HomeMy WebLinkAbout032-538-10-2317-LUP-2004-215 �
Application for Land Use Permit o 0
County of Sawyer �
PO Box 676 -Hayward WI 54843
715/634-8288 0
The undersigned hereby makes application for a Land Use Permit and agrees that all work N $
shall be done in compliance with the requirements of the Sawyer County Zoning Ordinance w �
and the laws and regulations of the State of Wisconsin.
NO CONSTRUCTION MAY BEGIN UNTIL ALL PERMITS HAVE BEEN ISSUED. 1
PRINT—USE BLACK INK OR PENCIL �
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Owner Builder �'
`3`6`��o b.l. �-L, (��''�3 5RM E: �.
Mailing Address Mailing Address I O �
�hc>-�r�an �L t,t`.5'S1 °�r4mE � �
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City,State,Zip City,State,Zip s
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Daytime Phone Daytime Phone �
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Additional Information: Zone District ��� �
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Lot Size��p� X ��S� ''
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Date lot was created Acres �� �� � A
Is the property in a Shoreland District?(within 1000'of a lake ar pond,within 300'of a river,
creek or stream) If yes,how far from the shoreline&water name: (.I'b
Is there wetland near the proposed structure?If yes,how far �.l Q �
Building Land Use �
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�New ( )Filling �� Floodplain:( )Yes (xl No # n
( )Addition ( )Dredging � �
( )Alteration ( )Grading Chippewa Flowage: ( )Yes (�No �
( )Moving On ( ) � o
( � ( ) Driveway:( )State ¢(f County ( )Town Rd. °`'
5�
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Primary Structure Accessory Building Addition �n
('�{i Dwelling ( )Garage-attached/detached ( )Deck w
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O Year round O#of caz stalls O Porch i ;c �_
Q�Seasonal O Storage Building O Enclosed � � �,
O Frame built on site O Screenhouse O Living room � i �
O Modular/manufactured O Greenhouse O Kitchen w g,
( )Mobile/manufactured ( )Other ( )Bedroom v � r '�
( )Other primary structure ( ) ( )Relocate/enlarge � � F� C
( ) ( ) ( )#of new >
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Additional Information: °
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Type of Co�lstruction x�
Q6 Frame ' ( )Log ( )Pole/metal ( )Block ( )Concrete J �
( )Other
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Construction Cost:Primary Structure���'� �
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Accessory Building:$ Addition:$ z
voi 5�57 rg 3� '�
of Deed Certified Soil Test# °
CSM Vol Pg Lot# �.�3 SanitaryPermit# ��-' Q�� P � ��
Plat Envelope Or: �
Condo Vol Pg Yeaz Installed
Aff of ex septic Vol Pg Owner When Installed:
Gard Gazebo Vol Pg �
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Previous Variance: LUP: InspectionDate: SI�� ��
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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__�_ft.wide ft.wide ft.wide ft.wicte
`�6 ft.long ft.long fr.long ft.long F
Floor area�0 sq.ft. sq.ft. sq.ft. sq.fr. ;
Hgt.firom grade�to peak ft.hgt. ft.hgt. ft.hgt.
4
Stories�_ stories stories stories .
#of bedrooms�' _
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 or Authorized Agent:
2.Indicate location and size of existing and new structures. �
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3.Indicate location of well,septic tank,drainfield.
4.Indicate distance to existing structures,lot lines,septic system.
5.Indicate distance to the ordinary high-water mazk of any lake,
pond,river,stream,creek,and name the body of water. Princ Name:
The above ceNfes that the listed informah'on and intentiors are
6.Indicate any grading or clearing in excess of the construction site. tr�e a�d�orrea.Tne above persoosis nerety 9�ve Perm�Ss�o�ror
access to the property for onsite inspection.
7.Indicate distance to any wetland.
Permit Fee:
May 25, 2004 � _ -��
Issue Date Signature of Issu' ge t
May 25, 2005
Expiration Date
Office Comments:
Inspection Date: 50%Rule Applies: Avg.Setback: Within Reservation boundaries:
Restrictions and other information:
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