HomeMy WebLinkAbout026-144-00-5600-LUP-2004-360 �����. Application for Land Use Permit(�Non-shoreland*) �/ o ' ,
�' County of Sawyer �
N� PO Box 676 -Hayward WI 54843
715/634-8288 �
*Property that is not located within 300'of a creek,river or stream or within 1000'of a �t
flowage,lake or pond or does not have any of the above waterbodies located within �'
the property's boundaries. �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED.
��/�S PK� PRINT-USE BLACK INK OR PENCIL � �
ti ��'-J . v' t
i., e.t �[ LeNsrn.�cr�e�t c� �
��ti,,,f.s �• I�bF�nrrzr � o.
Owner Builder N� �
R �.Qpal � g�o �G���.G� .1f` .7T �.
Mailing Address Mailing Address a O �
S�k2 ��tLl �' �s'4Y7y ��rcn��n�4�, .� rdr�c �
City,State,Zip � City,State,Zip �c���� b O
�loS�o'1`�D� �ic�f3F-t���'G�����—aa�-3��L a
Daytime Phone Daytime Phone � �
Additionai Information: Zone District: r��� Z< D
�� t
Lot Dimensions: /���.�3��90�-24F I��, C,
` �
Date lot was created: l9/9 72 Acres: l o�1� n
0
Is there wetland near th proposed structure?If yes,how faz �
Building Land Use Floodptain:� )Yes (JQ,No =R
�
(oC}New ( )Filling 2
�
O Addition O Dredging Driveway access off of a(Check one): �
O Alteration O Grading O Private Rd O Town Rd. o
( )Moving On ( ) (�County Hwy ( )State Hwy „`'', �
� ) � ) o 0
t"
Primary Structure Accessory Building Addition � °
( )Dwelling �Gazage-allrril�d/detached ( )Deck W �
( )Year round (�)#of car stails ( )Porch =
O Seasonal O Storage Building O Enclosed �
O Frame built on site O Screenhouse O Living room �-' c�
( )Modular/manufactured ( )Greenhouse ( )Kitchen �
( )Mobile/manufactured ( )Other ( )Bedroom E
O Other primazy structure O O Relocate/enlarge E
� � ( � ( )#ofnew t
�
Additional Information: p
�
�
�
Type of Construction: �
�O Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �
( )Other ,�y .�
Construction Cost:Primary Structure$ � �
rn
Accessory Building:$ !D OG b Addition:$ � �J
� �f
Deed:Vol CL�I Pg��C Certified Soil Test# �'�]-/�3 °Q z
CSM:Vol Pg Lot# .rj(,: Sanitary Permit# U!-s'�+/ o, �
Plat Envelope �r� n� �
�
Condo Vol Pg Yeaz Installed: co
Aff of ex septic Vol Pg Owner When Installed:
� �
�
W
Previous office approvals/actions: ��
Variance:# LUP:# OI -'�l(�� SP:# CUP:# � I
I ' ' �
Inspection Report:# Change of Zone District: �,
��fr�K
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. Ca �4��4P #2. #3. #4. '
Size_ �� _ft. wide fr. wide ft. wide ft. wide
,32 ft. long ft. long fr. long ft. long '
Floor area �R $ sq. ft. sq. ft. sq. ft. sq. ft.
,
Hgt.from g�ade E.Z to pealc ft. hgt. ft. hgt. ft. hgt.
Stories '� stories stories stories
# of bedrooms � � '
�6wN kc/
Rear Lot Line ��I d�
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Fire Number and Name of Road S G 9`1 M C 7 � R a� F �
1. Enter lot dimensions and indicate north by arrow. Signature o Owner or Authorized Agent:
2. Indicate the location and size of the requested construction
SignaNre � /
activities. Pnnt ame: Samu �• tfo�i✓kE
3. Also, lndicate the locatlon and distance to the well, The above ceRifes ihat the listed informa6on antl intentions are
We and cortect.,thal all work shall be pedormed in compiiance
Sept1C tank anCl c�Talnfield, wetland areas, lot 11tte5 and to tY1e with the requirements oi ihe Savryer Counry Zoning ordinance
and the laws and regula�ons of ihe State of Wisconsin, and if
CORtCPIIIIC Of 211C I08d. acling as owner(s)agent, has the permission of the owner�s)to
peAorm ihe wo�c requested on this application. The above
personsls hereby give permission kr access lo the property for
onsiteinspection.
Permit fee: $
July 19, 2004 ' —
Issue Date Signature of Is ing ent
July 19, 2005 0
50/o Rule: Average Road Setback: _
Expiration Date
Office Comments:
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