HomeMy WebLinkAbout024-641-14-1403-LUP-2004-575 Application for Land Use Permit(*Non-shoreland*) o o -��
County of Sawyer �
PO Box 676 -Hayward WI 54843 �
715/634-8288 J
*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 �
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Owner � �
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Mailing Address Mailing Address O� �
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City,Stat Zip City,State,Zip
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Daytime hone aytime Phone
Additional Information: Zone District: le�`� �
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Lot Dimensions: `�-
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Date lot was created: J�'�-�� Acres: /: c� o �
Is there wetland near the proposed structure?If yes,how far �
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Building Land Use Floodptain:� j�es (�No �
(�New ( )Filling �
O Addition O Dredging Driveway access off of a(Check one): � �
O Alteration O Grading O Private Rd �.Town Rd. o
O Moving On O O County Hwy O State Hwy i."'i G�
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Primary Structure Accessory Building Addition � °
�/�Dwelling ( )Garage-attached/detached ( )Deck w
y( Yeaz round O#of car stalls O Porch =
Stora e Buildin ( )Enclosed `D
)Seasonal ( ) g g � �
O Frame bui1C on site O Screenhouse O Living room
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen �Ct TI
( )Mobile/manufactured ( )Other ( )Bedroom
( )Other primary structure � ) ( )#of new�enlarge � �
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AddirionalInformation: � �
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Type of Construction: . �
( )Frame ('�l Log ( )Po1e/metal ( )Block ( )Concrete
( )Other .tiy �
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Construction Cost:Primary Structure$�G�✓ �
Accessory Building:$ Addition:$ *� �
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Deed:Vol.�/�_Pg�_ Certified Soil Test# '�:-L�Z�/ - z
CSM:Vol�Pg�Lot#_�_ Sanitary Permit# �-G�`/�y� b, �
Plat Envelope Or: i� �
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Condo Vol Pg Year Installed: � �
Aff of ex septic Vol Pg Owner When Installed:
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Previous office approvals/actions
Vaziance:# LUP:# SP:# �UP:#
Inspection Report:# Change of Zone District c��I��
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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.
#L i—�o�Sf #2. �ltzaV,.fl,�.,� #3. #4.
Size 1-lv ft. wide �i�ft. wide ft. wide ft. wide
�fr. long `�`'� ft. long fr. long ft. long
Floor azea_��sq. R � ��I�I S9 fr Sq. g, sq. fr.
Hgt.from gade_�to peak ft. hgt. ft. hgt. fr. hgt.
Stories_�_ stories stories stories
# of bedrooms�_
Rear Lot Line
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Fire Number and Name of Road L.[�� l �- i�t�� l /S 3
1. Enter lot dimensions and indicate north by arrow. Sign3 u of Owner o�Author'zed Agent:
2. Indicate the location and size of the requested construction ��- :�.�-r � �"-�.r
Signature
activities. �
Pont Name: �� ' Y :.- �(J.� v � r�9 9S
3. A1So, 1ndlCate the IoCatlon and d15tanCe to the Well, The above ceRifes Uat the listed information and inten ons are
hue and correct., ihat all work shall be performetl in compliance
SeptiC tatllc and dlalnfleld, wetland areas, lot 11nes ancl to the with the requirements ot the Sawyer County Zoning ONinance
and the laws and regulations of the State of Wiscronsin, and if
centerline of the road. ading as owner(s)agent has the permission ot tne ovmer(s)to
peAorm the work requested on this appliration. The above
personsls he2by give permission for aceess to the property for
onsite inspection.
Permit fee: $ �C�'i
October 13, 2004
Issue Date Signature ofIs in gent
October 13, 2005
50% Rule: Average Road Setback:
Expiration Date
Office Comments:
�OUND LAKE .
14 TWP 41 R. 6 W
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CERTIF{ED SURVEY MAP N0.
SE 1/4 -NE 1I4 SEC. 14, T41N, R6W
TOWN OF ROUND LAKE
SAWYER COUNTY , WISCONSIN
N,V4 COR. 9EC. 1� 2680.12� NE. COR. SEC. 11
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LEGEND �
�� SCALE- 1�� = 60�
j�- — FOUND 2" I.P. LAPPEO W�TH � �
T D" 6RON2E 7ABLET '0 �` J/
'.By ��$GDIY$/� Y
o — ser i" x z4' :.v. '.��, �.' GENE C. �'•
WT.-1.15 LBS/LIN. FT. '�,� SHAFFER �
_5- 9 ��� � siaa�• � Y
� � EXISTING BUILDING ��7 �jd� ( �� •�P
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TMIS INfTRUMENT wIS DRAFTED BY G. C. S. 2-a.Q �'/ SURV
IL7./. Eu1 CLAIRE, W15CONSIM
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