITS HAVE BEEN ISSUED. �
L�PPe�,n�I y��} F�Y PRINT-USE BLACK INK OR PENCIL 3 �
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Owner Builder a �
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Mailing Address Mailing Address � p �
12a��ssa.� , w.r SY$67 �
City,State,Zip City,State,Zip
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Daytime Phone Daytime Phone S
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Additional Information: �ne District: Il- 1 -'
Lot Dimensions: +(3�o x *13o2D� (/�
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Date lot was created: Acres: �{3.a$D 9
Is there wetland near the proposed structure?If yes,how far -F I oo� 0 5
Building Land Use Floodplain:O Yes (�No �
O New O Filling Chippewa Flowage:O Yes (j� No c�
(�(�Addition O Dredging Driveway access off of a(Check one): �
( )Alterarion ( )Grading ( )Private Rd (�Town Rd. �
( )Moving On ( ) ( )County Hwy ( )State Hwy °'
� ) � ) � `�
v, r
Primary Structure Accessory Building Addition o 0
( )Dwelling � )Garage-attached/detached ( )Deck � �
O Year round O#of car stalls O Porch v,
( )Seasonal ( )Storage Building ( )Enclosed � �
O Frame built on site O Screenhouse O Living room co
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen •`_',
( )Mobile/manufactured ( )Other ( )Bedroom p
O Other primary structure OO q�a��.bH�,ker�add� O Relocate/enlazge �
( ) ( ) -�� Si�qq2 ( )#ofnew ,
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AdditionalInformation: �'' a
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Type of Construction: � W
( )Frame ( )Log ( )Pole/metal ( )Block OO Concrete 9� �
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( )Other —
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Construction Cost:Primazy Structure$ � �
Accessory Building:$ Addition:$ �
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Deed:Voi 63S Pg ��3 Certified Soil Test# � �z
CSM:Vol Pg Lot# Sanitazy Permit# °Q 7�
Plat Envelope Or: o, J
Condo Vol Pg Yeaz Installed: �;,
"I,oads and Flows": Vol Pg Owner When Installed: o �
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Previous office approvals/actions: �
Variance:# LUP:# �l7- ��� 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 aadition,each alteration in a separate column. ,
#1. ex�53i.�v Y�ti�ICe� #2. l�4rker adc�. #3. #4. !
Size Tft.wide ��i0� ft.wide fr.wide ft.wide
ft.long 176� ft.long ft.long ft.long
Floor area sq.ft. �$,Ibo sq.ft. sq.ft. sq.fr.
HgG from grade � to peak r ft.hgt. ft.hgt. ft.hgt.
Stories — — stories stories stories ,
#of bedrooms
Lake/Pond/Flowa e/River/Stream Name
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Fire Number and Name of Road o"2 S$ON L�fke_ D�
1. Enter lot dimensions and indicate north by azrow. Si ature o�Owne or Authorized Agent:,.
2. Indicate the location and size of the requested construction ���2���.��c�'�tc'u�di..'t�%
ignature f�Y;�+.�"� 'rj C.
activities. /t� � -�
PtlnWame:l��t%/.�/JLS ,iz"/.=r�/(,�
3. Also,1ndlCate the location and Qistance to the We��, The above cedifies ihat the listed intortnation and intentions are
true arM conect.,Mat all work shall be peAormed in compliance
septic tank and drainfield,wetland areas,lot lines, with the requirements of ihe Sawyer County Zoning ONinance
and ihe laws and regula6ons of ihe State of Wiswnsin,and if
centerline of the road and waterbodies. aams as owner�s�a9e�t nas cne�r�r��ss�o�or me ow�er�s�to
peAortn ihe work requested on this application. The above
personsls hereby gNe permission for awess to the property for
� 8\ onsiteinspedion.
Permit fee:$ ��0O•�� a x J
Total land azea within 300'of the waterbody:(A) _
Total impervious surface area[including this project](B)
(B)/(A)x 100=%Used (Shall not exceed 15%[or 25%with a conditional use permit].)
Shoreline Vegetation Protection Area:Mitigation Required?O Yes (�No
December 7, 2004 - "
Issue Date Signature ofIs in gent
December 7, 2005 50%Rule: AverageRoadSetback:
Expiration Date
Office Comments:
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SCA�L'E: I INCH=400 FEE
DRAWN BY: �
COLON (:) INDIGATES GC