HomeMy WebLinkAbout032-437-17-4101-LUP-2004-450 Application far Land Use Permit(*Non-shoreland*) o o �
County of Sawyer �
PO Box 676 -Hayward WI 54843
� 715/634-8288
*Property that is not located within 300'of a creek,xiver 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 �;
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Mailing Address Mailing Address O �
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Cit�tate,Zip City,State,Zip �
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Daytime Phone Daytime Phone �
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Additional Information: Zone District � 1�-/
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Lot Dimensions:
Date lot was created: Acres L�� o
Is there wetland near the proposed stnzcture?If yes,how far G �
Building Land Use Floodptain�f )Yes (�No �°
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(�New ( )Filling
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O Addition O Dxedging Driveway access off of a(Check one): �
O Alteration O Grading O Private Rd ��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 :
(�Seasonal -Karr}-�r� O Storage Building O Enclosed �
O Frame built on site O Screenhouse O Living room �
( )Modular/manufactured ( )Greenhouse ( )Kitchen �
( )Mobile/manufactured ( )Other ( )Bedroom �
( )Other primary structure ( ) ( )Relocate/enlazge '
� � ( ) ( )#of new �
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Additional Information: p
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Type of Construction: �
(�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete
( )Other ro �
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Construction Cost:Primary Structure$ � �5(�Q � �
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Accessory Building:$ Addition:$ �
# 3��� ��3 �
Deed:Vol Pg Certified Soil Test# °Q
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CSM:Vol Pg Lot# Sanitary Permit# [`'`/- L�14 i� o, '7�
Plat Envelope Or: N I`
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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:
Vaziance:# LUP:# SP:# CUP:#
Inspection Report:# Change of Zone District: ��D,,
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. _�70�� C�
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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. wide
�� ft. long ft. long ft. long ft. long
Floor area �{�o�sq. ft. sq. ft. sq. ft. sq. ft.
Hgt.from grade to peaic ft. hgt. fr. hgt. ft. hgt.
Stories_l_ stories stories stories
#of bedrooms_�
Rear Lot Line
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Fire 1�Iumber and Name ofRoad �(�l�,�r�-r��,� "��,a � , Q��� ��
1. Enter lot dimensions and indicate north by arrow.
Signa o ner r uthorized Agent:
2. Indicate the location and size of the requested construction
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aCY1V1t1BS. Slgnature
3. Also, 1ndlCate the IoCatlOn 2Ild dlStanCC to the Well, The above�cedifies that the listed information and intentions are
true and correct., that all work shall be pertortned in compliance
septic tank and drainfield, wetland areas, lot lines and to the with the requirements of the Sawyer Counry Zoning Ordi�ance
and the �aws and regulafions ot the State of Wisconsin, end i(
CCIlt8i11riZ Of Y11C i08d. ading as owner(s)agent, has the permission o(the owner(s)to
perform ihe work requested on this application. The above
persons/s hereby give permission for axess to ihe property(or
onsite inspection.
Permit fee: $ I`jS t S U z zs
August 20, 2004
Issue Date Signature ofIss �ng gent
August 20, 2005
50% Rule: Average Road Setback:
Expiration Date
Office Comments:
5. 1 2 . 1 I . I
I 3. 1 4. 1
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14. 1 13. 1
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15. I 16. I
SCALE: I INCF{= 400 FEET FOR ASSESSMENT USE ONLY NOT
DRAWN BY: C �� DATE : 7�30/81 INTENDED TO SHOW CONCLUSIVE
COLON (:) INDICATES GOVT. LOT EVIDENCE OF OWNERSHIP OR
BOUNDARY LOCATIONS