HomeMy WebLinkAbout032-540-30-3107-LUP-2004-057 Application for Land Use Permit(*Non-shoreland*) x
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County of Sawyer �, �
PO Box 676 -Haywazd WI 54843
715/634-8288
*Properiy 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 INeuoen.b�� L.tu�n�T�sf Builder <' �
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Mailing Address Mailing Address ` O
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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: �
Lot Dimensions:
Date lot was created: Acres: S. '" 'n'~� o
Is there weUand near the proposed structure?If yes,how faz 'Y�D �
Building Land Use Floodptainff j Yes O No =°
( )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 i,"', �
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Primary Structure Accessory Building Addition � °
( )Dwelling ( )Gazage-attached/detached ( )Deck W
( )Yeaz round ( )#of car stalls ( )Porch � �
( )Seasonal (y�torage Building ( )Enclosed � `
O Frame built on site O Screenhouse O Living room ��
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen
( )Mobile/manufachued ( )Other ( )Bedroom
( )Other primazy structure ( ) ( )Relocate/enlazge �
( ) ( ) ( )#of new �
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Additional Information: „
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Type of Construction:
( )Frame ( )Log (�ole/metal ( )Block ( )Concrete �
( )Other
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Construction Cost:Primary Structure$ � �
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Accessory Building:$ �3+ :�"j�:5 • `- � Addition:$ � �
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Deed:Vol i c Pg 3d�, Certified Soil Test# i N�l � °O
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CSM:Vol�_Pg �a$ Lot#�j� Sanitary Permit# .� J ",} � ro
Plat Envelope pr; N
Condo Vol Pg Yeaz Instailed: "' �
� �Aff of ex septic Vol Pg Owner When Installed: %
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Previous office approvals/actions:
Vatiance:# LUP:# �'C�-55�� SP:# CUP:#
Inspection Report:# Change of Zone District:
. 31s'�a„-
3(�31y
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 3G� ft. wide ft. wide ft. wide ft. wide
<!% ft. long ft. long ft. long ft. long
Floor azea ��� sq. ft. sq. ft. sq. ft. sq. ft.
Hgt from grade to peak�ft. hgt. ft. hgt. ft. hgt.
Stories stories stories stories
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# of bedrooms �/
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Rear Lot Line
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Fire Number and Name of Road 7/3G. crr /�� �: �`� _ � j- � ' l ,
1. Enter lot dimensions and indicate north by arrow. Sign�e of Qwner o�Au ri�z ent:
2. Indicate the location and size of the requested construction ���jd (�_ �44 6�—
Signature
activities.
PnntName:�-.�'�ns. % ) :�
3. Also, 1ndlcate the locatlon and diStance to the well, The above cerUfes that the listed information and intentions are
true and correct.,that all work shall be performed in compiiance
septic tank and drainfield, wetland areas, lot lines and to the wilh ihe requiremenLs of lhe Sawyer County Zoning Ordinance
and the laws and regulations of the State of Wisconsin, and if
CCritOillriB Of t110 708d. acting as ovmer(s)agent, has the permission of the owner(s)to
peAorm Ne work 2quesled on this application. The above
personsls hereby give permission for access to the property for
onsAeinspection.
Permit fee: $ �3 DO�
April 1 , 2004 �
Issue Date Signa ure of Iss �ng ent
April 1 , 2005
50%Rule: Average Road Setback:
Expiration Date
Office Comments:
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NOTE ! Deed gqps and \ SCALE : I INCH = 400 FEET
nvorinnc in fh�a nrprt ND A WAl Q V • At{( � e�
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```'``,^��,1�ltlll�h/,j'''' $eceived(or record the
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