006-339-36-5302-LUP-2004-266 Application for Land Use Permit(*Shoreland*) o o •
County of Sawyer � [_�_
PO Box 676 -Haywazd WI 54843
715/634-8288
*Property that is located within 300'of a creek,river or stream or within 1000'of a
flowage,lake or pond or has 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
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Owner l Builder a �
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Mailing Address Mailing Address -� O
,��f��)Q C� r.,.-� �T 72 Loo�_X�9•�x�a ' � � W� s �s'fs�2 �
City,State,Zip City,State,Zip
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Daytime Phone , Daytime Phone �-
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Additional Information: Zone District: �-� =
Lot Dimensions: ro
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Date lot was created: Acres: 33•`!�
Is there wetland near the proposed structure?If yes,how faz S�� o
Building Land Use Floodplain:O Yes (�No �
(7g New O Filling Chippewa Flowage:O Yes � No c�
O Addition O Dredging Driveway access off of a(Check one): x�
O Alteration (k)Grading �)Private Rd O Town Rd. �
( )Moving On ( ) ( )County Hwy ( )State Hwy "°
� ) � ) � �
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Primazy Structure Accessory Building Addition o 0
O Dwelling QQ Garage-attached/de ached O Deck �
O Year round (�)#of caz stalls O Porch �„ �
( )Seasonal ( )Storage Building ( )Enclosed �
O Frame built on site O Screenhouse O Living room �,
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen °
( )Mobile/manufactured ( )Other ( )Bedroom -
( )Other primary structure ( ) ( )Relocate/enlarge �
� � ( ) ( )#of new i
Additional Information: �
� �
�
0
Type of Construction: �
(x)Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �
�'
( )Other � ,�
Construction Cost:Primary Structure$ �,� O D U �
ro I�
Accessory Building:$ Addition:$ � �.1
`°- �0
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Deed:Vol_ �l5'l Pg�� Certified Soil Test# �; z
CSM:Vol Pg Lot# Sanitazy Permit# "� '�
Plat Envelope Or: � �
Condo Vol Pg Year Installed: c�
� �
"Loads and Flows": Vol Pg Owner When Installed: �
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Previous office approvals/actions: �'
Vaziance:# LUP:# SP:# CUP:# �.
Inspection Report:# Change of Zone District: �
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yi yP�l
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,l,Tde ft.wide fr.wide fr.wide �
��:� � ft.long ft.long ft.long ft.long
Floor azea;`;�',f`�" sq.ft. sq.ft. sq.ft. sq.ft.
Hgt.from gcade f:' � to peak ft.hgt. ft.hgt. ft.hgt.
Stories_� stories stories stories
#of bedrooms u �
Lake/Pond/Flowa e/River/Stream Name
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; _. _. $G � 36 X a y
' Gar�age �`
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Fire Number and Name of Road �7�� �v�����..�
1. Enter lot dimensions and indicate north by arrow. Si natUre of Owner or Authorized Agent:
2. Indicate the location and size of the requested construction �f.�c� Sc�c �'<.�--
Signature;��
activities.
PnnlName �.� `�"`��y���
3. A150,1ndlCate the IoCatlon and CI1StanCe to ttle Well, The above certifies thal ihe listed informatlon and intenlions are
true and cortecl,that all work shall be pedortned in compliance
Septic t8II1{3T1C1(�Talnfleld,wetl3IId aYeas,lot 11nes, wlth the requirements of the Sawyer County Zoning Ordlnance
and ihe laws and regulations of the State of Wisconsin,and if
centerline of the road and waterbodies. a�c��s as owner�s�a9e�t na5 cne Pe�m�Ss�on or me ow�e��s�to
peAortn the work requested on this application. The above
personsls hereby give permission for access to the property for
onsi!=insoec!ion.
Permit fee:$��U.U U
Total land area within 300'of the waterbody:(A) ��� �� r� -
Total impervious surface area[including this project](B)
(B)/(A)x 100=%Used (Shall not exceed 15%[or 25%with a conditional use permit].)
Shoreline Vegetation Protection Area:Mitigation Required?O Yes O No
��
June 15, 2004 �,��e��`�"` � '"--'--%?��>
Issue Date Signature of Issuing Agent
June 15, 2005 50%Rule: AverageRoadSetback:
Expiration Date
Office Comments:
nt 3y: SANlYER COUNTY Zoning; 715638 3277; Jun-9-04 9:01AM; Page 2/�
SHORELAND PRESERVATION AGREEMENT
(Shoreline Ve�etation Protection Arcal
Land Use Permit No. D y�� {To be entered by the Z,oning Office) Indez No. Q y - ,���
WHEREAS,(list all owners) �� y�,��„/ � �,�,,� Gp-. _
owns real estate within Sawyer County that is subjeot to the'Sawyer County Shoreland Regulations, and
WHEREAS,in order to secure a Land Use Permit.
3 NOW,THEREFORE,the owner(s)hereAy certifies that,as a condition of issue of said T.and i7se Permit,that
the SHORELINE VEGETATION PROI'ECTION AREA on said real estate is intact to a minimum depth of
� 35'landward&om the ordinary high-water mark of the waterbody.
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' The owner(s)hereby agrees to comply with the shoreland vegetative protection atea requirements of Section
t 4.410 SHORELAND VEGETATION PROT'ECTION AREA,Sawyer County Zoning Ordinance,in effect on
the date that the land use pemiit is issued by the zoning office.The ownet(s)further agtees to allow authoriud
� represrntatives of the Govermnental Unit to enter onto the owner's property at the following descrip6on
between the hours of 8:00 A.M.and 6:00 P.M.[Section 9.13(1)POWERS,Snwyer County Zoning OrdinanceJ
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 daie of expiration of the land use permit. F�owever,the owner's obligation to maintain the SHORET.TNF.
�VEG$TAT[ON PROTECTION AREA in accordance with Section 4.410 SHORELAND VEGETATION
� PROTECTION AREA, Sawyer County Zoning Ordinance temains in effect.Violation of this Agreement will
C authorize, in addiGon to other penalties and relief requireci under the Sawyer County Zoning Ordinance,
m)unctive relief,resYoration of said real estate,the revocation of said Land Use Permit and the removal of all
struclures approved by the issue of said Land Use Permit and the revocation of any other wes approved by die
�issue of said Land Use Permit. All parties agree that this Agreement shall be filed with the Sawyer County
� Zoning Office. �p�
a vare�e r � � : oe6- 331�i'G "S
�Legal Description of Property: �°✓t•'xk*t•�f L c�f3 o ne L � � �1-t ✓���•J l� S i X ���J
�v�CIJSi� SfCJ�lO✓� T✓li rtY — S 1 x � �� � � � Ow��% ��ir��r—,(/iHt
(��( ) N�,:�-ri, , , 4h y� 7� �z< <�� w�lt- _
Dated thi� �� day of 7�° Y
'19 �s: r.-.�'
(Owner) ,,—<<-7/ ;v<s G�-.-.-,�.4�- (Owner)
(Owner) (Owner)
(Owncr) (Owner)
Thls insWment was dratteQ hy:
Sawyer County Zoning OfFce
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