HomeMy WebLinkAbout010-941-21-3444-LUP-2003-704 Rn�E�1 D M�N T
Application for Land Use Permit(*Non-shorela d*) ,
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County of Sawyer --- V � �
PO Box 676 -Haywazd WI 54843 �
715/634-8288
*Properiy that is not located within 300'of a creek,river or stream or within 1000'of a p� a
flowage,lake or pond or does not have any of the above waterbodies located within � �
the property's boundaries. W
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. �
PRINT-USE BLACK INK OR PENCIL
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I LG e�i� `J/F/ti(C a �
Owner Builder �' �
/���� W. C��� N-� il �.Q ����� w. C���-Y l�;u ►�Q o:
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Mailing Address � Mailing Address � �
/-��/,�a-�r.Q i,JT ��$�F3 /-��a�r��a� �z 5�F&�� �
City, tate,Zip City,State,Zip �
7/S �.��'00�� 7/S—/S'7-�t�g7 \f\�
Daytime Phone Daytime Phone �
Additional Information: Zone District: �' �
Lot Dimensions: ,��{0 �����5��� y�
Date lot was created: � �u �oc� Acres: J� n ( 1
� 1 o �
Is there wetland neaz the proposed structure?If yes,how faz �IJ�O G
Building Land Use Floodptain-f j Yes (�No :;
( )New ( )Filling �
O Addition O Dredging Driveway access off of a(Check one): �
O Alteration O Grading O Private Rd O Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy ; �
� ) � ) � �
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Primary Structure Accessory Building Addition � �
( )Dwelling ( )Garage-attached/detached ( )Deck W
( )Yeaz round ( )#of caz stalls ( )Porch �.
O Seasonal (�Storage Building O Enclosed �
O Frame built on site O Screenhouse O Living room U�
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen 1�
( )Mobile/manufactured ( )Other ( )Bedroom p _
( )Other primary structure ( ) ( )Relocate/enlazge '
� ) � )
Additional Information: \ p
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Type of Construction: W � �
( )Frame ( )Log (�(Pole/metal ( )Block ( )Concrete � I�,,
( )Other �
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Construction Cost:Primary Structure$ o���O�U � �
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Accessory Building:$ Addition:$ � �
Deed:Vol 1 d� Pg /7 7 Certified Soil Test# 0 3 -3�� °O z
CSM:Vol�_Pp,3Z1-3d�ot# �-- Sanitary Permit# D 3— �f�( � �
Plat Envelope Or: N �
Condo Vol Pg Yeaz Installed: �
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Aff of ex septic Vol Pg Owner When Installed:
Y� �
Previous office approvals/actions: - v
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Variance:# LUP:# O3 7O�� SP:# CUP:# �
Inspection Report:# Change of Zone District: �\�Ip�'�
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12y3 �
Describe the construction using these columns. List the dimensions of each structure in a separate
column. List each story, each addition, each alteraHon in a separate column. °
#1. #2. #3. #4.
Size � ft. wide ft. wide ft. wide ft. wide
�a' fr. long ft. long ft. long ft. long
Floor azea '��'� sq. ft. sq. fr. sq. ft. sq. ft.
Hgt from g�ade to peak ft. hgt. ft. hgt. ft. hgt.
Stories stories stories stories
# of bedrooms
Rear Lot Line
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Fire Number and Name of Road /f�S„2 S /�x+-r i r �� ���`Z
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1. Enter lot dimensions and indicate north by arrow. Signa�uf' Owner r Aut orized Agent:
2. Indicate the location and size of the requested construction �
gnaWre
activities.
PnntName:
3. AISO, indicate the location and distance to the well, The above certlfies that the listed information and imentions are
true and cronecL, that all work shall be pedormetl in compliance
septic tank and drainfieid, wetland azeas, lot lines and to the with the requirements of ihe Savryer County Zoning Ordinance
and �he laws and regulations of the State of Wisconsin, and if
CCRtEi11RC Of tI1C i0ad. acting as owner(s) agent, has the permission of the owneQs) to
perfortn the work requested on this appliption. The above
persons/s hereby give permission for aaess to the property for
onsite inspectlon.
Permit fee: $ ���
May 4 , 2004 ����,.r� �C '�c! -.�2��u 7� �
Issue Date Signature of Issui g A nt� �
May 4 , 2005
50% Rule: Average Road Setback:
Expiration Date
Office Comments: NO�' � h� �'� �O�' CA7c'c�`I`cti'e-2C.lAQ �� O� �^'��-
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010-941-21 2103 oN oh -21 2117 p �
� PRIVATE ROAD � � �
1 66' WID1H. 1
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1 � \ NOTE� GAPS EXISTS BETVEEN I -21 2116
010- 41-21 ADJ�INING PARCELS. 010-941-21 5
Z � �,�, � ADDITIONAL RESEARCH OR 2>>4 010-847-21 2106 ��� 21�1$ 2� 1p�p_g+�
�,F�� � � \� RE�UIRED. RK MAY BE -21 2715
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� op�941 4A i01022�-00 2f ie i 070-130-00 NOTE� GAP EXISTS
010-941 � 0700 BETYEEN ADJOINING
-21 2309 -y� 2317 � ' -- --- PARCELS. ADDITIONAL
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w� p ♦ i �O` a WORK MAY BE RE�UIRED.
w� A�`�ry i ? �Jp � �o $'o 070-736-
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a"I � 5 9A'Oi � � 20�S 9$ 6 HAYWARD HEICHTS
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BEfVEEI/ I10.10INING CS/Mi 1 N O O O ACREAf� AND OMNfR. SIIOYM
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Sl/tVET VOqK MAT 1E � N i 2700 PMCQ NM. fUTNER
REOUIPE3 pON i 27 pO \ �,O 2 RESEARq1 YAY BE REWWED.
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r i 010-130-00 �%y', �i i $ occua�na+ enseuer+t �
1N 3 2 O1 � 2800 16 Yi�S 13 �� � ,�$ 878/329 OF DEEDS
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SHOWN AS 66' WIDTH FOR � SHOWN AS 66' W1DTH FOR MAPPING C
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