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008-190-00-0500-LUP-2004-370 Application for Land Use Permit(*Shoreland*) o � � County of Sawyer �; � PO Box 676 -Hayward 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 �� u/1 K � �a l'l l�r� �//"�f �e 9"/v/�'I�� a�v � Owner �nilder p< 22oZ-2,i�� /� �' �Za'� ,5��-�T � Mailing Address Mailing Address � °�E N � � � �� e C��.� ((� r s�f��' �i�� C�� (,��. �`f�6 �> � ��,�' w � City,State,Zip / City,State,Zip/ y� �d r,`�'�.,A � �/.S- 23� -Z23� ��- � ��- ZZc `L `�'- 1��c� o, a Daytime Phone Daytime Phone � �Q' '`� 5 �� Additional Information: Zone District: �j�� C � W � � � n ��° � r Lot Dimensions: �'' �'`��("LC o(.. � �• Date lot was created: Acres: , ��C � Is there wetland near the proposed structure?If yes,how faz o � , � Building Land Use Floodplain:O Yes O No � ` � (�j New ( )Filling Chippewa Flowage:( )Yes ( ) No �o O Addition O Dredging Driveway access off of a(Check one): � � O Alteration O Grading O Private Rd �j Town Rd. � � ( )Moving On ( ) ( )Counry Hwy ( )State Hwy °Q � ) � ) �C 0 0 N ,..t � r Primary Structure Accessory Building Addition o 0 (�Dwelling (�age-attache etached ( )Deck � OO Yeaz round (Z,)#of car stalls O Porch �., ( )Seasonal ( )Storage Building ( )Enclosed � O Frame built on site O Screenhouse O Living room c� ( )Modulaz/manufactured ( )Greenhouse ( )Kitchen � ( )Mobile/manufactured ( )Other ( )Bedroom � � ( )Other primazy structure ( ) ( )Relocate/enlazge � � ( ) ( )#of new AdditionalInformation: � � e �' c � Type of Construction: � �, (�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete I� � )Otber �C��_Q M ��-�(��✓'� d y OOOc'�. � Construction Cost:Primary Structure$ � .ti Accessory Building:$ 1�,uG u Addirion:$ � `^� � ce / � Deed:Vol_��.Pg� CertifiedSoilTest# C�`�'Q�� z Y �� °Q '� CSM:Vol Pg Lot# Sanitar Permit# , - Plat Envelope Or. � J�^ Condo Vol Pg Year Installed: N I� � "Loads and Flows": Vol Pg Owner When Installed: � � "t Previous office approvals/actions: Q Variance:# LUP:# SP:# CUP:# ' Inspection Report:# Change of Zone District: � � �I�� '�8S9' � Describe the construction using these columns.List the dimensions of each structure in a separate column.List each story,each additiou,each alteration in a separate column. #1. OU �i #2. ��1}Ot�'i� #3. #4. Size Z g ft.wide 7,�/ _ft.wide it.wide ft.wide ��ft.long Z`� ft.]ong ft.long ft.long Floor azea�sq.ft. S�sq.ft. sq.it• sq•ft. Hgt.fiumgt�de_ topealc fi.l�gt. ft.hgt. ft.hgt. Stories � _�stories stories stories #of bedrooms Z Lake/Pond/Flowa e/River/Stream Name �ia ��' � V� �'�� P�� PFl�T Y LINY�: _ .. , �1�—��-. - �I \ �`� ��Sp IC FlF,[U ►—rA�yb'-- L __"_ ��; yi �° � ,� � W�� g� �I; ;I E,� tsi' U��a�,J -----_____—. oa�T� �� '—�— --f� —_ .,> -- -- —__ r __ _ _-- - -- --�/�5T__.__�fi��'�___�� ,` ±� Pirc Numbcr v�d Ntine of Ro�d I. �nter lot dimcnsious and indicate nortl�by arrow. Signatul'e of Owner or Authorized Agent: 2. Indicate the locatiou and size of the requested conslruction y( Signalure activities. .� Pdnt Name: /.�a✓�� p U I/ti 3. Also,111dicaCe tlle locat1o11 ancl dlst�nce to t11e well, 7he above cer�lles that lhe Ilsted Informatlon and Intentions are true arM cortect.,that all work shall be pedormed in wmpiiance SE 1.1C Y&Tllt Blld(�T'&11lrIC�a,wetland areas,lot lines, with the requiremenLs of the Sawyer County Zoning Ordinance p and the laws and regulatlons of the State of Wisconsin,and if centerline oF thc road and waterbodies. ac��9 as ow�er(5l ese��,na5 me��m�55�o�or me owr�ed5)ro pedortn Ihe work 2quested on ihis application. The at�ove personsls hereby gNe permission for access to lhe properry ior onsite inspedion. ✓ � Permit fee:$_� `� �� -- Total land area within 300'of the waterbody:(A) 1 7 �1��-� Total impervious surface area[including this project](B)� (B)/(A)x 100=%Us2d �'��_�(Shall not exceed I S%[or 25%with a conditioual use permit].) Sl�oreline Vegetation Protection Area:Mitigation Required?O Yes (�No July 20, 2004 — Issue Date Sigunture of Iss i g � ent July 20, 2005 o Avera e Road Setbacic 50/o Rule: B Expiration Date Office Comments: 5�� SHORELAND PRESERVATION AGREEMENT (Shoreline Vegetation Protection Area) Land Use Permit No. Q y--3 r/(� (To be entered by the Zoning Office) Index No. �-3 7v WHEREAS, (list all owners)�j/�� //��j l q , 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 SHORELII�;E V�GETATICN PROTECTdCP: AP.EA or said reai estate :s intact to a min:nram depth o: 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) further agrees to allow authorized representatives of the Governmental Unit to enter onto the owner's property at the following description abetween 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 permit. However, the owner's obligation to maintain the SHORELINE a VEGETATION PROTECTION AREA in accordance with Section 4.410 SHORELAND VEGETATION v 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 Pt� 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 Deseciption of Property: �� (� cS ��, � � ��`' 3 � ��(.(� Dated this �5 day of v v�� , �DDG� (Owner - (Owner) (Owner) (Ownec) (Owner) (Owner) This instrument was drafted by: Sawyer County Zoning Office i ° � 2 � 3 � r 4 m 5 ^ � � 6 AKE ° 0 � � CHETAC 7 0 � puB��c v^i ,q ccE-SS ° WOODHA 8 � TOG✓n! OF Ep6EGv M SEC. 34� TWP 3B �l . � ,, FOR. DETA/L ED PL `o EN I�EL O PE 76 �� g � pEE DS OPf/CE �