HomeMy WebLinkAbout026-939-11-5113-LUP-2004-004 Application for Land Use Permit o o �•
County of Sawyer �
PO Box 676 -Hayward WI 54843 �,�
715/634-8288 C
The undersigned hereby makes application for a Land Use Permit and agrees that all work -- s �
shall be done in compliance with the requirements of the Sawyer County Zoning Ordinance
and the laws and regulations of the State of Wisconsin. r-- ,
NO CONSTRUCTION MAY BEGIN UNTIL ALL PERMITS HAVE BEEN ISSUED. n
PRINT—USE BLACK INK OR PENCIL � �
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Owner Builder � O
lL�. J�3 ��T�,S �;�e �
ailing Address 1 Mailing Address � �
MN � �
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City,State,Z' �� �-�'(.; City,State,Zip �
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Day[ime Phone Daytime Phone '`�
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Additional Information: Zone District �� �'`�
Lot Size �—
A
Date lot was created I�SS 7(o Acres �• � � �
Is the property in a Shoreland District?(within 1000'of a lake or pond,within 300'of a river, '
creek or stream) If yes,how far from the shoreline&water name: �
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Is there wetland neaz the proposed structure?If yes,how far �
Building Land Use �
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( )New ( )Filling Floodplain:( )Yes ( )No # :;
�Addition ( )Dredging � o
( )Alteration ( )Grading Chippewa Flowage: ( )Yes ( )No �
( )Moving On ( ) r"
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( ) ( ) Driveway:( )State ( )County ( )Town Rd. y �
Primary Structure Accessory Building Addition
�J Dwelling ( )Garage-attached/detached ( )Deck �
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O Year round O#of car stalls O Porch
( )Seasonal ( )Storage Building ( )Enclosed _i�
O Frame built on site O Screenhouse O Living room 1 �
( )Modular/manufactured ( )Greenhouse ( )Kitchen
( )Mobile/manufactured ( )Other (�C)Bedroom - �
( )Other primazy structure ( ) ( )Relocate/enlarge
( ) ( ) ( )#of new � a
ry4 �
Additional Information: "
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Type of Construction �
( )Frame � ( )Log ( )Pole/metal ( )Block ( )Concrete �
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( )Other
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Construction Cost:Primary Structure$ - ..
Accessory Building:$ \;=�Addition:$ ,��,:`1��C7. ' ��' � Z
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Vol�Pg ��of Deed Certified Soil Test#O�/-Ob��7 4'- '�L•� W `l
CSM Vo] y Pg c-�=��O Lot#�_ Sanitary Permit#�'Q�y 7 4'` �'� I
PlatEnvelope ¢7�t Or: : � `�C
Condo Vol Pg Year�nstalled
Aff of ex septic Vol Pg Owner When Installed:
Gard Gazebo Vol Pg
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PreviousVariance: LUP:��y �i InspectionDate: �'�"-'� Ft���
a81'10
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 columu.
#1. #2. #3. #4.
Size :=' � ft. wide ft. wide ft. wide ft. wide
�� ft. long ft. long ft. long ft. long
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Floor area S�"'`' sq. ft. sq. ft. sq. ft. sq. ft. • �
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Hgt.from grade to peak ft. hgt. ft. hgt. fr. hgt.
Stories � stories stories stories
# of bedrooms a —� v:, � , , �
Lot Line or Lake/River name:
/ '
�N •�: �k���� i /� : ,- � � � � ;. r
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4
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Fire Number and Name of Road �� ��� ��� � l� I � ,�C �% �` '� i � e�'���� l�i«� �u
1. Fill in lot dimensions and indicate north by arrow. Signature of Owner or Authorized Agent:
2. Indicate location and size of existing and new structures.
3. Indicate locarion of well, septic tank, drainfield.
4. Indicate distance to existing structures, lot lines, septic system. n�> , .�,
5. Indicate distance to the ordinazy high-water mark of any lake,
/'�--'-_(� .... �...--�jY ;`,,,- a•- , . ; _,.�
pond, river, stream, creek, and name the body of water. P��t Name:
The above certifes ihat lhe listed infortna�on and inten6ons are
6. Indicate any grading or clearing in excess of the construction site. o-�e a�d co�rea.rne ato�e Persoos�s ne�eby y�ve Perm�s5�o�ror
access to the pmperty for onsite inspection.
7. Indicate distance to any wetland.
Permit Fee: �� �O�.`
January 13 , 2004 ' ��"
Issue Date Signature ofIss g ent
January 13 , 2005
Expiration Date
Office Comments:
Inspection Date: 50% Rule Applies: Avg. Setback: Within Reservation boundaries:
Restrictions and other information:
, Inspec5on � Private U Public Violation �' ZciLag ❑ Ssni��tion I I�. ,
� Dwdling ❑ Mobile Hozzte ❑ Commercial ❑ Garage � Addition I
Qi Setback - Lake � Setback - Road �Setback - Lut Linc ❑ Soils Veritication � �
� � Avera�a Setback = 60.25'. �04-o Rul� - Sl�bpo _ F:
5.
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�i�D 716;422, CSM 4�'226 �788, RR-1 Acres: 1340 6889N Victory, Heights Circle � 3
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Discussed ��i.h Lazry Mu:?ay
! Date � Time Octubet 1, 200'_', 1:30 PM �
! Signature uf Inspector —_� w���n-�-
TOWN OFSAND L
SEC. 9 TW P 39N. � R.!
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SCALE 1��=50� W �
MONUMENTS � SET I I/4�� X 30�� O.D. IRON PIPE
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BEARINGS BASED ON THE NOR7H LfNE -� \
SEC. I I, t39N, R9W. , ASSUMED TO . BEAR d
DUE EAST. iO
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