HomeMy WebLinkAbout024-841-12-1402-LUP-2004-309 Application for Land Use Permit(*Non-shoreland*) o o �
County of Sawyer �
PO Box 676 -Hayward WI 54843
715/634-8288 7�
*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 j
the property's boundaries. �
CONSTRllC��N SHr L NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED.
/( PRINT-USE BLACK INK OR PENCIL � �
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Owner Builder <�
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Mailing Address Mailing Address �
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City,3tate,Zip City,State,Zip � .
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Daytime Phone Daytime Phone �
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Additional Information: Zone District: ��-� �
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Lot Dimensions t�2�-�
Date lot was created: � Acres: � n �
Is there wetland near the proposed structure?If yes,how far � G �
Building Land Use Floodptain-( j Yes �No ����°
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( )New ( )Filling ��
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��Addition O Dredging Driveway access off of a(Check one): �
O Alteration O Grading O Private Rd �Town Rd. o �
( )Moving On ( ) ( )County Hwy ( )State Hwy N—"�j
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Primary Structure Accessory Building Addition � °
1�1 Dwelling O Garage-attached/detached O Deck W v�
�Yeaz round O#of car stalls O Porch � 4i
Stora e Buildin ( )Enclosed
( )Seasonal ( ) g g �
O Frame built on site O Screenhouse O Living room , �l
( )Modular/manufactured ( )Greenhouse ( )Kitchen
( )Mobile/manufactured ( )Other ( )Bedroom �
( )Other primary structure ( ) ( )Relocate/enlarge `�
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AdditionalInformation: �_j '
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Type of Construction: ✓
�J Frame ( )Log ( )Pole/metal ( )Block ( )Concrete t� )'�
( )Other .d �-]
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Construction Cost:Primary Structure$ o
Accessory Building:$ Addition:$ � -
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Certified Soil Test# '7 t$-3� °Q
Deed:Vol yYB Pg Z� � z
CSM:Vol Pg Lot# Sanitary Permit# �i�zZ y b, �
PlatEnvelope Or: N '`�
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Condo Vol Pg Year Installed: � �
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Aff of ex septic Vol Pg Owner When Installed: j
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Previousofficeappxovals/actions: q0-27'� ��
Vaziance:# LUP:# r/B-3� SP:# CUP:# ��
Inspection Report:# Change of Zone District: �1��
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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. #2. #3. #4.
Size �O fr. wide ft. wide ft. wide ft. wide
�`-\ ft. long ft. long ft. long ft. long
Floor azea �7`5� sq. ft. sq. ft. sq. ft. sq. ft.
Hgt.from grade to peak fr. hgt. fr. hgt. ft. hgt.
Stories 1 stories stories stories
# of bedroom��
Rear Lot Line
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Fire Number and Name of Road ��� ��3 i�' ��v�-°' � '``�
1. Enter lot dimensions and indicate north by arrow. ignatufe f Owner or Authorized Agent:
2. Indicate the location and size of the requested constnzction
i nature
activities.
Pnnt Name: L���
3. Also, lndicate the location aTld distance to the well, The above ceRifes ihat the d iniortnation an ime ons are
hue and correct.,ihat all wo shall be pedormetl ompliance
septic tank and drainfield, wetland areas, lot lines and to the wnn me �q��reme�m or me sawye� co��ry zoo� o�d�oaoce
antl ihe laws and regulations of the State of Wisconsin, and if
CentePllne of tlle Toad. acting as owner(s)agent,has ihe permission ot the owner(s)to
pedorm the work requested on this applica�on. The above
personsls hereby give permission for aceess to the property(or
onsite inspection.
Permit fee: $
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June 28. 2004 �� �
Issue Date Signature of Issuing Agent
.Atnn 8, 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
' � . ' 'HILDRETH RD� � �
. SHOWN AS 66' 1NDTH FOR � �;,�� '
MAPPING PURPOSES. �
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