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Home My WebLink About024-741-19-5214-LUP-2004-378 _ - . / m �.��,��. Application for Land Use Permit (*Non-shoreland) r ,� • . 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. (�j�/ CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. � PRINT-USE BLACK INK OR PENCIL � �� I�A awd IY11 �NA� � G o F B F rvry�„� y � �2i3 G g � _ � Owner �a �� Builder ¢: r�LF G/� �' \ �� y,jdc,u �ia� 53hs rY1� ?�� 7 0. Mailing Address Mailing Address � p fi�A�w�9-/i-� !,u ! S'��5�3 � � �12 N � '�- City, State, Zip City, State, Zip �` 7�5—y�a —�y7� �t8 ��aqsJa�d � Daytime Phone Daytime Phone �-� � Additional Information: Zone District �R. � � - � Lot Dimensions: � �� u �'d t �, Date lot was created �. U o� Acres �•�$3 . Is there wetland near the proposed structure? If yes, how far �d . Building Land Use ( )New ( ) Filling Floodplain: ( ) Yes ( )No # o ' O Addition O Dredging Driveway access off of a (Check one): � � ( ) Alteration ( ) Grading ( ) Private Rd ( ) Town Rd. � ( ) Moving On ( ) Commercial ( ) County Hwy ( ) State Hwy � � � ) � ) ,°c� r Primary Structure Accessory Building Addition ' . � O Dwelling � Garage-attached etached O Deck r� O Year round (J�# of car stalls O Porch � ( ) Seasonal ( ) Storage Building ( ) Enclosed �� O Frame built on site O Screenhouse O Living room ( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen � ( ) Mobile/manufactured ( ) Other ( ) Bedroom Relocate/enlar e ��_;, A ( ) Other primary structure ( ) ( ) g O Single family or multi-unit O O # of new Additional Information: �� ' � � � � Type of Construction � - (�.Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete � � ( ) Other � y Construction Cost: Primary Structure $ ��So O , , � Accessory Building: $ Addition: $ � � � 3 � �`�°y Certified Soil Test# U y' v Q 6 � Deed z CSM Vol �3 Pg a7�J Lot# /-�3 Sanitary Permit# 4 ��— � �� - � Plat Envelope %� 6 y37 Or: � Condo Vol Pg Year Installed � Aff of ex septic Vol Pg Owner When Installed: Previous office approvals/actions: Variance: LUP: SP: CUP: Inspection Report: Change of Zone District: 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 .� C #2. #3. #4. Size � � ft. wide ft. wide ft. wide ft. wide 22 ft. long ft. long ft. long ft. long Floor area /8 y sq. ft. sq. ft. sq. ft. sq. ft. H�rt. from grade � to peak l b ft. hgt. ft. hgt. ft. hgt. Stories _� stories staries stories # of bedrooms �/�- Rear Lot Line �'� � G�� Fire Number and Name of Road I q3D � � �-�`�— 1 . Fill in lot dimensions and indicate north by arrow. Signatur�wner Aut orized Agent: 2. Indicate location and size of existing and new structures. Signature 3. Indicate location of well, septic tank, drainfield. � / �� L p� �U�� Print Name: 4. IndiCate diS�anCe t0 existing StT'uCtures, lot lines, SeptiC system. The above certifes that the listed information and intentions are true and correct., that all work shall be performed in compiiance 5. I11diCate distance to the ordinary hlgh-WateT' mark of any lake, with the requirements of the Sawyer County Zoning Ordinance and the laws and regulations of the State of Wisconsin, and if acting as owner'(s) agent, has the permission of the owner(s) to pOrid, I1VeT', StT'eaTll, CTee1C, 2rid riaTTle t11e bOdy Of WateT'. perform the work requested on this application. The above personsls hereby give permission for access to the property for 6. Indicate Vegetative buffeT ZOT1e. onsite inspection. 7. Indicate size and location of all impervious surfaces. 8. Indicate any grading or clearing in excess of the construction site. Permit Fee: � � �� ' �� _ 9. Indicate distance to any wetland. r-. �+ a � — Issue Date Signature of Issuing Agent `�'A,�' ..��1 .�GO �' Expiration Date Office Comments: Total % impervious surface: Mitigation required: Restrictions and other information: 1-'ri�4+e ��,�2 �QS�,n,c,Nt" 0 a � Q �or�,t� c—_ '� 3z � � 50' a' �u a� fl � ,�v $�o u s A-- o��r --� `f� �4� � � wrU. 5�� 33�v Application for Land Use Permit(*Non-shoreland*) o o • County of Sawyer � � �� PO Box 676 -Hayward WI 54843 715/634-8288 c *Property that is not located within 300'of a creek,river or stream or within 1000'of a •y flowage,lake or pond or does not have any of the above waterbodies located within = the property's boundazies. W � CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. � PRINT-USE BLACK INK OR PENCIL � �� s I�c•/ ,Et�{� � C M��,�,I�c�u G� o t�.— �.� a I Owner , Builder �: 1a339 G�-U//�► A�,Nc., Po Box Q�? �� t , , Mailing Address Mailing Address / � O �\t uu-�.o.�t FL. 3y7�� wp�co ��r. s-�r�_ � City,State,Zip City, tate,Zip � �1�7— 3r6 —3�G/ ��,fi-- G3 y— .�cr6 � � � Daytime Phone Daytime Phone �- � Additional Information: Zone District:��.—1-- + � i� Lot Dimensions: �Z.a'X S�O� � Date lot was created: o�d 0 3 Acres: � �83 n \ Is there wetland near the proposed structure?If yes,how faz �� . Building Land Use Floodptain:( j Yes (�No =+ �` � (�}New ( )Filling �, O Addirion O Dredging Driveway access off of a(Check one): � O Alteration O Grading (7�Private Rd O Town Rd. o ( )Moving On ( ) ( )County Hwy ( )State Hwy N � O O o S r Primary Structure Accessory Building Addition � ° p"j Dwelling O Garage-attached/detached �Deck w t� (y�Yeaz round ( )#of car stalls ( )Porch � O Seasonal O Storage Building O Enclosed � O Frame built on site O Screenhouse O Living room " b¢I�4odulaz/manufactured ( )Greenhouse ( )Kitcben � ( )Mobile/manufactured ( )Other ( )Bedroom � O Other primacy structure O O Relocate/enlarge �� ( )#of new "� AdditionalInformation: �� . �'JP�F c:� �n� �� '� � � q�c � � Type of Construction: u -� (�QFrame ( )Log ( )Pole/metal ( )Block ( )Concrete � ( )Other .ti a /.� DUU � � Construction Cost:Primary Structure$ � Accessory Building:$ Addition:$ � 'C t�a�6 90 y � � Deed:Vol Pg Certified Soil Test# ��/� �'�� - z CSM:Vol ,�3 Pg �7 Lot#� Sanitary Permit# U t/— /U� a� � Plat Envelope ��Oy37 Or: N v � Condo Vol Pg Year Installed: �? � p Aff of ex septic Vol Pg Owner When Installed: Previous office approvals/actions: � Variance:# LUP:# SP:# CUP:# lnspection Report:# Change of Zone District: 7Nbl�y 2553 � Descri6e 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. O� #2. (r�,l� —J�t-rc� #3. �t-l�- #4. Size�ft. wide _�ft. wide �Y fr. wide fr. wide �_ft. long � ft. long % ft. long 8. long Floor azea i�yo sq. ft. !�' sq. ft. �% sq. ft. sq. ft. Hgt.from grade�to peak�ft. hgt. �ft. hgt. ft. hgt. Stories ( �,stories t stories stories # of bedrooms <— Rear Lot Line ��J�..IZ, Dri U�- cu�^^- � �1 G� � .�-�" ` ivR�-U � I y � �u�lc 7�� l�o P�'� c �3�, Fire Number and Name of Road ff Fh-v c� �� 0/(�- 1. Enter lot dimensions and indicate north by azrow. Signaturo of Owner or Authorized Agent: 2. Indicate the location and size of the requested construction J11�,�, l� 1- �� mre activities. � � . � (o�,.�, PtlntName:�� !C�'IGr 3. A1So, indicate the location and distance to the well, The above certifes ihat the listed iniormation and imentions are true and correct., that all work shall be peAormed in compliance se tic tank and drainfield, wetland azeas, lot lines and to the with the requirements of the Sawyer Counry 2oning Ordinance p and the laws antl regulations of the State of Wisconsin, and if CentCtllne Of tI1C 2o3d. acting as ovmer(s)agent has the permission of the owner(s)to perfortn the work requesled on this application. The above personsls hereby give permission for atcess to the property for onsite inspection. Permit fee: $ c?00 � 50 c`750 July 27 2004 — (�tl� Issue Date Signature of Is ing nt July 27, 2005 50% Rule: Average Road Setback: _ Expiration Date Office Comments: � � �� ;2.i � / � '� �, `r ✓ 2.2 2.5 �� I ;2.8 � `l :2.6 � ` \ � � � ��` �� G ��_ �2.7 :I'� t2.3 � � �_a�._t_._ --- i �''3 Asu , - � '2.13 ' I :2.14 ;2 :2.15 � :I. ,2.11 3 .2.1 4 �2.17 � :2.IZ . 2.9 � , I.I 2 :2.10 � �3�� 3\3�3 :3.1 :3 \2 � �' ^ •.3�� \ ✓ ^ '3\5 i 5 ✓ ✓_ 3.4 6.3�6 ,�:3�? :3.1.8 i 5.3� 3 � a :3�9 :3.7 3.1 I 2 I 3$ �� \ ROUND '� :3z � \ :4.1 L AKE � :4.2 �4.10 � \ � / /i � � / / � / � i � �\ z � / / � I � � �6.3 / � 2 3 2 6.4 / i ro � � " :7.7 6 � , i, 2 .6.6 N � t� '�• r .1�` 6.7 f :q.l� :7.9 � � t e c�R.�-� � c �� .�.v �Y M�� _ Q��k ►� (�o�c�K►�c�k (,c� 2, hu,r�� a�a�� v�1 �ou�, o� R�uha (�k� S�u��cr�OuhkT, WiS�o�siv� v � � �_ � �...q 5 • ~ ��.00 ` �� $ �` �qt•5'i� 1 ��ti�9 i IJ �9 0 �lb• . /� 1 i � � � D I .— ,,°�� 1 �JwJ fi- � r � � 1 �, s� �• ; o�' 3 0 2 � � � � e e� �/ ' R� n " � C �S � A i o 2 �. 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