HomeMy WebLinkAbout032-540-28-3406-LUP-2003-319 OC� �
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Application for Land Use Permit o � � ,
County of Sawyer ��
PO Box 676 -Haywazd WI 54843 �
715/634-8288 �
The undersigned hereby makes application for a Land Use Permit and agrees that all work � a
shall be done in compliance with the requirements of the Sa�vyer County Zoning Ordinance � ` � r
and the laws and regulations of the State of Wisconsin. � � {y�
NO CONSTRUCTION MAY BEGIN UNTI L A L L P E R M I T S H A V E B E E N I S S U E D. N
PRINT-USE BLACK INK OR PENCIL �
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Owner Builder a
f�iy�n�r�Jt� N� �rt
,��iy «,��«i��z �,
Mailing Address Mailing Address � O
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r�clvl/�h c/� �/y75 h��X�lo/f�l, �.� 1'�/�1 T5 ;
City,State,Zip City,State,Zip
7/5-��S-3579 7��_y3S- 3S7y �
Daytime Phone Daytime Phone
Additional Information: Zone District
1���- `�
Lot Size�f4('��C,S
`� Date lot was created cTG�(J.-%'J�-/�Sf� 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 faz from the shoreline&water name: IVO �
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, Is there wetland near the proposed structure?If yes,how faz �1� C]
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Building Land Use �
New Fillin °
� ) g Floodplain:( )Yes (/}No # �o
( )Addition ( )Dredging �
Alteration � o
� ) ( )Grading Chippewa Flowage: ( )Yes (/No ^
( )Nloving On (:� " �/„4i
0
� ) ( ) Driveway:( )State ( )County ( )Town Rd.
Primary Structure Accessory Building Addition O
�)Dwellin �v�� I
S ( )Garage-attached/detached ( )Deck c
O Year round O#of caz stalls O Porch I
( )Seasonal ( )Storage Building ( )Enclosed
(/}Frame built on site O Screenhouse O Living room O
( )Modular/manufactured ( )Greenhouse ( )Kitchen � A~
( )Mobile/manufactured ( )Other ( )Bedroom I
O Other primary structure f�- /��- O Relocate/enlazge
� � � ) ( )#ofnew >
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Additional Information: �
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Type of Cosjstruction `°
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f/�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �
( )Other C�,
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Construction Cost:Primary Structure$ 7GGG.`?'�
Accessory Building:$ �- Addition:$ "�' s� z
Vol ����l Pg '-f f/ nf7lPP,t Certified Sos Te�±# — ��
CSM Vol Pg L,ot# Sanitary Permit# �3-O/,5 I�- I �
Plat Envelope Or: � �
Condo Vol Pg Yeaz Installed OD
Aff of ex septic Vol Pg Owner When Installed: �i
Gazd Gazebo Vol Pg 1�
Previous Variance: LUP: Inspection Date: �\�
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