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HomeMy WebLinkAbout030-737-02-5306-LUP-2004-005 � ' �C�'=� � Application for Land Use Permit o o O County of Sawyer �, � PO Box 676 -Haywazd WI 54843 � 715/634-8288 � The undersigned hereby makes application for a Land Use Permit and agrees that all work , 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 -�'�-r�� JZ u s t� ��1-yu e �' � Owner Builder � � '<' 7yG` — Z � S7- o' . Mailing Address Mailing Address � � � JZ 1- C E L��� LV-�- -5^�/�6�' :; City,State,Zip City,State,Zip � � '7/5- z.3v — �� Z� � Daytime Phone Daytime Phone � � Additional Information: Zone District R R`� �' �' �\ , Lot Size {Z y,r� � k'� Date lot was created �- � � - � � Acres �� 13 rn n�e-'�- �9 Is the property in a Shoreland Dishict?(within 1000'of a lake or pond,within 300'of a river, �� � creek or stream) If yes,how far from the shoreline&water name: p� Is there wetland near the proposed structure?If yes,how faz � � Building Land Use � � � (j�New ( )Filling Floodplain:( )Yes ( )No # ti � ( )Addition ( )Dredging � � ( )Alteration ( )Grading Chippewa Flowage: ( )Yes ( )No ,��., ( )Moving On ( ) G o ( ) ( ) Driveway:( )State ( )County ( )Town Rd. J '" Primary Structure Accessory Building Addition J �Dwelling ( )Garage-attached/detached ( )Deck ' )Year round O#of car stalls O Porch � ( )Seasonal (�Storage Building- ( )Enclosed 9� (yQ Frame built on site i Screenhouse,� O Living room � p ( )Modular/manufactured ( )Greenhouse ( )Kitchen � ( )Mobile/manufactured ( )Other ( )Bedroom � ( )Other primary structure ( )_ ( )Relocate/enlarge � ) ( ) " ( )#of new > � m � Additional Information: b � �0 � Type of Construction 'k �Frame � ( )Log ( )Pole/metal ( )Block ( )Concrete � ( )Other {, , Construction Cost:Primary Structure$ jb voc ty —� Accessory Building:$ � S 0�x _ Addition:$ � Z 7y Vol b/� Pg "�of Deed Certified Soil Test# � CSM Vol�Pg�9 S� Lot# �p Sanitary Permit# �����(T� Plat Envelope �-3`'°�� Or: � Condo Vol Pg Yeaz Installed Aff of ex septic Vol Pg Owner When Installed: Gard Gazebo Vol Pg � �0 Previous Variance: LUP: Inspection Date: \a\ �'\ 3 i555 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. �ba #3. �kc� !ak d� #4. Size� ft.wide ft.wide �`� ft.wide ft.wide �Q fr.long ft.long f� ft.long —T ft.long Floar area�sq.ft. sq.ft. � sq.ft. sq.ft. Hgt.from grade�,to peak ft.hgt. ft.hgt. ft.hgt. Stories � stories stories ° � stories #of bedrooms� Lot Line or Lake/River name: ��. ����4 Fire Number and Name of Road �l5°=-: l:%� ����� �� t-- 1.Fill in lot dimensions and indicate north by arrow. Signature of Owner or Authorized Agent: 2.Indicate location and size of existing and ne�v structures. � ` 3.Indicate location of well,septic tank,drainfield. ����� u� 4.Indicate distance to existing structures,lot lines,septic system. 5.Indicate distance to the ordinary high-water mazk of any lake, pond,river,stream,creek,and name the body of water. P�m�Name: The above ceRifes that the listed information and intentions are 6.IT1dlCate any g2ading OL Cleatlrig ln eXCeSS of t�le ConStrilCtiOn Slte. true and correct.The above personsls hereby give permission tor access lo Ute property(or onsite inspection. 7.Indicate distance to any weiland. Permit Fee: � A �,c; January 13, 2004 ' Issue Date Signature of Issui A e t January 13, 2005 Expiration Date Office Comments: Inspection Date: 50%Rule Applies: Avg.Setback: Within Reservation boundaries: Restrictions and other information: TCD WFtOM IT M.4�' CONCERN: Ot�[ OCTOg�R ?3, 2003, f D6TEPJ�IIN�U TI-f� G�ROI.�t.ND 6LEVf�T(OMS O� Tk-tE RR.4P0SEDBk.t.fLk�INC� SlT� Dh! l_DT 6 O� GERTt�16D Sl.�R�lEY �340�, g�lN� PfERT O� GfOV�NMENT t�DT3, S�GTION 2, T3j N, R�V�I, S�EI�/`(6R COI.tNT�, WISCONSfN, OWNE'P P�Y Pf�I.tL RI.LST, �45 Sf-tOWN �6�OW. 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