HomeMy WebLinkAbout032-438-06-3304-LUP-2004-652 . �
Application for Land Use Permit (*Non-shoreland*) r .,,,� �
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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.
PRINT-USE BLACK INK OR PENCIL ,
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Owner Builder �:
�-IU6 l.J � lYl:l I�er s f. '�- Sa�►nsL �.
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Mailing Address Mailing Address �
����n wo c�c� C� �- ���`/3 7 'F` `���1-� �
City, State, Zip City, State, Zip
�S� � b7- �1S�l S— �. sa.�
Daytime Phone Daytime Phone
Additional Information: Zone District: 1�� -� `�
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Lot Dimensions: ��j 6 � r j 3 0�� �
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Date lot was created: Acres: n
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Is there wetland near the proposed structure? If yes, how far N� �
Building Land Use Floodp�ain:-( j �es �Cj No � C
�New ( ) Filling � �
( ) Addition ( ) Dredging Driveway access off of a(Check one): � �
( ) Alteration ( ) Grading ( ) Private Rd QQ Town Rd. o
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy N �
� ) � ) o �
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Primary Structure Accessory Building Addition � °
� Dwelling ( ) Garage-attached/detached ( ) Deck W
1 Porch
( ) Year round ( ) # of car stalls ( , � �� ?
� Seasonal ( ) Storage Building ( ) Enclosed � � �
( ) Frame built on site ( ) Screenhouse ( ) Living room � T �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen W s �
( ) Mobile/manufactured ( ) Other ( ) Bedroom ,� A
( ) Other primary structure ( ) ( ) Relocate/enlarge � Z
� � � � ( ) # ofnew W � �
Additional Information: • ` �
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Type of Construction:
�Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete '�
( ) Other ,..d �
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Construction Cost: Primary Structure $ ��`'}'�' 1�-�( C�L���: � �
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Accessory Building: $ Addition: $ ^ �
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Deed: Vol Pg Certified Soil Test# � Z
CSM: Vol Pg Lot# Sanitary Permit# p`�-031 h�' o, �
Plat Envelope Or: N �C.
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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: •
Variance: # LUP: # SP: # CUP: #
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Inspection Report: # y�-00 a' Change of Zone District:- :
ll�`�'°�{,�
33��5
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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. ��� ;i� #2. #3. #4. •
Size�_ft.wide fr.wide fr.wide ft.wide
�ft.long ft.long fr.long fr.long
Floor area 6�� sq.ft. sq.ft. sq.ft. sq.ft. .
Hgt.from gtade I��to peak ft.hgt. ft.hgt. ft.hgt.
Stories � stories stories stories
#of bedrooms � �j���
a
Rear Lot Line
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2 t•
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166
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Fire Number and Name of Road
1. Enter lot dimensions and indicate north by arrow. Sign ure of Ownef or Authorized Agent:
2. Indicate the location and size of the requested construction
Signalure
activities. �
PnntName: u f 1 tl b U�.R
3. Also,1nCIlCate tlle IOCaUOn ailcl dlStanCe t0 t}le well n� The above cenifes that the listed intormalion and intentiors are
true and conect.that all work shall be pedormed in comp iance
�ptic tank and drainfield,wetland azeas lot lines an to the w�m me r���remeot5 0}me sawyer co��ry zo��o9 o�d��,a�ce
and the laws and regulafions of the State of Wisconsin,and if
CCritCIliriO Of tI1C i02 . acting as owner(s)agent has the permission of the owner(s)to
perform ihe work requested on this application. The a6ove
personsls hereby give permission tor axess to Ne property for
onsite inspedion.
Permit fee:$ 17s
November 10, 2004 - z� _
Issue Date Signature of Issui g ent
November 10, 2005 50%Rule: Average Road Setback: _
Expiration Date
Office Comments
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O O O O
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O O .. O � O O � N a O
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M a � M
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3 MILE CORNER ROAD
SCALE: I INCH= 400 FEET FOR ASSESSMENT USE ONLY NOl
�_�_�_3 DRAWN BY: CK DATE: 6/10/81 INTENDED TO SHOW GONCLUSIVE
COLON (:) INDIGATES GOVT. LOT EVIDENCE OF OWNERSHIP OR
BOUNDARY LOCATIONS