HomeMy WebLinkAbout030-737-19-2201-LUP-2004-135 i . �
Application for Land Use Permit(*Non-shoreland*) o� o '
County of Sawyer �
PO Box 676 -Haywazd WI 54843
715/634-8288 �
*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 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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1 �0��5� _ �/G✓�(aue� �Nild'�u/S �uC_ a � �
Owner Builder N'
la�la �/ Co,�el,, R� sGos .fas� 3�d s�. �:
Mailing Address Mailing Address � �-�
�xe�u � l/1 �S'&3S Supri�o� G/.L S`/$�O � ..
City,State,Zip City,Sta Zie p �
�ls-9y3-asg3 �/S-39S-s�os � � j_
Daytime Phone Daytime Phone � �_
Additional Information: Zone District: /4 -a � ,
K�
Lot Dimensions:
Date lot was created: Acres: .3 G• �SS o _
Is there wetland near the proposed structure?If yes,how faz �/� G
Building Land Use Floodptain-( j I`es �No �°
�Q New ( )Filling �
O Addition O Dredging Driveway access off of a(Check one): �
O Alteration 4Q Grading O Private Rd Q4 Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy i,"', �
� ) � ) o S
Primary Structure Accessory Building Addition �
0
( )Dwelling ( )Gazage-attached/detached ( )Deck W �
( )Year round ( )#of car stalls ( )Porch =
( )Seasonal 7�Storage Building ( )Enclosed � ,
O Frame built on site O Screenhouse O Living room � �,
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen O �=.
( )Mobile/manufactured ( )Other ( )Bedroom c,� �
( )Other primary structure , ,� '�t, 1 � � ` ( )Relocate/enlarge p 'r
� � � � � ( )#of new ' ��
� `..
Additional Information: � , � �, - �., � : !� � � � � � � � i A
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.. � �
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Type of Construction: �
( )Frame ( )Log �Pole/metal ( )Block ( )Concrete Q y�
( )Other ,..d �..3
Construction Cost:Prim�Structure$�� � �
Accessory Building:$_�o� . DO Addition:$T�� � �✓'�
� �/�-/C::C% `° I'N
Deed:Vol Pg Certified Soil Test# °Q
z
CSM:Vol Pg Lot# Sanitary Permit# o, x
Plat Envelope Or: ��
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Condo Vol Pg Yeaz Installed: /V f� Pr;oJ �lo I�68 �n I�
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Aff of ex septic Vol Pg Owner When Installed: �
,'R� ( n D��1, w
Previous office approvals/actions: �
Variance:# LUP:# SP:# CUP:# ^''�
Inspection Report:# Change of Zone District: � ��,��'���
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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. MR�n o s� #2. �jc;s�`S.�^n`�' #3. cW +o�a c QK���. #4. I � .
Size z' fr.�v✓ide �O ft.'wide 30' fr• �'�de ft. wide
H D� . long GO' ',ft. long 5'S� ft. long �� ' fr. long
Floor area�sq. ft. 00 'I.sq. ft. ��yo sq. ft. '� sq. ft.
Hgt.from gade�to peak / ff,� ft. hgt. ��ft. hgt. � l , fr. hgt.
Stories ;' � /'' stories / stories / stories
#of bedYooms 3
�es�e�biRe r � r o ac�. ���.e
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i � 30%�4SX�d�4..> rrj
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Fire Number and Name of Road � a ya �_�oe�� R�
1. Enter lot dimensions and indicate north by arrow. Signaturepf wr�2r o uthorized Agent:
2. Indicate the location and size of the requested construction � C�
Sig Nre
activities. (� /� (�
PnntName: ed�3" 1'1 VSe'Mi �
3. Also, indicate the location and distance to the well, The above certifies ihat the listed infomiation and inte b�s a�
We and cortecl,Mat all work shall be peAormed in compliance
Sept1C t2.i1�C&llC� dralnf eld, wetland 2Seas, lot 11nes and to tlle with the requiremenLs ot the Sawyer County Zoning Ordinance
and ihe laws and regulations of the State of Wisconsin, and if
CBIItC711ri0 Of�1C iO3d. acting as owner(s)agent,has me permission of the owner(s)to
pedortn ihe work 2quested on ihis appliration. The above
personsls hereby give permission for access to Ne property for
onsite inspection.
Permit fee: $ f V�
May 5 2004 ' -
Issue Date Signature of Iss� ng ent
May 5, 2005 50%Rule: AverageRoadSetback:
Expiration Date
Office Comments: (��'OI�Q..Q C� C�-Ur� 1�� �(Z,v�^-��-' ��"�'�
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