HomeMy WebLinkAbout032-538-09-3302-LUP-2004-549 Application for Land Use Permit(*Non-shoreland*) o o �
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
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 J Builder <'
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Mailing Address Mailing Address �
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City,State,Zip � City,State,Zip
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Daytime Phone Daytime Phone
Additional Information: Zone District: �� -�
Lot Dimensions: ~"
Date lot was created: Acres: � -� i n `
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Is there wetland neaz the proposed structure?If yes,how faz G
Building Land Use Floodp}ain-( )Yes (�C)No �
�New ( )Filling � �
O Addition O Dredging Driveway access off of a(Check one): �
O Alteration O Grading O Private Rd (�Town Rd. o
O Moving On O O County Hwy O State Hwy c,'''�
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Primary Structure Accessory Building Addition � °
( )Dwelling �Garage-attached/detached ( )Deck W
( )Year round ( )#of car stalls ( )Porch =
O Seasonal O Storage Building O Enclosed �
O Frame built on site O Screenhouse O Living room '
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen � �
( )Mobile/manufactured ( )Other ( )Bedroom �.' �
( )Other primazy structure ( ) ( )Relocate/enlarge �
� � � � ( )#of new �, �,��
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AdditionalInformation: �r p
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T e of Construction:
(�'rame ( )Log ( )Pole/metal ( )Block ( )Conarete �
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Construction Cost:Primary Structure$ � �
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Accessory Building:$ "' %� Addition:$ �
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Deed:Vol_�Pg � Certified Soil Test# �f - /`<3 � /-yc;� z
CSM:Vol Pg Lot# Sanitary Permit# 'jl �/l.% ��/ �r,`� o, �
Plat Envelope �r� N
Condo Vol Pg Yeaz Installed: o e
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Aff of ex septic Vol Pg Owner When Installed:
Previous office approvals/actions: '
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Variance:# LUP:# 'i/ �.`/�`, SP:# CUP:# ,
Inspection Report:# Change of Zone District: iG / '� ki ��y�
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3`3�"1'-f
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 �yr:� sq. ft. sq. ft. sq. ft. sq. fr.
Hgt from gade�to pealc fr. hgt. ft. hgt. fr. hgt.
Stories / stories stories stories
# of bedrooms (
Rear Lot Line
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Fire Number and Name of Road t � "l/ `�`/ �� r i �
1. Enter lot dimensions and indicate north by arrow. Signiture.of Owner o�Autholized Agent:
2. Indicate the location and size of the requested construction j/. �: t- � !' �
" � � " Slgnature
activities.
Print Name:
3. A150, 1ndlCatE tlle lOCation and diStanCe YO tlle well, The above ceRifies Nat the listed Information and intentions are
true and conect.,ihat all work shall be pedormed in compliance
septic tank and drainfield, wetland areas, lot lines and to the w�m cne req��reme�� or me sawye� co��ry zoom9 om��a�ce
and the laws and regulations of the State of Wisconsin, and if
centerllne of the road. acting as ownef(s)agent, has the permission of fhe owner(s)to
perform the work requested on this application. The above
personsls hereby give permission for access to the property for
onsiteinspeclion.
Permit fee: $ ; �
September 30. 2004 \ A ti-�O � `�-1 �-t 1Y�`?�.1 - ��-0�� z�'
Issue Date Signature ofIssu� nt
September 30, 2005 50%Rule: Average Road Setback: _
Expiration Date
Office Comments:
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i? 16 SCALE: I INCH= 40o FEE
DRAWN BY : lSRD D
COLON (:) INDICATES GO