HomeMy WebLinkAbout024-741-30-1301-LUP-2004-162 Application for Land Use Permit (*Non-shoreland*) o o ;�;�
County of Sawyer W r,�Q�i��,;� � � -
P O B o x 6 7 6 - H a y w a r d W I 5 4 84 3 �
715/634-8288 v
*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 REQUIRED PERMITS HAVE BEEN ISSUED. � '
PRINT-USE BLACK INK OR PENCIL � _�
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Owner ��a t� ,, <<'�� �:«f= C�=�iiSE .Tf�c Builder c;
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Mailing Address Mailing Address O
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City, S ate, Zip City, St te, Zip �
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Daytime Phone Daytime Phone sq�,,r �
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Additional Information: Zone District: (�c 1-� ���%�5� �
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i�D �y"T(�Z3'� S
�-��:; , - Lot Dimensions: (,c i � 3 I fi
Z_y�!07``3�t'.`� , '�, l �rr S�N� �
Date lot was created: Acres: �D� 7�� � z
Is there wetland near the proposed structure? If yes, how far �s
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Building Land Use Floadptain: ( j Yes (�No `� F
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( )New ( ) Filling � ,
�Addition O Dredging Driveway access off of a(Check one): � .�.i
�Alteration ( ) Grading �.Private Rd ( ) Town Rd. o
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy ,w
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Primary Structure Accessory Building Addition � °
( ) Dwelling (�f Garage-attached etached ( ) Deck W
� Year round (3) # of car stalls (�.Porch S �
( ) Seasonal ( ) Storage Building ( ) Enclosed �
( ) Frame built on site ( ) Screenhouse ( ) Living room i �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen p �
( ) Mobile/manufactured ( ) Other ( ) Bedroom --
Relocate/enlar e � �
( ) Other primary structure ( ) ( ) g , �,�
( ) ( ) (3) # of new ;�rY;�.�'.S � �
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AdditionalIr�formatior�: �� �,�ts•T�,,.�� �%�����'��c �' S�a�e ������ � ;
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Type of Construction:
(�rame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete � �
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( ) Other ,� . �
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Construction Cost: Primary Structure $ .�L% �Y� � • �
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Accessory Building: $ ���,E�C��='.�' Addition: $ .1���-��`'� � �' ��/�"j`�'� � �,
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Deed: Vol l0�7 Pg �5 Certified Soil Test# -�---`��==��,5"� Z
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CSM: Vol Pg Lot# Sanitary Permit# ��� -�� �-I � o�
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Plat Envelope Or: . � / � N �
Condo Vol Pg Year Installed: ���-'�3 �
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Aff of ex septic Vol Pg Owner When Installed: "
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Cv(L r Gj�,c'f�iLl?R- �'�c v i��' �hr(r�E� !?-�
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Previous office approvals/actions:
Variance: # LUP: # SP: # CUP: #
Inspection Report: # Change of Zone District: , i�y
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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. ]�eux #2. G-wnhv� #3. #4.
Size_� �� ft. wide ' ft. wide ft. wide fr. wide
�3 _ ft. long '-�E ft. long fr. long ft. long
Floor area 13'I � sq. ft. �� sq. fr. sq. fr. sq. fr.
Hgt. from giade to peak ft. hgt. ft. hgt. fr. hgt.
Stories �_ � stories stories stories
# of bedrooms Y
RearLotLine �iD� 1' Co�f+� Sr��"�+� L�LKN- l�r
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Fire Number and Name of Road ' ` d 33'� �='µ?�'` 5 �h'bY �"`Fc�"
1. Enter lot dimensions and indicate north by arrow. '� a re q�0 ner or Auth�rized Agenh
2. Indicate the location and size of the requested construction i�.� � ia(:x.�:z�u� �����
Signat
activities. �
PnntName: �In^; m` Lec'Nalr �p{d'Ue1J �'.clF-�
3. Also, 1ndlCate the loCation and dlStanCe to the Well, The above ceNfes that the listed info ation and intentions are
true and coned., thal all work shall be perfortned in compliance
septlC tank and dlainfield, wetland areas, lot 11nes azlcl to the with the requiremenis ot the Sawyer Counry Zoning ordinance
and ihe laws and regulations of the State of Wisconsin, and if
C01lt0Pllri0 Of Yt1C I'08d. ading as ownel(s) agent, has ihe permission of the owner(s) to
pedortn the work requested on this application. The above
personsls hereby give pertnission for access to the propeAy for
onsite inspeclion.
Permit fee: $
May 11 , 2004 �� � � 1-� �� - �_ C�
Issue Date Signature of Issu g A e t
May 11 , 2005 50% Rule: AverageRoadSetback:
Expiration Date
Office Comments:
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