HomeMy WebLinkAbout026-939-27-3401-LUP-2004-056 Application for Land Use Permit(*Non-shoreland*) o 0
County of Sawyer � )� �
PO Box 676 -Haywazd WI 54843 � O
715/634-8288
*Properiy 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 boundazies.
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIFtED PERMITS HAVE BEEN ISSUED.
PRINT-USE BLACK INK OR PENCIL
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Mailing Address Mailing Addres O
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City,State,Zip City,State,Zip
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Daytime Phone Daytime Phone
Additional Information: Zone District: I-i '� �
Lot Dimensions:
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Date lot was created: �-1��'� Acres: ,��L n
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Is there wetland near the proposed structure?If yes,how faz �
Building Land Use Floodptain:� j Yes O No =°
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1�New ( )Filling
Dred m Drivewa access off of a(Check one): `D
( )Addition ( ) g� g Y �
O Alteration O Grading O Private Rd O Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy n, �
O O o S
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Primary Structure Accessory Building Addition � °
( )Dwelling ( )Garage-attached/detached ( )Deck W
( )Yeaz round ( )#of car stalls ( )Porch .'=
O Seasonal OO Storage Building O Enclosed �
O Frame built on site O Screenhouse O Living room `� ��l
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen � ��'
( )Mobile/manufactured ( )Other ( )Bedroom �
( )Other primazy structure ( ) ( )Relocate/enlazge ��
� � ( ) ( )#of new � fr'
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Additional Information: <
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Type of Construction: � �J
( )Frame ( )Log �Q Pole/metal ( )Block ( )Concrete ��
( )Other — ,�
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Construction Cost:Primary Structure$��� � �
Accessory Building:$` ,�(°�0��,�`'' Addition:$ _ � �
713/y3�.3 �°
Deed:Vol Pg Certified Soil Test# B$�/30 °Q z
CSM:Vol� �(�l Pg �� Lot#_1�� Sanitary Permit# 9a- r7� o, �
Plat Envelope Or: �, �
Condo Vol Pg Yeaz Installed: �
Aff of ex septic Vol Pg Owner When Installed: � �
Previous office approvals/actions: y,;
Variance:# LUP:# qs-{7� ��i�SP:# CUP:#
Inspection Report:# Change of Zone District: 00-0'i'S 3I-��
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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.
#1. #2. #3. �4:
Size�ft. wide ft. wide ft. wide � � fr. wide
�ft. long ft. long ft. long ft. long
Floor azea C��/� sq. ft. sq. ft. sq. ft. sq. ft.
Hgk from giade �� to peak fr. hgt. ft. hgt. ft. hgt.
Stories stories stories stories
# of bedrooms
Rear Lot Line
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Fire Number and Name of Road rj�� � (v p,���W� �
1. Enter lot dimensions and indicate north by arrow. Si n ure of Owner 4���! ed Agent:
2. Indicate the location and size of the requested construction j' ��iLti�
SignaNre
activities.
Print Name:
3. Also, indicate flle locatlon and dlstance to the well, The above cedifes mat the listed iniormation and intentions are
4ve and cortect.,that all work shall be peAormed in compliance
Sept1C tanlc and QI'alnfield, wetland azeas, lot 11ne5 and to flle with ihe requirements ot me Sawyer County Zoning Ortlinance
and the laws and regula�ons of ihe State of Wiscronsin, and if
centerllne of the road. acting as ovmet(s)agent has the permission ot ihe owner(s)to
perfortn the work 2quested on �his application. The above
persons/s hereby give permission for access to Ne property for
onstteinspection.
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Permit fee: $ fC�
April 1 , 2004 _ 7�--
Issue Date Signature of Iss ' g ent
Apri1 1 , 2005 50% Rule: AverageRoadSetback:
Expiration Date
Office Comments:
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Parts cf the SW;+< SF�., SE;� S4i��, and NE'i4 SWj, Section 27, T 39 N, R 9 W, Sand Lake
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rod, 1 ,502 lbs / ft, o � �
O = 3/�+" iron rod, found
Q= 2" iron pipe, with
brass cap, found �
O- 2" iron pipe, found °,`_
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