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HomeMy WebLinkAbout002-840-28-5215-LUP-2001-143 � �� 7S� , Application for Land Use Permit r .� County of Sawyer f � PO Box 668 -Haywazd WI 54843 ' 715/634-8288 Thc undersigned hereby makes application for a Land Use Permit and agrees that all work � shall be done in compliance with the requiremenu of the Sawyer Counry Zoning Ordinance � and the laws and regulations ofthe State of Wisconsin. PRINT—USE BLACK INK OR PENCIL ��a z.I �1-Lv n ne. W� I S�i^'q n�� ��.;re C�c�u � � Owner Builder o: � !y oz;S ]'��' c�t.. 9/57 �o� r��ti��:,� �.xo ° � Mailing Address Mailing Address f° � �-�yl,�. Va\I�y n,a/�S1 Z4 �J�� �.�_ s��ry 3 City,State,Zip ��1—� City,S te,Zip—� 95 L�-F 31-33 e o �3�—S`7'�3 'y(� .3 70/�(��-k6n�3S Daytime Phone Daytime Phone Building Land Use � ( )New illing Zone District=y�`� � ( )Addition �Dredging ( )Alteration (�l Grading Lot Size � ( )Moving On � ) q � ( ) ( ) Acres l. L�3 9 c Primary Structure Accessory Building Addition � � ( )Dwelling ( )Garage-attached/detached ( )Deck � ( )Year round ( )#of car stalls ( )Porch � ( )Seasonal �Storage Building ( )Enclosed � O Frame b�ilt on site O Screenhouse O Living room � ( )Modular/manufactured ( )Greenhouse ( )Kitchen ( )Mobile/manufacmred ( )Other ( )Bedroom ( )Other primary structure ( ) ( )Relocate/enlarge ( ) ( ) ( )#of new � �. \ Type of Construction � ( )Frame ( )Log �Pole/metal ( )Block ( )Concrete � = ( )Other � � � 1 I J_ � �`� Construction Cost$ / �V a� � � -\ � .� f Vol�P��of Deed Certified Soil Test# /�'C'-D�I�I ' CSM Vol P� Sanitary Permit# /�d Y�7ry °a � Plat Envelope Or: � z c� � � Condo Vol Pg Year Installed � y 9 O � Aff of ex septic V P Owner When Installed: I � � �Vbe�hu �.1/0.11���"�lj� f �� p I � � �� a33 I Application for Land Use Permit — Page 2 Describe Construction: List dimensions of each structure, story, addition, or alteration. #1. - 2. #3. #4. Size �o ft. wide ft. wide ft. wide ft. wide _�_�ft. long ft. long ft. long ft. long Floor area )zo� sq. ft. sq. ft. sq. ft. sq. ft. Hgt.from gcade%to pe� ft. hgt. ft. hgt. ft, hgt. Stories� � stories stories stories # ofbedrooms C� reaz lot line or waterline of lake/river In the box sketch in: � � � Location and size of all � Z� „ I existing and proposed structures.� �� � , / 0�� Z �i Location of septic system. � �� 1_� I �� 1� � -� L la c> � Indicate distance to: Waterline/Wetlands �� 3� Road ' � i Lot lines �'��' �S Septic system/privy �>Q�cl' �\ '� � �� Well `'� �Z� Distance between structures. � Indicate NoRh. � ���Z S�� � ln)0<�S�o n �y Fire Number: �� 7 7 `f� /✓ t1 e.�,��r ��� ��'� �� � Y�.� ���,��t---� a SignatureofOwner �n�Z � The above certifies that the listed ��`'�hS�. information and intentions are true and � ]�_ correct.The above person/s/hereby /��� give pernilssion for access to the property for onsite inspec[ioa ------- CCritCIl117C Of iO3d------- Issue Date M�Y 21, 2001 Expire Date �Y Z1 , 2002 Office Comments: '�`/ ��L�'��%'?'%�� Signature of Zoning Administrator C.Lti�i�� eU'� •• �..kivCi c�� C1�:!P.}zR* SNfP O� FlC�l.9.�a��iY LOC�p►+ TIC;��S. � N C� F� SS L KE TOW �A _ A � SEC . 28 TWP 40 N . 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