HomeMy WebLinkAbout026-939-14-5101-LUP-2004-630 Application for Land Use Permit o 0
County of Sawyer � �%
PO Box 676 -Hayward WI 54843
715/634-8238
The undersigned hereby makes application for a Land Use Permit and agrees that all work J �
shall be done in compliance with the requirements of the Sawyer County Zoning Ordinance -
and the laws and regulations of the State of Wisconsin. , '
NO CONSTRUCTION MAY BEGIN UNTIL ALL PERMITS HAVE BEEN ISSUED.
PRINT—USE BLACK INK OR PENCIL �
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Owner Builder ' �'
� ���� �)! '�� F r e.t�l�h �i^c�i� o'
13y kroll s� � p
Mailing Address Mailing Address �
r-� � � � ��y � 7 l-� , �,ard,, �. ) ; S4 �`l._,� �
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City,State,Zip City, ate,Zip
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�l Ce3- S�i S - S?� `.'`I _ _
Daytime Phone Daytime Phone -
Additional Information: Zone District �^ �1 �
Lot Size S
Acres i S�
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 far from the shoreline&water name: �
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Is there wetland neaz the proposed structure?If yes,how far � �
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Building Land Use ' G
(��New ( )Filling Floodplain:( )�es ( )No # �
( )Addition ( )Dredging � �
( );^,,,era;ior. { ;Grading Chippewa Flowage: ( )Yes ( )No I�
( )Moving On ( ) o
� � � � Driveway:( )State ( )County ( )Town Rd. 6� �"
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Primary Structure Acc�ssory Buildi� Addi on �
(v�Dwelling (�GazageEattachedYdetached (�eck
( )Year round (2)#of caz stalls ( )Porch `
( )Seasonal ( )Storage Building ( )Enclosed �
(v�Frame built on site O Screenhouse O Living room � p"
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen
( )Mobile/manufactured ( )Other ( )Bedroom �
( )Other primary structure ( ) ( )Relocate/enlarge �
� � ( � ( )#ofnew p
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0
Additional Information:
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Type of Construction �
(�rame ( )Log ( )Pole/metal (✓jBlock (�oncrete �
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( )Other �" �
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Construction Cost:Primary Structure$ ��c�/��o o °`'6 <<��«•' �"^`;• �
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AccessoryBuilding:$ 1�� noo Tor�-S�- Addition:$ �:GD o z
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Vol �/"a '� Pg�L`Lof Deed Certified Soil Test# 0 1 - o O 1
CSM Vol�_Pg ?,r� Lot# o� Sanitary Permit# O 1- / ..�1 ��y��
P1atEnvelope ��� Or: �
Condo Vol Pg Yeaz Installed
Aff of ex septic Vol Pg Owner When Installed:
Gazd Gazebo Vol Pg
Previous Variance: L�'� 01 "�`� Inspection Date: $I I��
a���,�
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. �N��
#1. #2. #3. #4•
Size �%3 ft.wide �ft•wide �,._�•µ'ide �ft•wide
�_ft.long ,��I ft.long �_ft.long �(�_ft.long
Floor area�u 6 6 sq.ft. S� sq.ft. so��_sq.ft. �sq.ft.
Hgt.from gade�_to peak � ft.hgt. !o� ft.hgt. ft.hgt.
Stories �. �--
stories stories stories
#of bedrooms `i
Lot Line or Lake/River name:
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Fire Number and Name of Road (o�7�`� 3 r e e z u Po�'n�F- ,Ln
1.Fill in lot dimensions and indicate north by arrow. Slgnatu�e of Owner o�Authorized Agent:
2.Indicate location and size of existing and new structures. n j��___ �(?, ��'�.cE�.�
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3.Indicate location of well,septic tank,drainfield.
4.Indicate distance to existing structures,lot lines,septic system.
5.Indicate distance to the ordinazy high-water mark of any lake,
pond,river,stream,creek,and name the body of water. P�n�Name:
The above certifes Nat Ne listed information and intentions are
6.Indicate any grading or clearing in excess of the construction site. eU.eessto me p perety ro ons t�nsp�ection by 9've permission tor
7.Indicate distance to any wetland.
Permit Fee:
November 4, 2004
Issue Date Signatwe of I ui g gent
November 4, 2005 ,
Expiration Date
1\_�,, _n 2am�.w..e.e�-�o���U���u`cQ0�2o�1��u_�,,��.cN
Office Comments: IJ�X�t�P '�'�
Inspection Date: 50%Rule Applies: Avg.Setback: �����L� .
Restrictions and other information:
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. #2. #3. #4.
Size � �3 ft. wide � ft. wide I �,,,__ ft. wide � ft. wide
�_ ft. long � �i ft. long �� ft. long �_ ft. long
Floor area �i � sq. ft. cS' � sq. ft. s'o sq. ft. a�y Sq• �•
Hgt. from grade '� to peak �_ ft. hgt. �O`_ ft. hgt. ft. hgt.
Stories a. �_ stories stories stories
# of bedrooms �s
Lot Line or Lake/River name:
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Fire Number and Name of Road (o � '7� � �re f z u l�� ��►'►.� �./)
1. Fill in lot dimensions and indicate north by arrow. Signature of Owner or Authorized Agent:
2. Indicate location and size of existing and new structures. /72� �-f�, ��
3. Indicate location of well, septic tank, drainfield.
4. Indicate distance to existing structures, lot lines, septic system.
5. Indicate distance to the ordinary high-water mark of any lake,
pond, river, stream, creek, and name the body of water. Pnnt Name: '
The above certifies that the listed information and intentions are
true and correcL The above personsls hereby giv9 permission for
6. Indicate any grading or clearing in excess of the construction site. a«:e�s co�ne pro�e�y for ons�ce ��s�e�c�o�.
7. Indicate distance to any wetland. !
Permit Fee:
Novemb�r 4 , 2004 �" ,
Issue Date Signature of I u' g gent '
�
November 4 , 2005
Expiration Date '
• • �p :�' "'oC..�.�� �'`� � 0'�
Office Comments: �
Inspection Date: 50% Rule Applies: Avg. Setback: _Z��ce .
Restrictions and other information: '
',
TOWN OF SAND LAKE
SEC. 14 TWP 39 �. 9 W.
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