HomeMy WebLinkAbout006-440-35-3101-LUP-2004-618 �,
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Application for Land Use Permit(*Non-shoreland*) o o '
County of Sawyer � � �"��
PO Box 676 -Haywazd WI 54843 �
715/634-8288 p'
*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
l�l�'�Ce��p� ct��n N
.���r �
�ERALD �/2ED�RlCK �
Owner Builder a'
7y13 /� �R�/tAWr�Y 7�13/v I�P.oR4u.'Ay o'
Mailing Address Mailing Address O
�oR�Tr� � 1i✓i 5`ifb'yG� LoREr�TA� (�/i StlB�jCo � �
City,State,Zip City,State,Zip � �
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Daytime Phone Daytime Phone j
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Additional Information: Zone District: �-� �
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Lot Dimensions: �
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Date lot was created: Acres: �� o a
Is there wetland near the proposed structure?If yes,how far � �
Building Land Use Floodp}ain:� j 3'es (�}No :;
( )New ( )Filling '�
(�'Addition O Dredging Driveway access off of a(Check one): �
O Alteration O Grading O Private Rd '�'i Town Rd. o
( )Moving On ( ) ( )County Hwy ( )State Hwy N �
60���rr�e �'�'� ( ) "' �
A
�IL�f�uoRS � r
Primary Structure, Accessory Building Addition � °
(�Dwelling. ( )Garage-attached/detached ( )Deck W
QQ Year round O#of car stails O Porch :
( )Seasonal ( )Storage Building (�'Enclosed �
( )Frame built on site• ( )Screenhouse ( )Living room � �
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen � �
( )Mobile/manufactured ( )Other ( )Bedroom
O Other primary structure QI� �61�FN-'r�i oFF liFM� O Relocate/enlarge '
( ) ( ) ( )#of new = �
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AdditionalInformation: �' p
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Type of Construction: �
(j�Fxame ( )Log (�Pole/metal (xf Block ( )Concrete -- �
( )Other
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Construction Cost:Primary Structure$ � �
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AccessoryBuilding:$���� DWflddition:$ ��C � o
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Deed:Vol �3�� Pg I�C Certified Soil Test# "° z
CSM:Vol Pg Lot# Sanitary Permit# Q, �
Plat Envelope Or: �, �
CondoVol Pg YearInstalled: P�`�o� �v �91a4> "' �
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Aff of ex septic Vol Pg Owner When Installed:
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Previous office approvals/actions: �z _��y
Variance:# LUP:# 9l�' 158 SP:# CUP:#
Inspection Report:# Change of Zone District: I ���
I�` Z\I
t�'�
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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. #2. #3. #4.
Size�iwft de ��ft iw de ft. wide ft. wide
�� � ft. long 3� �� , ft. long ft. long ft. long
Floor azea .� � sq. ft. /'�J,1 i- sq. fr. sq. ft. sq. ft.
/r9�—
Hgt.from grade /o t to peak / 0 ' fr. hgt. fr. hgt. ft. hgt.
Stories r stories - stories stories
# of bedrooms
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�J � 6 Rear Lot Line
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ry ��
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Fire Number and Name of Road � �-{ / 3 N � I'C�� � Ll_'C'.c-t-(�
1. Enter lot dimensions and indicate north by arrow. g ature,of„Ouy�Der or A honze gent:
2. Indicate the location and size of the requested construction � �d� �
SignaNre
activities. G[/pfE�Lp[ac,�(G �
3. Also, IndlCatC the IoCatlon ancl d15tanCe to the Well, Thetabove certifes ihat the listed information and intentions are
We and cortect., that all work shall be peAormed in compliance
septic tank and drainfield, wetland areas, lot lines and to the w�m cne requ�reme��s or me sawye� co��ry zoo�n9 oro��a�ce
and the laws and regulalions of lhe State of Wisconsin, and if
COritCTI1riC Of th0 iO3d. acling as ownef(s)agent has the permission of the owner(s)to
peAortn the work requesled on this application. The above
personsls hereby give permission for aaess to the property for
onsite inspection.
C� O
Permit fee: $ 5 �
October 28, 2004
Issue Date Signature ofIs i gent
October 28, 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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