HomeMy WebLinkAbout024-741-04-2101-LUP-2004-273 � Application for Land Use Permit (*Non-shoreland*) o
County of Sawyer � � ,
PO Box 676 - Hayward WI 54843
715/634-8288
*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.
�y� `C� ��T—USE BLACK INK OR PENCIL � `
^ . Y'� 'f"5c�i v � 1N�. t"� - .� C'h�r��^ � i�
�.�;v� � 'I ' �t�'t Y�: a
Owner Builder �:
�I�1�r� �� S��-���a�� ���� ����►��. � �
��
Mailing Address Mailing Address �
L` Z.�:'L�� ���� � ��� -� �cz�'1� � �
Cit , State, Zip City, State, Zip �, J
�(�— ���— ����1 ��r �'►�t.�� �
Daytime Phone Daytime Phone
Additional Information: Zone District: ��� �
�
Lot Dimensions: �r�;� I;3�a'JC 1��C'�
Date lot was created: � Acres: �;� �� n
0
Is there wetland near the proposed structure? If yes, how far � �
Building Land Use Floadgtain:( j �es �No '
( )New ( ) Filling �
O Addition O Dredging Driveway access off of a(Check one):
( )Alteration ( ) Grading ( ) Private Rd ( ) Town Rd. o ��
( ) Moving On ( ) ( ) County Hwy �State Hwy N �'j
� ) � ) o �
� r
Primary Structure Accessory Building Addition � °
( ) Dwelling ( ) Garage-attached/detached �Deck W
( ) Year round ( ) # of car stalls Porch �
O Seasonal O Storage Building O Enclosed �
Screenhouse ( ) Living room
( ) Frame built on site ( ) " �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen �,
( ) Mobile/manufactured ( ) Other ( ) Bedroom �"'
( ) Other primary structure ( ) ( ) Relocate/enlarge � '
� � ( � ( ) # of new � �
�: ��
AdditionalInformation: �, �
�C �
6 �
Type of Construction:
(,� Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete � �
�
�
( ) Other � ,,�
Construction Cost: Primary Structure $ � �
�
Accessory Building: $ Addition: $ /� d�"�:s — � r
�. 3aiq5� � !
Deed: Vol S�/� Pg���/�' Certified Soil Test# �`' z
CSM: Vol Pg Lot# Sanitary Permit# � %�
Plat Envelope Or: �;
,, ._ �, �
Condo Vol Pg Year Installed: `�--� � ' `� �
Aff of ex septic Vol Pg Owner When Installed:
� �
4
Previous office approvals/actions: ,
Variance: # LUP: # SP: # CUP: # �
Inspection Report: # Change of Zone District: �,t�
� q� ,�
'� �
au���
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. �
#L n�c bL #2. #3. #4.
Size�ft.wide ft.wide ft.wide ft.wide
�ft.long ft.long ft.long ft.long
Floor azea�sq.ft. sq.fr. Sq�ft• S4•fr
Hgt.from grade�to pealc ft.hgt. fr.hgt. fr.hgt.
Staries stories stories stories
#of bedrooms
Rear Lot Line
�-fP,�x
�� 1���I
�� r \
� a�'
;� � �w�
�� ':\_�' �ay'-� ��,w,�
�� ���o�°��w� � f 1.31' —
�a: '
I.2�t' 3• W��
�
�4� �aus� yyi
� ��Iti��
au� _y 'J�
���
4�-
__ __
-- __ _;_ — _ _ _
�-- � 7 _
S�� ��= _
Fire Number and Name of Road �I�I 3 � S�-'k f��`'�' 7 7
1. Enter lot dimensions and indicate north by arrow. Sig�re of Own� 1'Authorized Agent:
2. Indicate the location and size of the requested construction �,.,,,, ��c 1 �`
Signature
activities. L, ��/.f-�S�,y,�
PnnWame: �7e v'�/
3. Also,lndicate the locatlon and distance to the well, The above cedi�es tnat the Ilsted information and intentions are
irue and cortect.that all work shall be pedormed in compliance
septic tank and drainfield,wetland areas,lot Iines and to the w�m me reqw�eme�ts or ma sa„�ye�co�ory zoo��9 o�dmaoce
and the laws and regulations of the Shate o(Wisconsin.and if
C0riY0Illri0 Of t118 T08d. acting as ownef(s)agen�,has the pertnission o(the owner(s)to
pedorm the work requested on lhis application. The a6ove
personsls hereby give permission for access to the property for
onsite inspection.
Ot.
Permit fee:$ 75
TnnP 7 5, 7004 —
Issue Date Signature of ssuing Agent
3��u ��
June 15, 2005 50%Rule:y�J��,_ Average Road Setback: _
Expiration Date t�Crµ,dXv�:�
�
Office Comments: ��-�' �-� �3- �'�' y ` 7a y� � ��' I �
��oOC� ��a, ly� � 3°1v � .
�l7°7� �.o�+c��'��`
TOW N OF ROU �1L
�EC. 4 TW P 4 f N.
g 33
� �
N
�0
I
.6.I .5.I
�
� 7.► .8.I
�
3
3 .io.i q.l
�
I 1.2
.I I.
I i.4
.��,� �2.�