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Home My WebLink About032-438-16-2201-LUP-2004-599 � Application for 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, 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. Cy��4 Q� PRINT-USE BLACK INK OR PENCIL �� (� •� . �,_ r �'�t Z�k�� L�f�',5 i.�,'S4•u� -�. � � /�,�� i� � . � ��:�, � Owner Builder c; � � �. t��o 7S C:� � 1 �7� 7 %�w� �5 � � Mailing Address Mailing Address � �'�n�-E-�� ..-�'.� �l l�(o ��L� 1.6�� L1�'T a� f�(�� „�� " � City, State, Zip City, State, Zip ' �7 r`�) �l -��s�n %�- ��' - �.�� -L/7.�w '' Daytime Phone Daytime Phone � Additional Information: /Gone District: ,�— � � � i�` Lot Dimensions: s—� c Date lot was created: Acres: �C�i n 0 Is there wetland near the proposed structure? If yes, how far � � Building Land Use Floadptain:-f j I�es � No � �New ( ) Filling � O Addition O Dredging Driveway access off of a(Check one): �, ( ) Alteration ( ) Grading ( ) Private Rd ( ) Town Rd. o ( ) Moving On ( ) �County Hwy ( ) State Hwy �, � � ) � � o � � r Primary Structure Accessory Building Addition � ° ( ) Dwelling ( ) Garage-attached/detached ( ) Deck W ( ) Year round ( ) # of car stalls ( ) Porch � ( ) Seasonal �Storage Building ( ) Enclosed � O Frame built on site O Screenhouse O Living room � � ( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen ff ( ) Mobile/manufactured ( ) Other ( ) Bedroom } �� ( ) Other primary structure ( ) ( ) Relocate/enlarge , \ � � ( � O # ofnew � �: � �. Additional Information: � � c� � � � Type of Construction: � ( ) Frame ( ) Log (� Pole/metal ( ) Block ( ) Concrete � ( ) Other y b � Construction Cost: Primary Structure $ _ _ � � � Accessory Building: $ l� uv Addition: $ � � �. - � �� 9 � Deed: Vol�`�!�� Pg i� Certified Soil Test# C�O`351 q �" z CSM: Vol Pg Lot# Sanitary Permit# O/-a33 DO"�'�. o� � Plat Envelope �r� N � Condo Vol Pg Year Installed: � Aff of ex septic Vol Pg Owner When Installed: '-' � � �. Previous office approvals/actions: Variance: # LUP: # Q� -0`7� SP� # CUP: # Inspection Report: # Change of Zone District: �'-��.i J � �� . f ! �� 33W �� 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. #l. #2. #3. #4. Size 30 ft. wide fr. wide ft. wide ft. wide '{D ft. long ft. long ft. long ft. long Floor area / Uu sq. ft. sq. ft. sq. ft. sq. ft. Hgt.from gade I� to peak ft• hgt• fr. hgt. ft. hgt. Stories � stories stories stories # of bedrooms�_ N � CU�tit. W d �' ��co kk � C P St�F'` � xL* �( �se�� '�J`C'+ flv� . ,R`FF '�- 79a�� __—__ New '�.�D�'F- ��,�. o-��k / BO �� Fire Number and Name of Road ��0��'� C.I Y lJ 1. Enter lot dimensions and indicate north by arrow. Sign e of 0 er Authorized Agent: 2. Indicate the location and size of the requested construction e � � 3ignature activities. � PnntName: ��/ � ��S�dd 3. AISo, 1ncllCate the IoCation and d1StanCe to the Well, The above ceRifies that lhe listed Information and i�e true and cortect.,thal aIl work shall be pedortned in comp�.iance septic tank and drainfield, wetland azeas, lot lines and to the w�m cna req��eme�m or me sawye� co�ory zo��A omi�a�ce and the laws and regulations of the State of Wisconsin, and if CCritCillriE Of tI1C [03d. acting as ownef(s)agent, has the permission of ihe owner(s)to perform ihe work requested on this applicalion. The above personsls hereby give permission for aceess to lhe property for onsite inspection. Permit fee: $ �a�zQ�Qy - �4- Issue Date Signature of Issui ge t �p/7n/�' S0% Rule: Average Road Setback: _ Expiration Date �� Office Comments: � Application for 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, 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. Cy��q Q � PRINT — USE BLACK INK OR PENCIL �� •� �,_ � �':�tc G►�k�` C!� ' ' ��1/ d" L L � -f';5 � ; s�nu ��--��. ��;�,. � : h� � Owner Builder �; � I 7� 7 f�w� �5 �. i��lo�7S Ci; � � Mailing Address Mailing Address � ' �� [,�T ti' ��" �.� _---� �' N+�� W'.� 5�/ �(o Ii ;� � City, State, Zip City, State, Zip ' � .�7 i� ) �l � - ��-'�n % ._ ��'�', _ � .� � _ L/ 7_�� Da ime Phone -}� Daytime Phone Yt Additional Information: %Gone District: /� - � p�-� � �, Lot Dimensions: s- c Date lot was created: Acres: �li n 0 Is there wetland near the proposed structure? If yes, how far � � Building Land Use Floodgtain:( j Yes � No `� � New ( ) Filling � O Addition O Dredging Driveway access off of a (Check one): �, ( ) Alteration ( ) Grading ( ) Private Rd ( ) Town Rd. o O Moving On O �( County Hwy O State Hwy � o � ) � � o � � r Primary Structure Accessory Building Addition � ° ( ) Dwelling ( ) Garage-attached/detached ( ) Deck W ( ) Year round ( ) # of car stalls ( ) Porch � ( ) Seasonal � Storage Building ( ) Enclosed � O Frame built on site O Screenhouse O Living room � � ( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen Q ( ) Mobile/manufactured ( ) Other ( ) Bedroom '� ( ) Other primary structure ( ) ( ) Relocate/enlarge }; � � � ( ) ( ) # of new � � �. AdditionalInformation: � A � cn � � Type of Construction: } � ( ) Frame ( ) Log (� Pole/metal ( ) Block ( ) Concrete ( ) Other ,� b Construction Cost: Primary Structure $_ _ _ � � � Accessory Building: $ l� �Lu Addition: $ � � � 7� � � � ' Deed: Vol�`��i� Pg I� Certified Soil Test # C�C�`,3yq �' z CSM: Vol Pg Lot # Sanitary Permit # O / -b� 3 DO-��,, o, � Plat Envelope Or: �, Condo Vol Pg Year Installed: � Aff of ex septic Vol Pg Owner When Installed: � � . � �. Previous office approvals/actions: Variance: # LUP: # Q � -O`?3 SP: # CUP: # Inspection Report: # Change of Zone District: ,; . ��`,� 33�f a"1 �� ,(�� TOWN 0 F 9 SEC. 16 T�A/P C H W 5. 2 � 6' � .5.3 . .5.5 5.1 � v 7.i a. i i7 io.i s. i u.i i2.i �