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HomeMy WebLinkAbout024-641-22-4101-LUP-2004-396 . � Application for Land Use Permit(*Non-shoreland*) o o . County of Sawyer � PO Box 676 -Haywazd WI 54843 O 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. , PRINT-USE BLACK INK OR PENCIL - � �, 4 ._ c� � �� � �-�"' a, Owner Builder N' � `(,� _ ' .` �• � Mailing Address Mailing Address � =R Ciry,State,Zip ;'� �. �-.�' � City,State,Zip Daytime Phone Daytime Phone / Additional Information: Zone District: �'�R-� Lot Dimensions: Date lot was created: Acres: �y•l� n Is there wetland near the proposed structure?If yes,how faz � Building Land Use Floadptain:( j Yes ('f�No =° � (�V�New ( )Filling � O Addition O Dredging Driveway access off of a(Check one): � O Alteration O Grading (�)Private Rd O Town Rd. o O Moving On O '( )County Hwy O State Hwy r."', � � ) � ) o � t" Primary Structure Accessory Building Addition � ° �lDwelling ( )Garage-attached/detached ( )Deck w �('J Year round ( )#of caz stalls ( )Porch �= O Seasonal O Stoxage Building O Enclosed � O Frame built on site O Screenhouse O Living room ( )Modulaz/manufactured ( )Greenhouse ( )Kitchen ( )Mobile/manufactured ( )Other ( )Bedroom - ( )Other primary structure ( ) ( )Relocate/enlarge � � � � ( )#of new Additional Information: � � � 0 Type of Construction: (7)Frame ( )Log ( )Pole/metal ( )Block ( )Concrete ( )Other .ti � Construction Cost:Primary Structure$ � � � Accessory Building:$ Addition:$ � � �857'7 �, Deed:Vol Pg Certified Soil Test# ��/'//S � Z CSM:Vol Pg Lot# Sanitary Permit# �y'.�SB o. � Plat Envelope ��� � I Condo Vol Pg Year Installed: � � Aff of ex septic Vol Pg Owner When Installed: w Previous office approvals/actions: Variance:# LUP:# SP:# CUP:# zI0`� Inspection Report:# Change of Zone District: $� f � aUNlO ,i��... . � 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. �-o �I- #3. i�e,�' #4. Size ft. wide �� ft. wide � o ft. wide ft. wide ft. long zco ft. long o� �e ft. long ft. long Floor area sq. ft. yl � sq. ft. z(�� sq. ft. sq. ft. Hgt. from grade to peak ft. hgt. ft. hgt. ft. hgt. Stories stories stories stories # of bedrooms {35 y Rear Lot Line :;� ;' �� � ��: ,. g " / ^�� t «.-. ,�..,-�� . � ..._y^<.� �' / � � � � � ✓'r , .� , ""�;:'�` , s:' { �. - ' � �.� � -� "�'�`�,v ���.. y� „`^^...... � � �� ,. �� � . 4 �� � ' � ' D �: �(�,� " ,� � ,� .�� U� r' - � , � - 1 1� � i � r i 4 � t � R a � • i • � Fire Number and Name of Road y � ' ;` � � , 1. Enter lot dimensions and indicate north by arrow. Signature of Owner or Authorized Agent 2. Indicate the location and size of the requested construction ,t i` ° �� Sign�ture activities. � ,��} � � ��� j � ,��� ,> Print Name: 3. Also, indicate the location and distance to the well, The above certifies that the listed i formation and intentio�e true and correct., that all work shall be performed in compliance with the requirements of the Sawyer County Zoning Ord�nance septic tank and drainfield, wetland areas, lot lines and to the and the laws and regulations of the State of Wisconsin, and �f acting as owner'(s) agent, has the permission of the owner(s) to centerline of the road. perfo�, the work requested on this application. The above personsls hereby give permission for access to the property for onsite inspection. Permit fee: $ 3� °�'� Au�ust 4 2004 + Issue Date Signature of Iss in ent August 4 , 2005 50% Rule: Average Road Setback: Expiration Date Office Comments: � _--- , %= ,�.......----�5" j'""_,__.....,....._� i ����~'•�r{ �� ��� , �' i � •, • i� I' I � .r � i � , � I I. 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