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HomeMy WebLinkAbout024-741-21-3201-LUP-2004-301 Application for Land Use Permit (*Non-shoreland*) o 0 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. H <'� PRINT—USE BLACK INK OR PENCIL , ���f1/�S'�}/�L�. !U- �'// L�� ' ��/ � �r.��.��� � � � �. Owner B ilder � �: /0 63 D ,� ���. �7^ � �s i�� � (`�;��%/ � � �� Mailing Address Mailing Address "��,,.}., j � �vR�.� G�.� ,sLfl5�.3 ' � � _��- �L � Y�y it , tate, Zi � � C� , St te, Zip Y P 7/s �35��T3 (�~J�rN I�s"- � 3 y`�5�! � D ytime Phone Daytime Phone � Additional Information: Zone District: ��`� - � � � Lot Dimensions: Date lot was created: Acres: o .��U o w.. Is there wetland near the proposed structure? If yes, how far � � � Building Land Use Floadptain:( j Yes �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 ,`; � � ) � ) o � � r Primary Structure Accessory Building Addition � I o O Dwellin g Q� Garage-attached etache ( 1 Decl� W ( } Year round �# of car stalls ( ) Porch � ( ) Seasonal ( ) Storage Building ( ) Enclosed � O Frame built on site O Screenhouse O Living room � � ( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen � ( ) Mobile/manufactured ( ) Other ( ) Bedroom � � ( ) Other primary structure ( ) ( )Relocate/enlarge � � � � ( � O # ofnew � ' � � AdditionalInformation: � � � � k.'s � � r1. Type of Construction: � �C) Frame ( ) Log ( )Pole/metal ( ) Block (X) Concrete ( ) Other ,� �d �Construction Cost: Primary Structure $�//; C �'�' � �'z _ � T (p .--. Accessory Building: $ Addition: $ � .-. � Deed: Vol a39 Pg�_ Certified Soil Test# °Q z CSM: Vol Pg Lot# Sanitary Permit# o, � Plat Envelope �r� N � Condo Vol Pg Year Installed: c� Aff of ex septic Vol Pg Owner When Installed: " � � Previous office approvals/actions: � Variance: # LUP: # SP: # CUP: # a Inspection Report: # Change of Zone District: �\\b �\ � 25�ay , � 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. ���f�� #2. #3. #4. Size�__ft. wide fr. wide ft. wide ft. wide _','�? ft. long ft. long ft. long ft. long Floor area �'yG sq. ft. sq. fr. sq. fr. sq. ft. Hgt.from giade��to peak ft. hgt. ft. hgt. ft. hgt. Stories� stories stories stories # of h_.�.�- � Y � �� Rear Lot Line . `. . .� F � �r.� � r , r_ ��`,l � ` �.., ' , � "'��..��'��% r . , � _._ � ^' , •;� �k�i . I ll �„�,a�'q y� . N�'�,i �s � i � i3,, ��,�` ,YC I4 'ro �.r. .`o {So � ��,� �� I �,a,.s I� il �� _ _... — if S£r - .--�.__-__�__,� , � 3s � � � � �- ��,_. ; r i> � � _ ��+ �� • ` Fire Number and Name of Road ��D�t) ����- � � E �k.T '� � '`e`� 1. Enter lot dimensions and indicate north by arrow. Signatur�e of�0 ner or Authofized Agent: 2. Indicate the location and size of the requested construction __-����-�'�"`_,/�1�� SignaNre activities. ���qyrA((. � �'f�LL�� PnniName: 3. Also, 1ndtCate t}le loCatlon ancl diStanCe to tlle wel], The above cerlifies Ihat the listed information and intentions are true antl cortect.,that all work shall be performed in compliance Sept1C tarilC and CITHlnfleld, wetl3rid azeas, lot Ilnes and to the wiN the requiremeNs of the Savryer Counry Zoning ONinance and the laws and regulations of the State of Wisconsin, and if CCRYCPI1riC Of thC I08d. acting as ownel(s)agenL has the permission of the owner�s)to perform Me work requested on this application. The above personsls hereby give permission for access to the property for onsiteinspection. o�. Permit fee: $ /VO June 28, 2004 ����2������'� Issue Date Signature of Issuing Agent TimP 9R_ 7n05 50% Rule: AverageRoadSetback: Expiration Date Office Comments: - �--- -Wr - -. .__ � / _ --..ay.. . - , . . .. �-�'_-------__---------------- + / � � _ � . __ -----�---� " � . , ,,./~ ' ' � � � � . _._ . ., . � � i i � rl � ; i , '. i i � � + � � i� ��G/' ^ ���� Z�Z/• j� � /� ' �j� � i �j�.\� �+'�� r/ � I �� '�j' � � � � I I I ; , ,��_j I � ; ; ; ; �� ; � - ----- - ,------ I ------ -_-- _ ___ __ - -------- - ------- ' i I � O�N I �� � � 1 I ' ��� I I , .`' I � � , ,�/N � \ .I ^' 'p'� I �` 1 � I � � � � � � � � ' oz ,� , , - --- , , . . , � �� � ��, ��� � � �� � .�, � � �, � �c 8. , \ � ! � � �� t'� N � ��, � .�,�.� o� � . � � �\�,�'�� I� � V \ ��� � . 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