HomeMy WebLinkAbout024-741-30-5417-LUP-2003-612 �� ��� X
Application or Land Use Permit(*Shoreland*) o o/ �
County of Sawyer �, � �
PO Box 676 -Hayward WI 54843
715/634-8288 J �
*Property that is located within 300'of a creek,river or stream or within]000'of a
flowage,lake or pond or has any of the above waterbodies located within �
the property's boundaries. �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. y� �
N�S QK7 PRINT-USE BLACK INK OR PENCIL
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Owner Builder a
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Mailing Address Mailing Address �
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(L�a�t�.�. M,LI ;��i �' � �
City,State,Zip City,State,Zip �
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Daytime Phone Daytime Phone '
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Addirional Information: Zone District: h�\ � ^
Lot Dimensions: G z�0' x � ���
l
Date lot was created: Acres: 5�
Is there wetland neaz the proposed structure?If yes,how far y`-�S ' o
Building Land Use Floodplain:O Yes O No �
O New O Filling Chippewa Flowage:O Yes (�No c�
(�Addition O Dredging Driveway access off of a(Check one): �
( )Alteration ( )Grading ( )Private Rd OC�Town Rd. �
( )Moving On ( ) ( )County Hwy ( )State Hwy °Q
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Primazy Structure Accessory Building Addition o ,.��.
(�Dwelling ( )Garage-attached/detached (J�Deck � r
O Yeaz round O#of caz stalls (�Porch W �
(y,�Seasonal ( )Storage Building ( )Enclosed �
O Frame built on site O Screenhouse O Living room co �_
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen �
( )Mobile/manufactured ( )Other ( )Bedroom _
�. A
O Other primazy structure O O Relocate/enlarge i I "
( ) ( ) ( )#of new f �'
AdditionalInformation: I -
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Type of Construction: c: �
(�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete � �;
( )Other �
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Construction Cost:Primary Structure$ J �
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Accessory Building:$ /Addition:$ `��'�v �
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Deed:Vol�_Pg �'>7 Certified Soil Test# ��°� - 3`� y � z
CSM:Vol Pg Lot# Sanitary Permit# 0° ;v
Plat Envelope pr. � V,
Condo Vol Pg Yeaz Installed: N
"Loads and Flows": Vol Pg Owner When Installed: � �
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Previous office approvals/actions: �
1
Variance:# LUP:# p3.(alz SP:# CUP:#
Inspection Report:# Change of Zone District: �i
8/za/ay
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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. � � r . ,� #2. ��J e ;,� _.��� �fi . � � #3. � �ie:,i #4. .
Size � ft.-wide : C;� ft. wide ft. wide fr. wide
� ft. long I �% fr. long � ' ft. long ft. long,
,
Floor azea Z°> � sq. fr. �_ sq. ft. o . sq. ft. sq. ft.
HgL fi-om�rade L to peak � ft. hgt. � � ft. hgt. ft. hgt. `
Stories� � �°L stories � stories stories
# of bedrooms ��
n L ke/Pond/Flowa e/River/Stream a e _ _
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Fire Number and Name of Road �� � �� � fv r—, ( !-t- ��,, �,;,, 4i
1. Enter lot dimensions and indicate north by arrow. Signatty{'e o�Owner or Authorized Agent:
2. Indicate the location and size of the requested construction �/.-��_
, —
activities. --
SignaNre
PnnWame: � ��.-� � � 7 - � � �
3. Also, lndicate the locatlon and distance to the well, The above cerfifies ihat Ne listed information and intentions are
true and correct.,Nat all work shall be peAormed in corcpliance
Sept1C tank ancl dl'alnfield, wetland azeas, lot �lnes, wiU the requirements of the Sawyer Counry Zoning Ordinance
and Ne laws and reguWtions of the State of Wisconsin, and if
centerline of the road and waterbodies. aa��9 as ow�er�s)ayent nas me Pe�n�ss�o�or me owoeqs��o
peAorm �he work requested on this application. The above
personsls hereby give permission for aaess to the property for
onsiteinspec6on.
Permit fee: $
Total land area within 300' of the waterbody: (A) ' -+.,' � �i
Total impervious surface azea [including this project] (B) 1 L ' �
(B)/(A) x 100 = % Used ,�j'°J6 (Shall not exceed 15%[or 25% with a conditional use permit].)
Shoreline Vegetation Protection Area: Mitigation Required? O Yes (�No
A��Q���+- 3i , zcry -
Issue Dat�— Signature of Iss ' g ent
Mar�h z5� z�(�Fj 50% Rule: Average Road Setback:
Expiration Date
OfficeComments: (D h10R�1 eX�ens�on , eYp�f�eS -� `�5`�
/�me,nded -�o '�r.�lud�c.. Scx`2enRc� �r. �'con4��.eo�..