HomeMy WebLinkAbout030-737-22-1104-LUP-2004-226 f
Application for Land Use Permit (*Non-shoreland*) o o �
County of Sawyer � � -
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 "
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 Bui der �:
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Mailing Address Mailing Address �
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City, State, Zip City, State, Zip
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Daytime Phone Daytime Phone
Additional Information: Zone District: � - �
Lot Dimensions:
Date lot was created: Acres: _S n
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Is there wetland near the proposed structure? If yes, how far � '�
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Building Land Use Floadplain:� j Yes ( j No �
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¢C�New ( ) Filling �
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 N �
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Primary Structure Accessory Building Addition � °
( ) Dwelling ( ) Garage-attached/detached ( ) Deck W
( ) Year round ( ) # of car stalls ( ) Porch �
O Seasonal � Storage Building O Enclosed �
O Frame built on site O Screenhouse O Living room � �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen � r`
( ) Mobile/manufactured ( ) Other ( ) Bedroom �` �
Relocate/enlar e � �
( ) Other primary structure ( ) � ) g '
� � � � ( ) # of new � ��
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AdditionalInformation: q� A
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Type of Construction:
( ) Frame ( ) Log (� Pole/metal ( ) Block ( ) Concrete �
( ) Other ,.d y
Construction Cost: Primary Structure $ �3 Do � �
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Accessory Building: $ Addition: $ �
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Deed: Vol��/ Pg /c:,° Certified Soil Test# 9�O-�5� �
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CSM: Vol Pg Lot# Sanitary Permit# �� - a�a � 7�
Plat Envelope �r� N
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Condo Vol Pg Year Installed: c�
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Aff of ex septic Vol Pg Owner When Installed: "
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Previous office approvals/actions: '�.
Variance: # LUP: # 95- I►`� SP: # CUP: #
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Inspection Report: # Change of Zone District: � �j � �
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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. Pnce Sr;rr� #2. #3. #4.
Size 11- fr• wide fr. wide ft. wide ft. wide
�fr. long ft. long ft. long ft. long
Floor area��_sq. f[. sq. ft. sq. ft. sq. ft.
Hgt.from giade��to peak ft. hgt. ft. hgt. ft. hgt.
Stories / stories stories stories
# of bedrooms
Rear Lot Line
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Fire Number and Name of Road /� 9 '3 n) fLw.y �/c'� —
1. Enter lot dimensions and indicate north by arrow. Signature f Owner or Authorized Agent:
2. Indicate the location and size of the requested constmction �„{,ac� I F �iz�1
SignaNre
activities.
Print Name: �th�f�T t �t`�"f�.
3. Also, 1ndlCate thC loCatlon ana dlStanCe to t}le well, The above certifies that the listed information and iNenticns are
true and coned.,that all work shall be performed in compliance
septic tank and drainfield, wetland areas, lot lines and to the with the requirements of the Sawyer Counry Zoning ONinance
and ihe laws and regulations of the Sfate of Wisconsin, and if
centerline of the road. acting as owner(s�aqent,has tne permission ot tne owner(s)ro
pedorm the work requestetl on this application. The above
personsls hereby give permission for access to the property for 1
��y onsite inspectian.
Permit fee: $ ��� �
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Issue Date Signature of Issu' g nt
�y}/J/,li,� zB,Zpp � 50% Rule: Average Road Setback: _
Expiration a e
Office Comments:
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