HomeMy WebLinkAbout024-741-19-5504-LUP-2004-043 „f �R�c. �CICF{.Ic/EIC� V�>�i6U SiTE A�vD cf+sc��ED o�T SF�I!,Act<_S
Application for Land Use Permit r
County of Sawyer � �
PO Box 676 -Hayward WI 54843
715/634-8288 0
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. a
NO CONSTRUCTION MAY BEGIN UNTIL ALL PERMITS HAVE BEEN ISSUED. � '
�� �n�� PRINT-USE BLACK INK OR PENCIL R O
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t�o be.c�T ��icot.�e2 SF�ME �
Owner Builder � �
5�1 8 3 188+`' Sir�<�� ''�:..� � � �
hlailing Addrass Mailiug Address
-�-,-'12rn i Nc�Tnr� , M 1J. Ss�2`i °
City,State,Zip City,State,Zip �, �
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952 �'1 . 2�U2 �U����-� a�� �
Daytime Phone Daytime Phone ,� p
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Additional Information: Zone District � �
LOY S1ZC I L=�X �'I OO p
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Date lot was created ��i, \V`I� Acres = 1.qcaF . 98
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: '15�-�l A��D LA IC�
Is there wetland near the proposed structure?If yes,how far �/p 3
Building Land Use 'c
( )New ( )Filling Floodplain:( )Yes (X)No # �
�Q Addition ( )Dredging I� o
( j Aiieratioii ( j vrauicig Cnippewa Flowage: ( j r es (>Cj No �
( )Moving On ( ) o
( ) ( ) Driveway:( )State ( )County ( )Town Rd. �
J
Primary Structure Accessory Building Addition � .0
��
QQ Dwelling QQ Garage-attached/detached � �
O Year round (1)#of caz stalls O Porch r�,
60 Seasonal ( )Storage Building ( )Enclosed �
LS'
O Frame built on site O Screenhouse O Living room �
( )Modular/manufactured ( )Greenhouse ( )Kitchen
( )Mobile/manufactured ( )Other (�Bedroom
O Other primary structure O QQ Relocat/enlazge
( ) ( ) ( )#of new <
�
Additional Information: � `` '�` ”
CN�ar�i�co 6x�sT�,vice eF�2u�..-� �,,,�o l_,n��<ti ntias�;��. . ,
-� �-��1, (�a.q�n..c.,�� ,...,�... �evi-�:��., rs..c.n...a� y —
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°�A0..%..d.� --fnv�-.-`I @..v`ire�-.e��ti.d-lwwl� :°
Type of Construction d �
(j�Frame ( )Log ( )Pole/metal ( )Block ( )Conerete � �
( )Other �
Construction Cost:Primary Structure$ �
Accessory Building:$ Addition:$ 2��� �s�, Z
�
Vol �5!`/ Pg���of Deed Certified Soil Test#
�
CSM Vol Pg Lot# Sanitary Permit#
Plat Envelope Or: �
Condo Vol Pg Year Installed P��o,r -�i l�l�a
Aff of ex septic Vol Pg Owner When Installed:
Gard Gazebo Vol Pg
Previous Variance: LUP: Inspection Date: 3��p�Oc.l
aSS7o �'1
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. R�D�ri on� #2. #3. #4.
Size Iq`8�� ft.wide ft.wide ft.wide ft.wide
I 4� ft.long ft.long ft.long ft.long .
Floor area 7 sq.ft. sq.ft. sq.ft. sq.ft.
;
Hgt.from grade�3 to peak ft.hgt. ft.hgt. ft.hgt.
Stories� stories stories stories
#of bedrooms�_
Lot Line ar Lake/River name: ` �
/GY7� 1�L AC�tJ 1-- � I�
� �n�'x y��'pp. �
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Fire Number and Name ofRoad I��/V l��-�-�4��us- f�o�d
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. /��� (� ��;s�
4.Indicate distance to existing structures,lot lines,septic system.
5.Indicate distance to the ordinary high-water mazk of any lake,
pond,river,stream,creek,and name the body of water. Pri�c Name:�' '��`�'' '^ �'Y""�
The above certifes that the listed information and intentions are
6.Indicate any grading or clearing in excess of the construction site. we a�d�o«ea.rne a�o�e Persons�s ne�eny y�YB Pe�m�s5�o�ror
access to the property for onsite inspection.
7.Indicate distance to any wetland.
�7k) cn�s���e 2-ii-v �t703 u c��:c�1 c�e tFe . �.5=
March 10. 2004 -
Issue Date Signature of Iss 'n A ent
March 10, 2005
Expiration Date
Office Comments:
Inspection Date: 50%Rule Applies: Avg.Setback: Within Reservation boundaries:
Restrictions and other information:
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