HomeMy WebLinkAbout032-539-02-2203-LUP-2004-131 ;1
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Application for Land Use Permit �-d✓
County of Sawyer � .
PO Box 676 -Hayward 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 �
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Own ��� Builder � '
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Mailing Address Mailing Address I� O
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City,State,Zip City,State,Zip
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Daytime Phone Daytime Phone �
Additional Information: Zone District ��i`� ,r
�,��f y pf NU�"� Sec �. `To�uNsV�.��S'J� �y` �.
� � jy," � + E a� cv�n�-.� Lot Size 'l' .,
a�� i�i�bw�y� a�s EI�-f��bti-Ia � � �
Date lot w�s cretated I97(v Acres /, � � �L,C'6�`� Z
Is the property in a Shoreland District?(within 1000'of a lake or pond,within 300'of a river,
creek or stream) If yes,how far from the shoreline&water name: /�)C�
Is there wetland near the proposed structure?If yes,how far /l��i� �
Building Land Use �"
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Qn New O Filling Floodplain:O Yes (j�No # ;;
( )Addition ( )Dredging � �
( )Alteration ( )Grading Chippewa Flowage: ( )Yes �No � �
( )Moving On �/�b r
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( ) � �r�� �q� Driveway:( )State ( )County �f Town Rd. �
Primary Structure Accessory Building Addition W
(X�Dwelling ( )Garage-attached/detached ( )Deck ; �
( )Year round ( )#of caz stalls ( )Porch � �
(Xj Seasonal ( )Storage Building ( )Enclosed �
(�Frame built on site ( )Screenhouse ( )Living room q� „'"
( )Modular/manufactured ( )Greenhouse ( )Kitchen �
( )Mobile/manufactured ( )Other ( )Bedroom �' �
( )Other primary structure (��Q� ( )Relocate/enlazge
� � ( ) ( )#of new �
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Additional Information: �
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Type of Co�lstruction i� „�
�}Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �
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( )Other i �
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Construction Cost:Primary Structure$ SDOO �'
Accessory Building:$ Addition:$ � U;, z
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Vol � 3��'�35 ofDeed Certified Soil Test# !'��/-0(c�o k �,
CSM Vol Pg Lot# SanitaryPerxnit# f.`y—l`�f2�? � �
Plat Envelope Dr� �
Condo Vol Pg Year Installed
Aff of ex septic Vol Pg Owner When Installed:
Gard Gazebo Vol Pg
LUp: Inspection Date: �����0�
Previous Variance: �
� �3�-IS88
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. flw e I��n� #2. #3. #4.
Size_��ft.wide ft.wide ft.wide ft.wide
,��o ft.long ft.long ft.long ft.long
Floor area�O sq.ft. sq•ft• SQ•ft� Sq•��
Hgt from g�ade�to peak ft.hgt. ft.hgt. ft.hgt.
Stories QNE, stories stories stories
#ofbedrooms DT/E,
Lot Line or Lake/River name:
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Fire Number and Name of Road
1.Fill in lot dimensions and indicate north by arrow. Signature of Owner r Authorized Agent:
2.Indicate location and size of existing and new structures. /`� �r����--�
3.Indicate location of�vell,septic tank,drainfield.
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4.Indicate distance to existing structures,lot lines,septic system.
5.Indicate distance to the ordinary high-water mark of any lake, ����E �EN+�F l�SO ti
ond,river,stream,creek,and name the body of water. a�nt Name.
p The above certifes ihat Ne listed informa6on and intenGons are
We and cortect The above persons/s hereby give permissi�n for
6.Indicate any grading or clearing in excess of the construction site. acce55to me Pmvemmronsue�ns�ea�on.
7.Ir.dicute distance to any wet�and.
Permit Fee:
May 5, 2004 -
Issue Date Signature of I uin gent
May 5, 2005
Expiration Date
Office Comments:
Inspection Date: 50%Rule Applies: Avg.Setback: Within Reservation boundaries:
Restrictions and other information:
TpWN OF WINTER
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