HomeMy WebLinkAbout030-737-21-2302-LUP-2004-442 Application for Land Use Permit(*Non-shoreland*) 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. �i`� �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. ��
PRINT-USE BLACK INK OR PENCIL �
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p��l� "—'-"-7 Builder ��
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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
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Additional Information: Zone District: �1Z-�
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Lot Dimensions ,�'
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Date lot was created: Acces�-+�n,� /) ,�t,a IO� � o �
Is there wetland near the proposed structure?If yes,how faz � �,\
Building LandUse Floodptain:( }Yes ( j�No �=° �'
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( )New ( )Filling
co �t''-
(�Addition O Dredging Driveway access off of a(Check one): �
( )Alteration ( )Grading ( )Private Rd ( )Town Rd. o ��
O Moving On O O County Hwy O State Hwy r,
G�
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Primary Structure Accessory Building Addition � �
( )Dwelling �Garage-attached/detached ( )Deck w `�
( )Yeaz round ( )#of car stalls ( )Poxch �
( )Seasonal ( )Storage Building ( )Enclosed � �
O Frame built on site O Screenhouse O Living room � �
( )Modular/manufactured ( )Greenhouse ( )Kitchen �'� �
( )Mobile/manufactured ( )Other ( )Bedxoom � �
O Other pximary structure ��.�.lca�i�c-z.�i Q�c- O Relocate/enlarge V �
� � � � r ,�� ( )#of new '
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Additional Information: >
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Type of Construction: �J
�Praine ( )Log ( )Pole/metal ( )Block ( )Concrete �
( )Other � ,�
Construction Cost:Primary Structure$ �
JAccessory Building:$ �C�„ Z`�'�Z Addition:$ ,C����'�� , x� �
, � � � �
Deed:Vol �� �Pg�_ Certified Soil Test# f�h-o 3� c�3-CAS� tl4 z
CSM:Vol Pg Lot# SanitaryPermit# $5-oZ5 o3-�3Z o, �
Plat Envelope �r� N j, .,
Condo Vol Pg Yeaz Installed: c�o I�
Aff of ex septic Vol Pg Owner When Installed: `-'
Previous office approvals/actions: �
Variance:# LUP:# SP:# CUP:# N
Inspection Report:# Change of Zone District: y i�b��
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Describe the construction using these columns. List the dimensions of each structure in a separate .
column. List each story, each addi ion, each alteration in a separate column.
#1. � B-L #2.� ��� •a� #3. #4. �
Size_��ft. wide . wide ft. wide ft. wide
, � fr. long � ft. long ft. long ft. long
Floor area F,a� sq. ft. sq• ft. 59• ft• Sq. ft•
Hgt.from grade to peak ft. hgt. fr. hgt. ft. hgt.
Stories J stories stories stories
# of bedrooms�'Z
Rear Lot Line
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Fire Number and Name of Road ��C�� � � �
1. Enter lot dimensions and indicate north by arrow. Si re of Owge o uthoriz d Agent:
2. Indicate the location and size of the requested constnzction ������ — 1� _
Signalure
activities. p �)
PontName:'7E�'�� �C� � i��-��K -'S�
3. Also, lndicate the location and distance to the well, The above ceNfies tnat the listed intormation and intentio are
true and correct.,that all work shall be pedortned in compliance
septic tank and drainfield, wetland azeas, lot lines and to the with lhe requirements of ihe sawye�co��ry zo�m9 o��oa��
and the laws antl regulalions of the Sfate of Wisconsin, and if
centerllne of the r0ad. acting as owner(s)agent has the permission of the owner(s)to
peAorm the work requested on this application. The above
personsls hereby give permission for access to ihe property for
onsite inspeclion.
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Permit fee: $ �� �
August 18, 2004 — � �
Issue Date Signature of Iss ng A ent
August 18, 2005 0
50/o Rule: Average Road Setback:
Expiration Date
Office Comments:
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