HomeMy WebLinkAbout002-840-21-5203-LUP-2001-523 �5.,1
�
Application for Land Use Permit o 0
County of Sawyer � �
PO Box 676 -Hayward WI 54843 � �
715/634-8288
The undersigned hereby makes application for a Land Use Permit and agrees that all work �o
shall be done in compliance with the requirements of the Sawyer County Zoning Ordinance b
and the laws and regulations of the State of Wisconsin.CONSTRUCTION NIAY NOT _
BEGIN UNTIL THE PERMIT IS ISSUEA ` t
PRINT-USE BLACK INK OR PENCIL � �
a
�/.elen �)c�c;.'� ��iyvi�r'nr�l� o �
Owner Builder ° �
/�/-�C/�i11C�c�s� 1��. �� " �
Mailing Address Mailing Address
�/`,dl�ev /�LL� s{"�-{�3,�- �
City,State,Zip City,State,Zip
`7l 3- 5?/-7.�.�`7 _
Daytime Phone Daytime Phone -
Bui(ding Land Use (� �
O 1Ve�v O Fillin� Zone District �� �
( )Addition ( )Dredging -
(�Q Alteration O Grading Lot Size �j'7 r+�e o �
( )Moving On ( ) .�
( ) ��� ���C ) Acres 3 �'7 �,rr,:��. '
_�^� c�
Prim Structure Accessory Building Addition �
(�Dwellin� ( )Gara�e-attached/detached ( )Deck �
O Year round O#of car stalls O Porch � �`
�j Seasonal O Stora�e Building O Enclosed C'A �
O Frame built on site O Screenhouse O Living room p'��
( 1 Modular/manufactured ( )Greenhouse ( )Kitchen
( )Mobile/manufactured ( )Other ( )Bedroom �
( )Other primary structure ( ) ( )Relocate/enlarge � �
( ) ( ) ( )#ofnew U
SU
T e of Construction � �
�Frame ( )Log ( )Po1e/metal �'j Block ( )Concrete � �
( )Other � c�,�
� �.
. �
Construction Cost$ /Q�j�� �
Vol �/E'�C Pg �(e:� of Deed Certified Soil Test# � ,�
CSM Vol Pg Sanitary Permit# r;L' z
Plat Envelope Or. Q2� �� �<(�� 'l� �'
Condo Vol Pg Year Installed 7��i;-w.�.,a I�
AffofexsepticV P OwnerWhenInstalled: � �I��IDi
D' �i 9 ri4 ��.--s�
�..-l9ln �ti,
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Application for Land Use Permit — Page 2
Describe Construction: List dimensions of each structure, story, addition, or alteration. �
#1 . ►^e� E- #2. c�� G�'�`__i #3. #4. �
Size .�� ft. wide ft. wide ft. wide ft. wide
_�� ft. long ft. long ft. long ft. long
Floor area �C" sq. ft. � sq. ft. sq. ft. sq. ft.
Hgt. from grade a,l ,, to peak ft. hgt. ft. hgt. ft. hgt.
Stories /�.�,. stories stories stories
# of bedrooms /
���` � � �y� rear lot line or waterline of lake/river
In the box sketch in:
Location and size of all
existing and proposed structures.
Location of septic system.
Indicate distance to:
Waterline/Wetlands
Road
Lot lines
Septic system/privy
Well
Distance between structures.
�� �;.���
Indicate North.
Fire Number:
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Signature of Owner
The above certifies that the listed
information and intentions are true and
correct. The above person/s/ hereby
give pernussion for access to the
property for onsite inspection. ------- CenteT'11ne of �(� e�'�._�� �d��
road-------
Issue Date Se�tember 26 , 2001 Expire Date September 26 , 2002
Office Comments:
�� � ` �
Signature of Zoning Administrator
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