HomeMy WebLinkAbout032-538-09-3201-LUP-2004-264 Application for Land Use Permit (*Non-shoreland*) o 0
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 c'
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Mailing Address Mailing Address �(x,�y� �'u-Q#' �
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City, State, Zip City, State, Zip � ��
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Daytime Phone Daytime Phone �.
Additional Information: Zone District: �—�
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LotDimensions: lo� SC (,��� �
Date lot was created: Acres: �G' n
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Is there wetland near the proposed structure? If yes, how far /</� �
Building Land Use Floodptain:� j IFes �No `�
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�New ( ) Filling �
( ) Addition ( ) Dredging Driveway access off of a(Check one): �,
( ) Alteration ( ) Grading ( ) Private Rd d'j.Town Rd. o
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy N
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Primary Structure Accessory Building Addition � °
( ) Dwelling ( ) Garage-attached/detached ( ) Deck W
( ) Year round ( ) # of car stalls ( ) Porch �
Stora e Buildin ( ) Enclosed CD
( ) Seasonal � g g �
( ) Frame built on site ( ) Screenhouse ( ) Living room � �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen w
( ) Mobile/manufactured ( ) Other ( ) Bedroom
Relocate/enlar e � A
( ) Other primary structure ( ) ( ) g �
� � � � ( ) # of new U'•
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AdditionalInformation: ; A
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Type of Construction: ti �
( )Frame ( ) Log �Pole/metal ( ) Block ( ) Concrete �
( ) Other � �
Construction Cost: Primary Structure $ ��� � �
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Accessory Building: $ ��'��`c".` Addition: $ �
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CLv. t���.�., �, Ssz.�r« �
Deed: ol Z` Pg� Certified Soil Test# � Z
CSM: Vol -- Pg Lot# Sanitary Permit# o� �
Plat Envelope Or: N " 1
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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: �
Variance: # LUP: # SP: # CUP: #
Inspection Report: # Change of Zone District: ���,�
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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��-rY�l� G,r. L3�-Db #2. #3. #4.
Size .�ft.wide ft.wide fr.wide ft.wide
.?6 ft.long ft.long ft.long ft.long ,
Floor azea /'% C% sq.ft. sq.ft. sq.ft. sq.fr•
Hgt.from gade�to peak ft.hgt. ft.hgt. fr.hgt.
Stories�_ stories stories stories
#of bedrooms—�
Rear Lot Line
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Fire Number and Name of Road �- �°f;�,c= ��
1. Enter lot dimensions and indicate north by arrow. Si�natufe of Owper or Authorized Agent:
2. Indicate the location and size of the requested construction � ;t. :?}/ _�c��� c'
,��� Signature
activities.
PrintName: 1«�� �7- /y.�<L.'�r..,.
3. Also,lndicate the locatlon and distance to the well, The above certires th t the listed intormation and intentions are
true and correct.,that all work shall be perfortned in compliance
septic tank and drainfield,wetland azeas,lot lines and to the wilh ihe requirements of the Sawyer County Zoning Ordinance
and the laws and regulations of the State of Wisconsin,and if
centerll]]e of the r0ad. acting as ownet(s)agent,has the permission of the owner�s)to
pedorm the work requestetl on this applica6on. The above
personsls hereby give permission for access to the property for
onsite inspection.
Permit fee:$%L3C�`�`�
June 11 2004 ���1��"� L.1���d��
Issue Date Signature of Issuing Agent
June 11, 2005 50%Rule: Average Road Setback: _
Expiration Date
Office Comments:
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SCALE: I INCH= ¢ �� FEET FOR ASSESSMENT USE ONLY NOl
DRAWN BY: �SR,D DATE : �2��7�80 INTENDED TO SHOW CONCLUSIVE
COLON (:) INDIGATES GOVT. LOT EVIDENCE OF OWNERSHIP OR
BOUNDARY LOCATIONS