HomeMy WebLinkAbout032-538-10-2404-LUP-2004-161 i n for Land Use Permit *Non-shoreland* � r �, '
Applicat 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 Builder �:
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Mailing :�ddre�.s Ma.iling Address � ��^"��
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Cit State, Zi � �
City, State, Zip Y� P
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Daytime Phone Daytime Phone � �c �
Additional Information: Zone District: ��'�f �
5
Lot Dimensions: � �
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Date lot was created: Acres: Co• �z � o
Is there wetland near the proposed structure? If yes, how far � �
Building Land Use Floadplain: ( j Yes (�No `�
( )New ( ) Filling �
� Addition O Dredging Driveway access off of a(Check one): �,
( ) Alteration ( ) Grading ( ) Private Rd ( ) Town Rd. o
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy �,
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Primar�� Structure Acc;�ssnry Buildin� !Additi � °
( ) Dwelling ( ) Garage-attached/detached Deck W
( ) Year round ( ) # of car stalls �Porch �
O Seasonal O Storage Building O Enclosed �
( ) Frame built on site ( ) Screenhouse ( ) Living room � �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen � �
( ) Mobile/manufactured ( ) Other ( ) Bedroom � �
( ) Other primary structure ( ) ( ) Relocate/enlarge (� �'
� � � � O # ofnew � Z
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AdditionalInformation: a A
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�Ty e of Construction: '`Z \
Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete �
( ) Other � y
Construction Cost: Primary Structure $ r i e� � �
Accessory Building: $ Addition: $ �P ,S 0 D, � �l
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Deed: Vol 5q�Pg N70 _ Certified Soil Test#__ Q�'6 l� � L
CSM: Vol Pg
Lot# Sanitary Permit# 99'�/v o� �
Plat Envelope Or: N �
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Condo Vol Pg Year Installed: �
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Aff of ex septic Vol Pg Owner When Installed: "
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Previous office approvals/actions: �a_ p�0
Variance: # LUP: # qj-d/Z� SP: # CUP: #
Chan e of Zone District: I�`I
Inspection Report: # g �'�
3�[0�38
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. PowC.ti ADD;�donE #2. #3. #4.
Size�_ ft. wide fr. wide ft. wide fr. wide
�~I fr. long ft. long ft. long ft. long
Floor azea 3 a�/ sq. ft. sq. ft. sq. ft. sq. fr.
Hgt. from grade /,2 � to lxak ft. hgt. fr. hgt. fr. hgt.
Stories '� stories stories stories
# of bedrooms -�--
Rear Lot Line
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Fire Number and Name of Road y3 y0/l� ���e (o/%�� °q- .
1. Enter lot dimensions and indicate north by arrow. Signatu�e of Own r dthorized Agent:
2. Indicate the location and size of the requested construction
S' aNre
activities.
PnntName: �1�1i.� Mew OMo-rf
3. Also, indicate the location and distance to the well, Tha above cerlifes Mat the Ilsled Info tion a mce�eons e�e
true and conect., that all work shall be perfortned in comp!iance
se tic tank and drainfield, wetland areas, lot lines and to the wilh the requiremenis of the Saxyer County Zoning ONinance
p and the laws antl regulations of the Sfale of Wisconsin, and it
Centerllne of the road. acfinq as ownet(s) agent, has the permission ot the owner(s) to
peAortn the work requestetl on lhis application. The above
personsls hereby give permission for access to the property for
onsite inspecfian.
o °
Permit fee: $ � S•
May 11 , 2004 Vr-�u h X.l'�P � � � —
Issue Date Signature ofI ui gent
May 11 , 2005 50% Rule: AverageRoadSetback: _
Expiration Date
Office Comments:
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67
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66
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SGALE: I INCH= 20o FEET FOR ASSESSMENT USE ONLY NOT
DRAWN BY: sRo DATE: //�/Z�Bo INTENDED TO SHOW GONCLUSIVE
GOLON G) INDIGATES GOVT. LOT gOIUNDARY LOCAT ONS �P OR