026-118-00-1700-LUP-2008-324 . � '
Application for Land Use Pernzit (*Shoreland*) o o � �/ -
County of Saw��er � �
PO Box 676 - Hayward V�I 54843
715/634-8288
*Property that is located within 300' of a creek, river or stream or within 1000' oi.'a
flowage, lake or pond or has any of the above waterbodies located within
the property's boundaries. �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL RE(ZUIRED PERMITS HAVE BEEN ISSUED.
PRINT—USE BLACK INK OR PENCIL �
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Owner Builder Q-
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Mailing Address Mailing Address � �
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City, State, Zip City, ,State, Zip � �
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Daytime Phone Daytirne Phone
Additional Information: Zone District: RR-I ,
Lot D:imensions:
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Date lot was created: Acres: ► 7 ?�
Is there wetland near the proposed structure? If yes, how far o
Building Land Use Floodplain: ( ) Yes ( )No �
( )New ( ) Filling Chippewa Flowage: ( ) Yes ( ) No �
(�)Addition O Dredging Driveway access off of a(Check one): �, �
( )Alteration ( ) Grading ( ) Private Rd ( ) Town Rd. -� �
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy � �
� ) � ) � � �
Primary Structure Accessory Building Addition �' o �
( )Dwelling ( ) Garage-attached/detached ( ) Deck � �
( ) Year round ( ) # of car stalls �Porch � W
( ) Seasonal ( ) Storage Building .(� Enclosed � �
( ) Frame built on site ( ) Screenhouse ( ) Living room , c�
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen �° �
( ) Mobile/manufactured ( ) Other ( ) Bedroom i (�j --
( ) Other primary structure ( ) ( ) Relocate/enlarge � � "
� � ( ) ( ) # of new
_ �
� p4
AdditionalInformation: ► O �
p � �
Type of Construction: °o O
( ) Frame ( ) Log ( ) Pole/metal ( ) Bloc:k ( ) Concrete °�
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( ) Other � ,�
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Construction Cost: Primary Structure $ ,.b �
Accessory Building: $ �cidition: $ /3 0O O �
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(c Z,9 l y 3 � OQ
Deed: Vol 58`1 Pg y!9 Certified Soil Test# 9(0�350 � Z
CSM: Vol Pg Lot# Sanita:ry Permit# 02-oqy �' �
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Plat Envelope Or: �
Condo Vol Pg Year Installed: N
"Loads and Flows": Vol Pg Owner•When Installed: � �
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1
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Previous office approvals/actions: .�
Variance: # LUP:# p 2.-1/�5 SP: ;� CUP: #
Inspection Report: # Change of Zone I�istrict: �r.{ "
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z�75�
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. �o�"c, �� #2. #3. #4.
Size�ft. wide ft. wide ft. wide ft. wide
/ �, •`'�ft. long ft. long ft. long ft. long
Floor area � 1 (Q sq. ft. sq. ft. sq. ft. sq. ft.
Hgt.from grade { J� to peak ft. hgt. ft. hgt. ft. hgt.
—r--
Stories l stories stories stories
# of bedrooms�_
Lake/Pond/Flowa e/River/Stream (Name)
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Fire Number and Name of Road ���`�`� �'' �'`� �``;:' � °,° "' ;��f ;"� "�'� ` `
1. Enter lot dimensions and indicate north by arrow. Si ture f Owner or u ' ed Agent:
2. Indicate the location and size of the requested construction ���
' nature �
activities. ,�
Print Name:/_� ol Y'C� �, �a ��l
3. Also, indicate the location and distance to the well, The above certifies th�at the listed information and intentions are
true and correct., that all work shall be performed in compliance
septic tank and drainfield, wetland areas, lot lines, with the requirements of the Sawyer County Zoning Ordinance
and the laws and requlations of the State of Wisconsin, and if
centerline of the road and waterbodies. act�n9 as ow�er�s�a�ie�c, has the permission of the owner(s)to
perform the work requested on this application. The above
persons/s hereby give permission for access to the property for
onsite inspection.
Permit fee: $
7 �. �',C:�'
Total land area within 300' of the waterbody: (A) ���, ` �
Total impervious surface area [including this project] (B) 1 (� u�"
(B) / (A) x 100 = % Used �5'��:-� (Shall not exceed 15%[or 25% with a conditional use permit].)
Shoreline Vegetation Protection Area: Mitigation Requ�ired? O Yes (x(No E�w °''�' &'� g zs=a8
� ZLO, Zoo� - 7�—
Issue Date Signature of Issu gent
� ��-�,�p,�, �,�, ?pp� 50% Rule: Average Road Setbacic:
Expiration Date
Office Comments:
Page 1 of 1 ,
Real Estate Property Listing Changed Current Year . •
Property Description �`"
�' BILLING ADDRESS (Tax Bill Destination)
PIN: 57_Q�f,;,�-38-09-08-5 15-140-001700 RICHARD PALM
Legacy PIN: 026118001700 1918 EVENSON DRIVE
,,.�......�,...,, ONALASKA WI 54650
Record ID: 26756
Map ID: -4.17.1 � MAILING ADDRESS (Mai/ing Destination)
County: SAWYER
Municipality: (026)TOWN OF SAND LAKE RICHARD PALM
1918 EVENSON DRIVE
Public Land SECTION 8 T38N R9W ONALASKA WI 54650
Survey:
Quarter: OTHER � OWNERSHIP (Owne�ship Last Updated:2/6/20077.•59:14
Quarter- SUBDIVISION AMJ
Quarter/Tract:
Plat/Entity Name: FAIRVIEW SUBDIVISION RICHARD PALM
Description: FAIRVIEW SUBDIVISION LOT 17 1918 EVENSON DRIVE ONALASKA WI
Recorded Acres: 0.771 54650
Calculated Acres: 0.000
Lottery Credit Site Address (/ast updated.•5/Z3/20081:35.�45PM)
Claims: � 4395N SISSABAGAMA RD
Waterbody(s): Sissabagama Lake(05-38-09) STONE LAKE WI 54876
Zoning: (RRl) Residential/Recreational One
Farmland No Current Assessment Valuations (last updated.•2/6/2007
Preservation: 7,•58.•34 AMJ
Assessment Typ__e Acres Land Improve _Total
Documents G1 -RESIDENTIAL 0.771 201,900 151,100 353,000
Doc#: /Vol- Totals: 0.771 201,900 151,100 353,000
CONVERSION 2/6/2007 Page: 584/419
TJT629/143 Districts (lastupdated.•Z/6/10077.•57.•32AM)
District Name Ty�e Code
State of Wisconsin STATE 1
Sawyer County COUNTY 57
Town of Sand Lake MUNICIPALITY 026
Hayward Community School District SCHOOL 2478
Technical College TECH 17
Parent Property(s) Child Property(s)
(whe�e the p�operly came (p�operties this property
from) created)
N/A N/A
http://tas.sawyercountygov.org/System/REAL PROPERTY/listing.asp?pid=26756 9/24/2008
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SCALE: I INCH' loo FEET FOR ASSESSMENT USE ONLYI NC
DRAWN BY: �-�i DATE: ��/12/82 INTENDED TO SHOW CONCLUSIV
COLON (�) INDICATES GOVT. LOT gOUNDARY�LOCATIONSIP OR
SHORELAND PI2ES�RVATION AGREEMENT
(Shoreline Ve¢etation Protection Arca)
Land Use Permit No.��(To be entered by the Zoning Office) Index No. W -J7��
WHEREAS, (list all owners) �lC�=�'1C'Q��a �C� �W�.
owns real estate within Sawyec County that is subjeat to the Sawyer County Shoreland Regulations, and
WHEREAS;in order to secure a Land Use Permit.
NOW, THEREFORE, the owner(s) hereby certifies that, as a condition of issue of said Land Use Permit, that
the SHORELINE VEGETATION PROTECTION AREA on said real estate is intact to a minimum depth of
35' landwazd from the ordinary high-water mazk of the waterbody.
The owner(s) hereby agrees to comply with the shoreland vegetative protection azea requirements of Section
4.410 SHORELAND VEGETATION PROTECTION AREA, Sawyer County Zoning Ordinance, in effect on
the date that the land use permit is issued by the zoning office. The owner(s) fiuther agrees to allow authorized
representatives of the Governmental Unit to enter onto the owner's property at the following description
between the hours of 8:00 A.M. and 6:00 P.M. [Section 9.13(1) POWERS, Sawyer County Zoning Ordinance]
to inspect the structure(s) or uses authorized by said Land Use Permit and to determine if the SHORELINE
VEGETATION PROTECTION AREA exists and that it is being preserved. This authorization shall terminate
on the date of expiration of the land use pecmit. However, the owner's obligation to maintain the SHORELINE
VEGETATION PROTECTION AREA in accordance with Section 4.410 SHORELAND VEGETATION
PROTECTION AREA, Sawyer County Zoning Ordinance remains in effect. Violation of this Agreement will
authorize, in addition to other penalties and relief required under the Sawyer County Zoning Ordinance,
injunctive relief, restoration of said real estate, the revocation of said Land Use Permit and the removal of all
structures approved by the issue of said Land Use Permit and the revocation of any other uses approved by the
issue of said Land Use Permit. All parties agree that this Agreement shall be filed with the Sawyer County
Zoning Office.
Legal Description of Property:
Dated this d f ,
�4'��1�-�-�h,� > �irK_.�
(Owner) (Owner)
(Owner) (Owner)
(Owner) (Ownec)
This instrument was drafted by:
Sawycr County Zo�ing Office
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