HomeMy WebLinkAbout032-539-17-2301-LUP-2004-522 �� .
Application for Land Use Permit(*Non-shoreland*) r .
County of Sawyer � �
PO Box 676 -Haywazd WI 54843 � �
715/634-8288 �; -
*Property that is not located within 300'of a creek,river or stream or within 1000'of a C, �
flowage,lake or pond or does not have any of the above waterbodies located within �- �
the property's boundaries. - i- '
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 Ma�lmg Address � O
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City,State,Zip City,State,Zip
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Daytime Phone Daytime Phone
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Additional Information: Zone District: -
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LoC Dimensions: L��7 x ( � � =
Date lot was created: �' � �� `� � Acres: l�' o �
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Is there wetland neaz the proposed stnzcture?If yes,how far 5�u�*-i`>�- -�-s o�t��v,,, A'`•'� ' ��
Building Land Use Floodptain-( j Yes (Xj No =R +-
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OC)New ( )Filling -
O Addition O Dredging Driveway access off of a(Check one): �
O Alteration O Grading O Private Rd O Town Rd. o
( )Moving On ( )_ (X.)Counry Hwy ( )State Hwy i,"', �i
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Primary Structure Accessory Building Addition � °
�Dwelling ( )Garage-attached/detached ( )Deck w
/ ( )Year round ( )#of cax stalls ( )Porch =
(X)Seasonal O Storage Building O Enclosed �
(X)Frame built on site O Screenhouse O Living room � lan
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen � �
( )Mobile/manufactured ( )Other ( )Bedroom >., �
( )Other primary structure ( ) ( )Relocate/enlarge ' �
� � ( � ( )#of new � �?
Additional Information: p
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Type of Construction: W �r
�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete 0 `
( )Other ,�
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Construction Cost:Primary Structure$ ��. ��� � �
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Accessory Building:$ _ Addition:$ �
�3/9C�/� ao
Deed:Vol Pg Certified Soil Test# — � z
CSM:VoI Pg Lot# SanitaryPermit# Q�/-J'�/'� o, �
Plat Envelope Or: �, ;1
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Condo Vol Pg Year Installed: co
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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: �/�,/6�
3S I 3�1
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. SeQs-��1 #2. #3. #4.
Size��ft.wide ft.wide ft.wide fr.wide
3 0l ft.long ft.long ft.long ft.long
Floor azea r�`��P sq.ft. sq.fr. sq.fr. sq•ft.
Hgt.from gade /_5 to pealc ft.hgt. fr.hgt. ft.hgt.
Stories / stories stories stories
#of bedrooms�_
N��,� �,��,�
la�'Lot Line
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�So�tl. LotLi��l
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Fire Number and Name of Road a�pt�c� �a,- `%- ) � `f - i.o�<<���( t h�'�i - ��ti'
1. Enter lot dimensions and indicate north by arrow. Signature of Owner or Authorized Agent:
2. Indicate the location and size of the requested construction ��,�� ,� i�1�,�/�„� (�-"��`E`�'"
Sgnature�-
activities. wn 1 r
PrintName: \��0..�:.r�C.e. �. �Y1�1��c
3. Also,1ndlCate the locatlon HTId dl5tance to the Well, The above certifies that the listed intormation and intentions are
true and cortect.,Nat all work shall be performed in compliance
septic tank and drainfield,wetland areas,lot lines and to the w�m me requ�reme�a or me Sawyer County Zoning Ortlinance
and ihe laws and regulations of the St21e of Wisconsin,and if
CEritCLI1riC Of thC I'08d. ading as owner(s)agent,has the permission of the owner(s)to
�76 w�r pedorm the work requested on this appliration. The above
� �.� personsls hereby give permission for access to the property for
� onsite inspection.
� orNe
Permit fee:$ � l.'?,�� C�,'Cf �
M�,,tc-� �. rite,{�
� �Sep mte her 9]., Y004 � -
Issue Date Signature ofI s i g gent
September 21, 2005 50%Rule: Average Road Setback:
Expiration Date
Office Comments:
POWER OF ATTORN�Y
Know all Men by these presents,that I, .��,;�;n C 1/�e����/F�
, property owner,Town of 1.�:�r��e� ,Sawyer County,Part of Government Lot
,�rA l/�, N'� 1/4,S <-Z ,T 3�,R S ,State of Wisconsin,have
made,constituted and appointed �c�,u,,c� x� of Z3!-coexe�^ �w=
in the County of C h��p�ti;c� ,State of Wisconsin,m true and lawful agent for
me and in my name,place and stead to do any and all things necessazy for the application
for,negotiation of,or obtaining of state,county and local permits with the County of
Sawyer,Wisconsin,giving and granting hereby unto said agent full power and authorize
to do so and perform all and every act and things whatsoever required and necessary to be
done in about said premises,as fully to all intents and purposes as I might and could do if
personally present,reserving full power of substitution and revocation,hereby ratifying
all that my said agent of his substitute shall lawfully do or cause to be done by virtue
thereof,
In witness her of,I have hereunto set my hand and seal this �`7� Day
of ,2004.
_ Q��-- e �����
Owner
Notary: � �
State of: ��,4,C�n_,
County of: �,�ppU,F'd,
Personally came before me this �7. day of ,2004,
T1ie above named {f' L to me to e the person who
executed the foregoing i trument and acknowle ged the same.
� ��� ��A �, ���)(�---
Notary Pu c Coun y State
My Commission expires: �r� a/�.C��
T D W N O F �. 1�
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SEC. 17 TWP. �3a
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