008-162-00-0600-LUP-2004-278 �-=:-
Application for Land Use Permit(*Shoreland*) o o •.
County of Sawyer �
PO Box 676 -Haywazd WI 54843
715/634-8288 �i�
*Property that is located within 30Q'of a creek,river cr strPam or within]000'of a �
flowage,lake or pond or has any of the above waterbodies located within ,� �
the property's boundazies. �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. ' 1
PRINT-USE BLACK INK OR PENCIL �
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Owner Builder a
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2y �3 ly�y'A„� ,v�,> �.
Mailing Address Mailing Address � O �
p�o� �„�; ��,� M it/, ss9 o i �
City,State,Zip � City,State,Zip
�n7-z��'-%rE.s �
Daytime Phone Daytime Phone
Additional Information: Zone District: �/e� `� +
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Lot Dimensions: �
Date lot was created: Acres: i �� 2
Is there wetland near the proposed structure?If yes,how far /Ve o �
Building Land Use Floodplain:( )Yes (✓j o G
O New O Filling Chippewa Flowage:O Yes ( No rn
(v�Addition O Dredging Driveway access off of a(Check one): �
O Alteration O rading O Private Rd (l�'own Rd. �
O Moving On (� CA � asr�.r��" O County Hwy O State Hwy 00 �
� � V � N S
Primary Structure Accessory Building Addition o 0
(v�Dwelling (y'Garage-attache etache ('v�Deck �
(�'�'ear round (�J#of caz stalls (vYP rcb �,
( )Seasonal ( )Storage Building ('�closed �
(�rame built on site � )Screenuouse (y�iving room �c �
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen v
( )Mobile/manufactured ( )Other ( )Bedroom _
( )Other primazy structure ( ) ( )Relocate/enlarge {'�
( ) ( ) ( )#of new � �
AdditionalInformation: h` „
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T of Construction: � vJ
(�rame ( )Log ( )Pole/metal ( )Block (V�Concrete s �
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( )Other Q �
Construction Cost:Primary Structure$ ��'3�'�DO ,.d d
Accessory Buildin :$ �� l���J Addition:$ �Qy 0�D �
�1► 11�5 ,� oc
Deed:Vol Pg�/Z(—�('� 7 Certified Soil Test# �0-�'a5(o � z
CSM:Vol Pg Lot# Sanitary Permit# _ �']-�O`1 °4 �
Plat Envelope Or: o, 1 �
Condo Vol Pg Yeaz Installed: �q�J 7 �;, I``�
"Loads and Flows": Vol Pg Owner When Installed: o �
�i c-�;i ' �k//���ar�—r vYJ� �,
Previous office approvals/actions: �� _ �� � a
Vaziance:# LUP:# 9�{- Ola SP:# CUP:# '� a b
Inspection Report:# Change of Zone District: S� ,`\� �
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Describe the construction using these columns.List the dimensions of each structure in a separate .
column. t a h sto ,each additio , ach alte�ion in a separate columq�. '
#1. �- ���,�io�t-�wr��#2. ���},,_«-� �Ic�v #3. ScJe°e� �c�cl,� #4.
Size /_L it.wide ��fr.wide �ft.wide ft.wide
��ft.long ��ft.long 2.l.�_� ft.long ft.long
Floor area 3 y o sq.ft. �7g sq.ft. �sq.ft. sq.fr.
HgC from grade��to peak��ft.hgt. -�c ��,�r �,�ft.hgt. ft.hgt.
Stories stories stories stories
#of bedrooms �
Lake/Pond/Flowa e/River/Stream ame
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�o ` 3
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Fire Number and Name of Road #�� � �✓ wFs �otiH-�- �;..P G'u;� ei���,
1. Enter lot dimensions and indicate north by azrow. Si nature f Owner or Auth ized gent:
2. Indicate the location and size of the requested construction � � -�{v�
Signature
activities. �� /
Pnnt Name: //�`+ f �4��y C'Ii/�YA L(✓'
3. Also,1ndlcate the location and distance to the well, The above ce�ifes that the listed info ation and i ntions are
We and conect,that all work shall be peAormed in compliance
septic tank and drainfield,wetland areas,lot lines, wiN Ne requiremenis of Ne Sawyer County Zoning Ortlinance
and the Wws and regulations of the State of Wisconsin,and if
centerllne of t}le road and waterbodies. acting as ownef(s)agent,has ine permission ot the owner(s)to
perform ihe work requested on this application. The ahove
personsls hereby give permission for access to the property(or
-7 onsite inspection.
Permit fee:$ /5 •��
Total land azea within 300'of the waterbody:(A).5 Ci, C'o�'
Total impervious surface azea[including this project](B)���
(B)/(A)x 100=%Used '�.9/ (Shall not exceed 15%[or 25%with a conditional use permit].)
Shoreline Vegetation Protection Area:Mitigation Required?O Yes (�No
JLne 17, 2004 -
Issue Date Signature of I m ent
June 17, 2005 50%Rule: Average Road Setback:
Expiration Date
Office Comments:
SHORELAND PRESERVATION AGRF.EMENT
(Shoreline VeEetation Protection Area)
Land Use Permif No. �/—z 78 (To be entered by the Zoning Office) Index No. 04� -�7�j
�
WHEREAS,(list all owners) � � • —
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�
� owns real estate within Sawyer County that is subject 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 mark of the waterbody.
� The owner(s)hereby agrees to comply with the shoreland vegetative protection area 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)fiu�ther 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]
C� 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 tercninate
7 on the date of expiration of the land use permit. However,the owner's obligation to maintain the SHORELINE
Q 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 par[ies agree that this Agreement shall be filed with the Sawyer County
Zoning Office.
Legal Description of Property: /V G/ ,� /V��T 7 Fr�7(� t'�/L� ��M l�c(l��
Dated this�day of 6 y
(Owner) s (Owner)
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(Owner) � �� (Owner)
(Owner) (Owner)
This instrument was drafted by:
Sawyer County Zoning Office
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