HomeMy WebLinkAbout032-539-12-1107-LUP-2004-320 / ` �
Application for Land Use Permit(*Non-shoreland*) o o '
County of Sawyer � �
PO Box 676 -Hayward WI 54843 �
715/534-8288 `�
*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 Z �
the property's boundazies. �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. r,
PRINT-USE BLACK INK OR PENCIL I
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Nl�iling Ar ddress— Mailing Address �
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Ciry,State,Zip City,State,Zip
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Da}7ime Phone Daytime Phone
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Additional Information: Zone District: �� �
Lot Dimensions:�(�j���.�ZC�
Date lot was created: Acres:��� n '
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Is there wetland near the proposed structure?If yes,how faz /YL� �
Building Land Use Floodplain:� j Yes �No �
�'�Iew ( )Filling �
O.Addition O Dredging Driveway access off of a(Check one): � �
O Alteration O Grading O Private Rd Q�(Town Rd. o
( )Vloving On ( ) ( )Counry Hwy ( )State Hwy N �
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Primary Structure Accessory Building Addition � °
�Dwelling ( )Garage-attached/detached ( )Deck W
( )Year round ( )#of caz stalls �-�erelr- �
�Seasonal ( )Storage Building ( )Enclosed �
)Frame built on site O Screenhouse O Living room �- �
( )Modular/manufactured ( )Greenhouse ( )Kitchen ;�
( )Mobile/manufactured ( )Other ( )Bedroom -
( )Other primary structure ( ) ( )Relocate/enlarge \
( � ( ) ( )#of new � �
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AdditionalInformation: � p
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Type of Construction: �1,'
( )Frame ( )Log �Pole/metal ( )Block dQ Concrete � 1"
( )Other �
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Construction Cost:Primary Structure$ ���� � �
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Accessory Building:$ Addition:$ � �
�# 3zzo7z �
Deed:Vol Pg Certified Soil Test# °Q
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CSM:Vol Pg Lot# Sanitary Permit# 04� ^�15 �, �
Plat Envelope Or: �, �J``
Condo Vol Pg Yeaz Installed: � I
Aff oFex septic Vol Pg Owner When Installed: �- �
Previous office approvals/actions:
Vaziance:# LUP:# SP:# CUP:#
Inspection Report:# Change of Zone District: ',��lb-)
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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�.wide ft.wide ft.wide fr.wide
�fr.long ft.long ft.long fr.long
Floor azea_�sq.ft. sq.ft. sq.ft. sq.fr.
Hgt.from gcade to peak ft.hgt. fr.hgt. ft.hgt.
Stories l stories stories stories
#of bedrooms�_
Rear Lot Line
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Fire Number and Name of Road '
1. Enter lot dimensions and indicate north by arrow. Si��re of Owner r Authori�ed Agent:
2. Indicate the location and size of the requested construction �_� e
Signature
activities <'�G�� ��
Pnnt Name: ���� �
3. Also,indicate the locatlon and distance to the well, rne above certires mat the�isted iniormation and imentions are
true and wned.,that all work shall be performed in compiiance
septic tank and drainfield,wetland azeas,lot lines and to the with the requirements of the Sawyer Counry Zoning Ordinance
and ihe laws and regulations of the State of Wisconsin,and if
CCIItOT'11RC Of the IOfld. acting as owner(s)agenL has the permission o(the owner(s)to
peAortn the work requested on ihis application. The above
personsls hereby give permission for aceess to the property for
onsile inspectian.
Permit fee:$�r��0•—
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June 30, 2004 r:i�>
Issue Date ignature of Issuing Agent
T �0, �n n S 50%Rule: Average Road Setback:
Expiration Date
Office Comments:
� N OF WIN TE R �
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