HomeMy WebLinkAbout026-939-18-2101-LUP-2001-465 Application for Land Use Permit r � `--
County of Sawyer � �
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PO Box 668 - Hayward WI 54843 �
715/634-8288
The undersigned hereby makes application for a Land Use Permit and agrees that all work � _
shall be done in compliance with the requirements of the Sawyer County Zoning Ordinance �
and the laws and regulations of the State of Wisconsin.CONSTRUCTION MAY NOT j---
BEGIN UNTIL THE PERI�IIT IS ISSUED. �
PRINT—USE BLACK INK OR PENCIL � ��
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Mailing Address Mailing Address �
St���2 I,r�,Ke (� � S tl�f 7� �t��,e Zu,k� (,c.� f S`/��� C
City, State, Zip City, State, Zip ' �
c`��s) �c�s - a y q o ��►S� ��.� - �y�o �.
Daytime Phone Daytime Phone
Building Land Use �
� New O Filling Zone District c� �
( ) Addition ( ) Dredging �
( ) Alteration ( �'Grading Lot Size o �'
( ) Moving On ( ) ,� �
( ) ( ) Acres �'�l� C�C=�Y'e5 � '�
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Primary Structure Accessory Building Addition � °
O Dwelling O Garage-attached/detached O Deck 0 0
( ) Year round ( ) # of car stalls ( ) Parch � `�
( ) Seasonal (}C) Storage Buildin� ( ) Enclosed '
O Frame built on site O Screenhouse O Livin� room �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen I�4 �
( ) Mobile/manufactured ('� Other ( ) Bedroom � ��1
( ) Other primary structure ( ) ��'1��t�v' ( ) Relocate/enlarge � a
O O O # ofnew �
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Type of Construction \ A
( ) Fraine ( ) Log (�l Pole/inetal ( ) Block ( ) Concrete �
( ) Other � �
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Construction Cost $ �� 3 ��v �
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Vol S 5 S Pg .3�of Deed Certified Soil Test # o
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CSM Vol Pg Sanitary Permit# � z
Plat Envelope Or: � �'
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Condo Vol Pg Year Installed � �
Aff of ex septic V P Owner When Installed: �
- Application for Land Use Permit — Page 2
Describe Construction: List dimensions of each structure, story, addition, or alteration.
#1 . #2. #3. #4. '
Size 5� ft. wide ft. wide ft. wide ft. wide
� ft. long ft. long ft. long ft. long
Floor area .� �,�� sq. ft. sq. ft. sa. ft. sq. ft.
Hgt. fi•om g�ade 2�2, to peak ft. hgt. ft. hgt. ft. hgt.
Stories � stories stories stories
# of bedrooms
rear lot line or waterline of lake/river
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In the box sketch in: '^
Location and size of all �
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existing and proposed stnlctures. �
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Location of septic system.
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Indicate distance to: � N �� �5-a � � � �
Waterline/Wetlands � S�e �
Road � � ;l�l�.�
Lot lines ,
Septic system/privy � �f y � :_.�� �i ��
Well ; `3a�-�"-�(
Distance bet�veen stnictures. ���
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Indicate North. '3 � "
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Fire I��umber: (��� rn
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Signa ure of O � r
The above certifies that the listed
inforniation and intentions are true and
correct. The above person/s/ hereby
��ive permission for access to the
property for onsite inspection. ------- CenteT'llne of rOaCl-------
Issue Date September 18 , 2001 Expire Date September 18 , 2002
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Office Comments: ���� � �
Signatt�re of Zoning Administrator
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