HomeMy WebLinkAbout026-185-01-0300-LUP-2004-311/ •
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Application for Land Use Permit (*Shoreland*) o o �'
County of Sawyer � �
PO Box 676 - Hayward WI 54843 g f � g
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715/634-8288 u
*Property that is located within 300' of a creek, river or stream or within 1000' of a � �
flowage, lake or pond or has any of the above waterbodies located within p � v �
the property's boundaries. ,�
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. — � r
PRINT-USE BLACK INK OR PENCIL
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Owner Builder Q- �
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/551 o vJ r//GTt�`�' f���th'S G�2 0. �
Mailing Address Mailing Address � �
5�,u E �.�-� � w.z S�B��, �`
Zi City, State, Zip � �
City, State, p � �
8GS- 65b � m �
Daytime Phone Daytime Phone � �
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Additional Information: Zone District: �-� " � �
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Lot Dimensions: ��x 375x r�o x 3�97 � "�.
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Date lot was created: 1 q 25� Acres: 1• o �3 �
Is there wetland near the proposed structure? If yes, how far �o 0 1�
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Building Land Use Floodplain: ( ) Yes (✓j No � �
(�New ( ) Filling Chippewa Flowage: ( ) Yes (�'No � �
O Addition O Dredging Driveway access off of a(Check one): � �
( ) Alteration ( ) Grading (►�Private Rd ( ) Town Rd. � �
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy o �
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Primary Structure Accessory Building Addition o 0
( ) Dwelling (� Garage etach ( ) Deck N
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( ) Year round (Z)# of car stalls ( ) Porch W
( ) Seasonal ( ) Storage Building ( ) Enclosed �
( ) Frame built on site ( ) Screenhouse ( ) Living room �?
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen �
( 1 Mobile/manufactured ( 1 Other O Bedroom �, _
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� � ( � ( ) # of new �
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AdditionalInformation: Q A
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_ Type of Construction: Q �
—'�-�rame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete �
( ) Other .-�
Construction Cost: Primary Structure $ � �
Accessory Building: $ Z�, ood Addition: $ � �
�v r�H E� •��-. `D
ScHN�6D�`�- P �
Deed: Vol �5 l pg '�� Certified Soil Test# 9/ - o s� q` - �-'�-Z- � z
CSM: Vol Pg Lot# Sanitary Permit# 9� ��b d 9�- z9� � 7�
Or: �. v� R�- �91 � �
Plat Envelope �
Condo Vol Pg Year Installed: °�� N
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"Loads and Flows": Vol Pg Owner When Installed: �
PLV MM�e.- .�
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Previous office approvals/actions: —
Variance: # LUP:# SP: # CUP: # w
Inspection Report: # Change of Zone District: �' \0�
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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. G—�2�/�C— #2. #3. #4.
Size z2 fr. wide ft. wide ft. wide ft. wide
z� ft. long ft. long ft. long ft. long
Floor azea 855 sq, ft. sq. ft. sq. ft. sq. ft.
HgG from grnde zo to peak ft. hgt. ft. hgt. fr. hgt.
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Stories I/z stories stories stories
# of bedrooms o
Lake/Pond/Flowa e/Itiver/Stream Name
S E� A rn4Lrt�D
Fire Number and Name of Road i SS i e w ✓i�r�izY N�«�f�5 Gr�
-• --~-- --- ------------- --- -- - � si�na,t�re o�t uwt�r or Hutnorizea Hge t:
2. Indicate the location and size of the requested construction �%�^aT�i�...�_/ 71�A�7e,C� . ,�i[ �r
,�
SignaWre �
activities.
PrintName: �icJ+14aDTPtv,y�vt2�Hn�zrJ P�✓.4 �'�-
3. Also, indicate the location and distance to the well, The above certifes that me listed intormation and intentions are
true and wrtecL, thal all work shall be performed in wmpliance
SephC tari1C and dPalnf eld, wetland azeas, IOt lines, with the requirements of ihe Sawyer Counry Zoning Obinance
antl lhe laws and regulations of the SWte of Wisconsin, antl if
Centerllne of the Ioad and waterbodles. acting as owner(s) agent,has the pertnission of the owner(s)to
perform ihe work requested on this application. The above
personsls hereby give permission for access to the property for
onsite inspeclion.
Permit fee: $
Total land area�300' of the waterbod A /o�3 z o
Y� � )
Total impervious surface area [including this project] (B) i 55�
30 . sro..�D aoo' arN�
(B) / (A) x 100 = % Used �5 (Shall not exceed �5%[or 25% with a conditional use permit].)
Shoreline Vegetation Protection Area: Mitigation Required? (� Yes O No
June 28, 2004 � �,(/����������'�
Issue Date Signature of Issuing Agent
June 28, 2005 50% Rule: Average Road Setback:
Expiration Date �(�c_
Office Comments: 5`1,�G�--�X�''�� ���� ����� �� ���� �
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SCALE: I INCH- 100 FEET FOR ASSESSMENT USE ONLY NO�
DRAWN BY: DATE � 6-2e 'a# VIDENCE OF OWNERSHIPCORSIVE
COLON (:) INDICATES GOVT. LOT BOUNDARY LOCATIONS