HomeMy WebLinkAbout024-841-13-5206-LUP-2004-406 , No�► — X � .
Application for Land Use Permit(*Shoreland*) o /,�
" County of Sawyer �
PO Box 676 -Hayward WI 54843 �
715/634-8288
*Property that is located within 300'of a creek,river or stream or within 1000'of a 1
flowage,lake or pond or has any of the above waterbodies located within � L
v �
the property's boundaries.
CONSTRUCTION SHALL NOT BEGIN UNTTL ALL REQUIRED PERMITS HAVE BEEN ISSUED. r �
PRINT—USE BLACK INK OR PENCIL �
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Owner � Builder a �
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Mailing Address Mailing Address ' O
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City,State,Zip City,State,Zip
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Daytime Phone Daytime Phone o �
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Additional Information: Zone District: �2- � �
t c,r�r� �r�
Lot Dimensions: 3�� �9 0� T'�1'
cc� r,a
Date lot was created: Acres: � • � � �
Is there wetland near the proposed structure?If yes,how far o `� �
B ilding Land Use Floodplain:O Yes O No � ,�
�l New O Filling Chippewa Flowage:O Yes O No y Z
O Addition O Dredging Driveway access off of a(Check one): '� ZL
( )Alteration ( )Grading �Q'Private Rd ( )Town Rd. �
( )Moving On ( ) ( )CounTy Hwy ( )State Hwy °0 �
� ) � ) � S
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Primary Structure Accessory Building Addition o 0
( )Dwelling ( )Garage-attached/detached ( )Deck � n`
O Year round O#of car stalls O Porch �, ���
( )Seasonal �}.Storage Building ( )Enclosed �
O Frame built on site O Screenhouse O Living room �c
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen ",
( )Mobile/manufactured ( )Other ( )Bedroom O �
O Other primazy structure O O Relocate/enlazge 1`'
� � � � ( )#of new i
�
AdditionalInformation: �- p
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Type of Construction: �
�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete '
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( )Other o .�
Construction Cost:Primary Structure$ �
ro
' Addition:$ � ,'�.
�F,ccessory Building:$�`L3 O O • "�
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Deed:Vo13`�'2- Pg ��� Certified Soil Test# 83'/'�� �, z
CSM:Vol � Pg�ls=Zl�ot# �� Sanitary Permit# 8�-�SZ � �
Plat Envelope ��� Or: � �
Condo Vol Pg Year Installed: N �
�
"Loads and Flows": Vol Pg Owner When Installed: �
Previous office approvals/actions: �
Variance:# LUP:# 96-�SP:# CUP:#
Inspection Report:# Change of Zone District: �I�a�o,�
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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, eac alteration in a separate column.
#1 . #2. #3. #4.
Size ft. wide ft. wide ft. wide ft. wide
ft. long / �o ft. long ft. long ft. long
Floor area sq. ft. � � � sq. ft. sq. ft. sq. ft.
Hgt. from grade to peak � ft. hgt. ft. hgt. ft. hgt.
Stories �_ stories stories stories �
# of bedrooms
��
Lake/Pond/Flowa e/River/Stream ame r�)
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1. Enter lot dimensions and indicate north by arrow. nature o w r or Authorized Agent:
2. Indicate the location and size of the requested construction
Signature
activities. .�e M�y � ��MM = ��+p
Print Name:
3. Also, indicate the location and distance to the well, The above certifies that the listed information and intentions are
true and correct., that all work shall be performed in compliance
septic tank and drainfield, wetland areas, lot lines, with the requirements of the Sawyer County Zoning Ordinance
and the laws and regulations of the State of Wisconsin, and if
centerline of the road and waterbodies. a�t��s as oW�er�s> a9e�t, has the permission of the owner(s) to
perform the work requested on this application. The above
personsls hereby give permission for access to the property for
� � onsite inspection.
Permit fee: $ � � �
Total land area wrt i ' of the waterbod A t� a � � � � � � �� � K � z� � � t o S q E-'��—
Y� � )
Total impervious surface area [inclu ' ro'ec � � '�
(B) / (A) x 100 = % Used (Shall not e %[or 25% with a conditional use permit].)
Shoreline V ion Protection Area: Mitigation Required? O Yes
Issue Da est � Signature of Iss g ent
August 4 , 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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