HomeMy WebLinkAbout026-939-16-5315-LUP-2004-407 Application for Land Use Permit(*Non-sboreland*) o o'�• " -
County of Sawyer � �
PO Box 676 -Hayward WI 54843
715/634-8288 � �
*Property that is noY located within 300'of a creek,river or stream or within 1000'of a r
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. � �
PRINT-USE BLACK INK OR PENCIL �
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Owner Builder �� �
'�i 9'/Z _Sf�7e/ce�.A ,�'7�7u �:
Mailing Address Mailing Address o �
�.Sf�,�r ���'E �cJ l .7��'��, �
City,State,Zip City,State,Zip �
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(�j5�� �=�CS�- � 7�L:4� �
Daytime Phone Daytime Phone �.
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Additional Information: Zone District: ��.-z
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Lot Dimensions:/oti l7 J� �°�X��"'��/��°� —�
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Date lot was created: (�'�-�9`�q Acres: � l� o
Is there wetland near the proposed structure?If yes,how far Nv � �
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Building Land Use Floodptain-� j Yes (��No � ,5�
( )New ( )Filling �, c�
(�Addirion O Dredging Driveway access off of a(Check one): � F
( )Alteration ( )Grading ( )Private Rd ( )Town Rd. o ���
O Moving On O O Counry Hwy �State Hwy N G�
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Primary Structure Accessory Building Addition � °
�Dwelling �)Garage-attached/detached ( )Deck W
)Year round (�#of car stalls O Porch � �"'
�Seasonal ( )Storage Building ( )Bnclosed �
O Frame built on site O Screenhouse O Living room
( )Modular/manufactured ( )Greenhouse ( )Kitchen � �
( )Mobile/manufactured ( )Other Oc�Bedroom �
O Other primary structure O �Relocate/enlarge t �
� � � � �#of new � �
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Additional Information: p
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Type of Construction: Cni
OC)Frame ( )Log ( )Po1e/metal ( )Block ( )Concrete �
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( )Other ,z .�
Construction Cost:Primary Structure$ � G'��v, `j�i � '�
0
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Accessory Building:$ Addition:$ ^ �
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'7io �-5� `°
Deed:Vol �II Pg �i�`� Certified Soil Test# `�9'�� °Q Z
CSM:Vol��_Pg /�.� Lot# ! Sanitary Permit# 99-OCo! o, �
Plat Envelope 1�59�"i Or: N �
Condo Vol Pg Year Installed: %/`�S j �, �
Aff of ex septic Vol Pg Owner When Installed: �,,,
�I�L 2 L `FJu C�x� �Ctl''S"� �'
Previous office approvals/actions: �z� �
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Variance:# LUP:# p/-O,Z3 SP:# CUP:#
Inspection Report:# Change of Zone District: ` a
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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. i3e�l� ro::.,� #2• #3. #4.
Size /C ft. wide ft. wide ft. wide ft. wide
��ft. long ft. long ft. long ft. long
Floor azea 2.�1 sq. ft. sq. ft. sq� fr• S9• ��
Hgt.from gacie /� �'rto peak ft. hgt. ft. hgt. fr. hgt.
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Stories / stories stories stones
#of bedrooms�_ �l �
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� � Rear Lot Line
�00� �t�
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Fire Number and Name of Road �S``�"7�- ��n� �'<°'' � �7�7 �'
1. Enter lot dimensions and indicate north by arrow. Sign of n or rthori d Agent:
2. Indicate the location and size of the requested construction ��� �
SgnaNre
activities.
PnntName: S�=�`'- �• �'��°<< Dvit��
3. Also, indicate the location and distance to the well, The above certifes that the listed information and intentions are
We and conecl.,that ail work shall be pedormed in compliance
septic tank and drainfield, wetland areas, lot lines and to the w�m me ����emeo�s or me sawye� co��ry zoo��y ommance
and the laws and regulations of the State of Wisconsin, and if
CCritOT'�1R0 Of Y}1C IOfld. acting as owner(s)agent, has the permission of the owner(s)lo
peAortn the work requested on Nis applica�ion. The above
personsls hereby give permission for aceess to the property for
�/ onsiteinspection.
Permit fee: $ �°5
August 4, 2004 - C�# _
Issue Date Signature ofIs in gent
August 4, 2005 0
50/o Rule: Average Road Setback: _
Expiration Date
Office Comments:
TOWN OF SANDL
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