HomeMy WebLinkAbout032-438-06-2203-LUP-2004-197 Application for Land Use Pernut /1�C�-������� o o �
County of Sawyer S�E OFFICE COR,1�u1t�;15 � '�
PO Box 676 -Haywazd 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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Owner Builder 1 �
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Mailing Address Mailing Address � �
U/cnnu�� w i _s'�/7�% �31-� �-___, r �s�Y�s�
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City,State,Zip City,State,Zip
>�� s��' 3Y>y `7•> �'c.�.' 3r�y �
Daytime Phone Daytime Phone -
Additiona]Information: Zone District I�R�� i�
Lot Size �
R
Date lot was created Acres �• �� �
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:
Is there wetland near the proposed structure?If yes,how far �
Building Land Use �°
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Q�j New O Filling � Floodplain:O Yes UO No # ;;
( )Addition ( )Dredging � �
O Alteration �QC)Grading Chippewa Flowage: O Yes (�No �
( )Moving On ( ) o
( � ( ) Driveway:( )State ( )County (�Town Rd. �'
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Primary Structure Accessory Building Addition �
J�Dwelling ( )Garage-attached/detached ( )Deck �
( )Year round ( )#of car stalls ( )Porch c�
Q�}Seasonal O Storage Building O Enclosed � �
( )Frame built on site ( )Screenhouse ( )Living room � �
( )Modular/manufactured ( )Greenhouse ( )Kitchen �
( )Mobile/manufactured ( )Other ( )Bedroom �' �
( )Other primary structure (X) ��;vy ( )Relocate/enlazge � �
� � ( ) ( )#ofnew >
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Additional Information: �
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Type of Construction �
(�'j Frame ( )Log ( )Pole/metal ( )Block (K)Concrete F��=� �
( )Other �
Construction Cost:Primazy Structure$ �� ,00 ` �'
AccessoryBuilding:$ �oo Addition:$ z
iVzw 3�►�C�7 v �
Vol Pg of Deed Certified Soil Test# �
CSM Vol Pg Lot# SanitaryPermit#n�•��,: ��;,.y ��-l)IJ' i�
Plat Envelope Or: Vv �
Condo Vol Pg Year Installed
Aff of ex septic Vol Pg Owner When Installed:
Gard Gazebo Vol Pg
SI1�����
Previous Variance: LUP: Inspection Date: „t,.�
Vt
33;�35
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. �� -r #3. #4.
Size�� ft. wide � ft. wide fr. wide ft. wide
�c- �ft. long l� ft. long fr. long ft. long
Floor area�a , sq. ft. ?�o sq. ft. sq. ft. sq. R.
Hgt.from gade a 1' to peak � ft. hgt. ft. hgt• �• h&'�•
Stories I ya �_stories stories stories
# of bedrooms�
Lot Line or Lake/River name:
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Fire Number and Name of Road y d'`/S' � ,e r i�
1. Fill in lot dimensions and indicate north by arrow. Signature of Owne�or Authorized Agent:
2. Indicate location and size of existing and new structures. -
,�. � i
3. Indicate location of well, sepric tank, drainfield. �-/ � ' � �,� •.,,,;
4. Indicate distance to existing structures, lot lines, septic system. ` l `�
5. Indicate distance to the ordinary high-water mazk of any lake,
pond, river, stream, creek, and name the body of water. Princ Name: �r r�y o� .`� (-�>t� 4�
The above certifes that e listed inlormation and intenGons are
6. Indicate any grading or clearing in excess of the construction site. we a�d�o�� rne ano�e Per�o�5i5 ne�eby y��e Per��55�0�ro�
access to Ne property(or onsite inspection.
7. Indicate distance to any wetland.
Permit Fee: �,� S"�
Ma� 19 �2004 �
Issue Date Signahue of Issui Ag n
May 19 , 2005
Expiration Date
OfFice Comments: �� C�l��l`lM�� �- re-W`(�OVe� � � � I a-� I �`�
Inspection Date: 50% Rule Applies: Avg. Setback: Within Reservation boundaries:
Restrictions and other information:
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3 MILE CORNER ROAD
SGALE: I INCH= 400 FEET FOR ASSESSMENT USE ONLY NOl
��.�_Q DRAWN BY: CK DATE:6/10/81 INTENDED TO SHOW CONCLUSIVE
COLON (:) INDIGATES GOVT. LOT EVIDENCE OF OWNERSHIP OR
BOUNDARY LOCATIONS