HomeMy WebLinkAbout026-131-00-2900-LUP-2004-357 �� �
Application for Land Use Permit(*Non-shoreland*) o 0
County of Sawyer �
PO Box 676 -Haywazd WI 54843
715/634-8288 O
*Property 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 oFthe above waterbodies located within Z �
the property's boundaries. �--
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. ,
vQm S �, PRINT-USE BLACK INK OR PENCIL � ,
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�..: i m � I C —'� c�lA�— � �— �
Owner Builder �
<' �
1 S 5Q� t..�.).S�ss��-, A-�-„��d �:
Mailin Addres Mailing Address S �
s,�d/.TL` ��-A:.-P W I S�g?� " co a
City,State,Zip City,State,Zip
't►S- 865- 2� d � � �-_
Daytime Phone Daytime Phone `D � �
Additional Information: '�Zone District: �'F�-n� �.A-l� �'� � d
� w�,s►c �v• -�
Lot Dimensions: 359.99 X 6`��•!� ' �
� 3yr.�� �.SS�Scss C
Date lot was created: . '�Acres: 5.�Y3 0 �
Is there wetland neaz the proposed structure?If yes,how far�R � �
Building Land Use Floodptain:� )Yes ,f�.No :;
�„New ( )Filling � � �
O Addition ��°"� Driveway access off of a(Check one): �
O Alteration O Grading O Private Rd O Town Rd. o
( )Moving On ( ) (��Co�y Hwy ( )State Hwy N �
� � � i A �
O
C�
Primary Structure Accessory Building Addition � �
�}Dwelling ( )Garage-attached/detached ( )Deck "'
w
( )Yeaz round ( )#of caz stalls ( )Porch �.
( )Seasonal ( )Storage Building ( )Enclosed ::
0
�'rame built on site O Screenhouse O Living room
( )Modular/manufactured ( )Greenhouse ( )Kitchen )
( )Mobile/manufactured ( )Other ( )Bedroom
( )Other primary structure ( ) ( )Relocate/enlarge � �
( ) ( ) ( )#of new �
AdditionalInformation: � I�
a '
o �
, �
Type of Construction: � �
(�.F'rame ( )Log ( )Pole/metal ( )Block ( )Concrete � �
( )Other b�
�d �Construction Cost:Primary Structure� 20 oae �
�—} rn
Accessory Building:$ Addition:$ � �
m
Deed:Vol��Pg_��� Certified Soil Test# oy-/9 9 °C z
CSM:Vol Pg Lot# Sanitary Permit# d�l -�5I o, �
Plat Envelope /�,( Or: �-- �
c-�
Condo Vol Pg Yeaz Installed: �
� �
Aff of ex septic Vol Pg Owner When Installed:
Previous office approvals/actions: 0
Variance:# LUP:# SP:# CUP:# � �iZ9��u�,
Inspection RepoR:# Change of Zone District: 1,���
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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. � S;d �IeK����� #2. a9ir�+ �'lu--- � #3. #4. '
Size 3d ft, wide 3�' ft. wide fr. wide ft. wide
�0 � ft. long '=� �' ft. long fr. long ft. long
Floor azea}�_�'�sq. ft. ��sq. ft. sq. ft. sq. fr.
z
Hgt.from giade I 4 ���o peak fr. hgt. ft. hgt. fr. hgt.
Stories 2 stories stories stories
# of bedrooms 2 •
�'� ' W Rear Lot Line 3 `'q ' 4 9
3��' � /�
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Fire Number and Name of Road � �
1. Enter lot dimensions and indicate north by arrow. Si n ure o wner o Authorized Agent:
2. Indicate the location and size of the requested construction
activities.
ignature
Pnnt Name:
3. Also, IndlCate ttle loCatlon and d15tanCe to tlle we��, The above ceRifes that the listed intormation and intentions are
true and cortect., Nat all work shall be peRormed in compliance
Sept1C t2i11C 2lid dralnf eld, wetlalld 3ieas, lot lines dTld to t}le with ihe requiremenLs ot the Sawyer Counry Zoning Ordinance
and the laws and iegulations of Ihe State of Wisconsin, and if
CCIITOI'�1ri0 Of Y.�1C L08d. acUng as owner(s)agent, has ihe permission of the owner(s)to
peAorm the work requested on ihis appliralion. The above
personsls hereby give pertnission for atcess to the properry for
� onsite inspeclion.
Permit fee: $ ���
T„i� is, 7004 - _
Issue Date Signature ofI i gent
July 17, 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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NOTE ALL L�NE4R MEASUREMENTS HAVE - � \ b_ �= OfyZ �"� -
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:�---r�— PART OF GOV �T LOTS 2 , 3, 4 SECTION 22 , 8� GOV 'T LOT I 8� NW I/4 NWI/4 SECTION 27,
--'" SCALE ALL IN T39N , R9W, TOWN OF SAND LAKE , SAWYER GO�JNTY , WISCONSIN .