HomeMy WebLinkAbout024-741-07-3401-LUP-2004-052 Application for Land Use Permit(*Non-shoreland*) o o �.
County of Sawyer �
PO Box 676 -Hayward WI 54843
715/634-8288 0� O
*Property that is not located within 300'of a creek,river or stream or within 1000'of a r
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. A
PRINT-USE BLACK INK OR PENCIL �' 1
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Mailing Address Mailing Address O
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City, tate,Zip City,State,Zip �
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Daytime Phone Daytime Phone s
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Additional Information: Zone District: �( '� q
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Lot Dimensions:
Date lot was created: ����✓ ���A�s: `�U ��/ � � n �
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Is there wetland near the proposed structure?If yes,how faz Y� � v� T
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Building Land Use Floodptain:� j Yes (�'No =° �j
�Iew ( )Filling �
O Addition O Dredging Driveway access off of a(Check one): d;
( )Alteration ( )Grading ( )Private Rd �Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy N �
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Primary Structure Accessory Building Addition � °
( )Dwelling ( )Gazage-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 a �- �
O Modulaz/manufactured O Greenhouse O Kitchen fi C m
( )Mobile/manufactured ( )Othe ( )Bedroom S � �
( )Other primary structure �'' / '�r/� ( )Relocate/enlarge t^ � `~
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AdditionalInformation: p '� >
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Type of Construction: W J
( )Frame ( )Log ( )Pole/metal ( Block ( )Concrete ,z
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Construction Cost:Primary Structure$ ��� � � �
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Accessory Building:$ �i Addition:$ x� -C
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Deed:Vol 3 3 S Pg I 7 Certified Soil Test# °Q
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CSM:Vol Pg Lot# Sanitary Permit# o, �
Plat Envelope Or: N v
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Condo Vol Pg Year Installed: i�r�nf l9 g co
Aff of ex septic Vol Pg Owner When Installed: " �
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Previous office approvals/actions: �
Variance:# LUP:# SP:# CUP:# \�4`
Inspection Report:# Change of Zone District: �
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Describe the construction using these columns. List the dimensions of each structu`re in a separate
column. List each story, each addition, each alteration in a separate column.
#1. #2. #3. #4.
Size �/ fr. wide ft. wide ft. wide ft. wide
�� ft. long ft. long ft. long � ft. long
Floor azea `�60 8 sq. ft. sq. ft. sq. ft. S4• fr•
Hgt from gade /7 to peak fr. hgt. fr. hgt. ' ft. hgt.
Stories � stories stories stories
# of bedrooms �_
Rear Lot Line
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Fire Number and Name of Road !� � a f uJ � 1�n L. Q ke �o a. C�
1 . Enter lot dimensions and indicate north by arrow. Signature of Owner or Authorized Agent:
2. Indicate the location and size of the requested construction
ign
activities. �
Ptlnt Name:
3. Also, 1ndlCate flle IOCatlon anl� d15tanCe t0 the WCII, The above ce�es that the listed informafion and intentions are
hue and conect., that all work shall be peAormed in compliance
septic tank and drainfield, wetlancl azeas, lot Ilnes and to the with the requirements of ihe Savryer County Zoning Ortllnance
and ihe laws and regulalions of ihe State of Wisconsin, and if
Centerllne of the Ioad. acting as owner(s) agent has the permission of the owner(s) to
perfortn ihe work requested on this appliralion. The above
personsls hereby give pertnission for access to Ne property for
onsite inspection.
Permit fee: $ o� D � (�Q
March 22 , 2004 -
Issue Date Signature of Iss i g g nt
March 22 , 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments: 1,�n /I J, ' Q�Q���r�. ��.� -!�k%ail,�6�'�^�
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� SCALE : I IFICH = 400 FEE1
DRAWN BY : D/
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