HomeMy WebLinkAbout032-438-18-2411-LUP-2004-207 Application for Land Use Permit(*Non-shoreland*) o �� � �,
County of Sawyer �
PO Box 676 -Hayward WI 54843 � �
715/634-8288 vJ �
*Property that is not located within 300'of a creek,river or stream or within 1000'of a Z �
flowage,lake or pond or does not have any of the above waterbodies located within �1
the property's boundaries. � `
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. � �
PRINT-USE BLACK INK OR PENCIL
///� r /� �
��1om rr� 9� /f�'Tk�tiR- Jr�t3o i%R" ��� �li.ar,�T.2u�'O i�iZ� �
a �
Owner Builder �'
/CJ/UPI /9Q r!r ���:rz_ OC�/03' /`�CJ f'P` /�v�_ �.
Mailing Address Mailing Address � �
�lv�sn,.��- �),�� S��>.�� �/v�,n�r� L��� i'�7�f _ �
�
City,State,Zip City,State,Zip � `.1
, �1
�,s- ��U-,��y �,J- ���- ���y � �
Daytime Phone Daytime Phone F �
/� G
AdditionalInformation: ZoneDistrict: /��-� rt
� �
Lot Dimensions:/(a -`� X /o��-5 � �
�/ �
Date lot was created: Acres: `7, � o �
Is there wetland near the proposed structure?If yes,how far �'u'D � ��
Building Land Use Floodptain�f J Yes �No � �,,
�New ( )Filling �
� )Addition O Dredging Dxiveway access off of a(Check one): � �
O Altexation O Grading �Private Rd O Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy i �
� ) � ) o �
Primary Structure Accessory Building Addition � °
J�Q Dwelling O Garage-attached/detached O Deck W �
( )Year round ( )#of car stalls ( )Porch =
(�Seasonal Swrage Building O Enclosed �
O Frame built on site �Screenhouse O Living room �v�
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen a �
( )Mobile/manufactured ( )Other ( )Bedroom � p--
( )Other primary structure ( ) ( )Relocate/enlarge � �
� � � � ( )#of new .�
� �-
AdditionalInformation: � p
�c `°
�
Type of Construction: � q
(�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete � �
�
( )Other ,�y y
Construction Cost:Primary Structure$ 0?5 Ut�[1-
v c, w
� I,
� t>O 17,i
Accessory Building:$ _�O� Addition:$ � �
3 15 Ilc �°
Deed:Vol Pg Cenified Soii Test# °Q z
CSM:Vol Pg Lot# Sanitary Permit# O y-�/yP o, �
Plat Envelope �r� i� �
Condo Vol Pg Year Installed: rn �
�
Aff of ex septic Vol Pg Owner When Installed:
�
Previous office approvals/actions: >
�
Variance:# I,UP:# SP:# CUP:#
Inspection Report:# Change of Zone District: 51�n`��
�
3 3�1'1 I
� �'
,�
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.
#L L`ki3i�v #2. SIiFD #3. `�r��-� #4.
Size�?�ft.wide ��1 ft.wide (c ft.wide ft.wide >.
�ft.long �fr.long Ic ft.long ft.long '
Floor area UG� � sq.ft. ��sq.ft. � sq.ft. sq.ft.
Hgt.from gtade �5 to peak /�1L ft.hgt. ft.hgt. ft.hgt. �
Stories I / stories stories stories
#of bedrooms�_
Rear Lot Line �
� ��
{� �� 3s,
3� � �
� :��--� ll z y � '� ZB� C�� �-` � 3 S� ,�-� �
T
�
� ��
30 -�
51,,t� ii C�
�y.
��1 IFire Number and Name of Road z_� t,v'i� �
1. Enter lot dimensions and indicate north by arrow. S' n e of Owner or At�thori d Agent:
2. Indicate the location and size of the requested construction , ���, —�,��„/.,�
activities. .T
�ignaNre
PrintNamel�flost�4S T Soda-Y��
3. Also,lndicate the location and distance to the well, The above certites that the listed intormation and intentions are
We and correcL,Nat ail work shall be perfortned in comoliance
SeptiC t3C11C and(�T8lnfleld,wetland 8Te2s,lot 11nes 3Tld t0 tlle with ihe requirements of the Sawyer Counry Zoning Ominance
and�he laws and regulafions of ihe State of Wisconsin,and if
CBritCL�1riE Of Y}18 L08d. acting as ownet(s)agenl,has the permission of the owner(s)to
perfortn the work requested on this application. The above
personsls hereby give permission for access to the property for
onsite inspedion.
Permit fee:$ �C'� �� 5 C �SL� ----
Mav 24 2004
Issue Date Signature of Iss ng nt
May 24 ,2005 50%Rule: Average Road Setback:
Expiration Date
Office Comments:
TOWN OF
SEC. 18 TWP 3�
T
L.2
�5 3
6.1 5.2 5.1
8.1 �
8.2
Z 8.1
8.3 3
8.4 � �
7.1
8.5 §
8.6 �
8.
8.7
�
8B d 9
10.I 9.I
I{.I . 12.1