008-938-34-5104-LUP-2004-478 ' Application for Land Use Permit(*Shoreland*) o o '
County of Sawyer �' � �---
PO Box 676 -Hayward WI 54843 `�
715/634-8288 O
*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.
��a^ PRINT—USE BLACK INK OR PENCIL � '
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Owner Builder o- �
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Mailing Address Mailing Address � O �
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City,State,Zip City,State,Zip
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Daytime Phone Daytime Phone
Additional Information: Zone District: ��`�
Lot Dimensions:
Date lot was created: Acres: /� I �
Is there wetland near the proposed structure?If yes,how faz o
Building Land Use Floodplain:O Yes O No G �
O New O Filling Chippewa Flowage:O Yes O No cP Q
O Addition O Dredging Driveway access off of a(Check one): �
( )Alteration ( )Grading ( )Private Rd ( )Town Rd. �
( )Moving On ( ) ( )County Hwy ( )State Hwy °Q
� ) � ) �
0 0
N ,.S
Primary Structure Accessory Building Addition o ,.��.
( )Dwelling (�iazage-attached/detached ( )Deck �
O Yeaz round O#of car stalls O Porch W
( )Seasonal ( )Storage Building ( )Enclosed �,
O Frame built on site O Screenhouse O Living room rn
( )Modulaz/manufactwed ( )Greenl�ouse ( )Kitchen ,•`_',
( )Mobile/manufactured ( )Other ( )Bedroom �
O Other primary structure O O Relocate/enlazge p
� � ( ) ( )#ofnew �
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AdditionalInformation: ��� (����OS �O tix,e_Qccc�1�Q � >
�p�'Ch 0.t�i�i�Dn. � c�o
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Type of Construction: � �
(�'F`rame ( )Log ( )Pole/metal ( )Block ( )Concrete �
n'
( )Other ,�
Construction Cost:Primary Structure$ ,.ti �
?;
f Accessory Building:$ /7� �2r1` Addition:$ o Vi
, - �eqrr � '�„
Deed:Vol y 4� Pg.�� Certified Soil Test# �; z
uo �y
CSM:Vol Pg Lot# Sanitary Permit# �
Plat Envelope Or: � �
Condo Vol Pg Year Installed: f;,� • Jz• i`t�� N �
v,
"Loads and Flows": Vol Pg Owner When Installed: �
�.
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Previous office approvals/actions:
Vaziance:# LUP:# %���C�1t• SP:# CUP:# �
Inspection Report:# Change of Zone District: � �I��'�
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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. L1 c ��S � #2. �.tP�1 rc #3. �ac_IC r�«� #4.
Size 3�ft. wide o2� ft. wide �fr. wide ft. wide
3 `� ft. long � � ft. long 1,z•�S�� ft. long ft. long
Floor area sq. ft. •�If sq. ft. //z�5� sq. ft. sq. ft.
Hgt&om g�ade to peak � ft. hgt. ft. hgt. ft. hgt.
Stories T stories stories stories
# of bedrooms
Lake/Pond/Flowa e/River/Stream Name
.
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Fire Number and Name of Road � ��''� �'�-', �-g � � � ���� fi�
1. Enter lot dimensions and indicate north by arrow. Si nature of Owner�I Authorized Agent:
2. Indicate the location and size of the requested construction ���i,i��;���-. L�����ti�� �-�
SignaNre
2CttV1Y1CS. PrintName:L'���h��✓�� (��(J02Evm9
3. Also, 1ndlCate the IOCat10n and d15tanCe to the We�l, The above certites that the listed intormation and intentions are
We and cortect, Nat all work shall be performed in crompliance
SeptlC tank ancl c$ainfield, wetland areas, lot I1nes, with me requirements of the Saxyer Counry Zoning Ordinance
and the laws and regulations of the Siate of Wisconsin, and if
CenteLllne of t}10 TOad and WatE7bodles. acting as owner(s)agenL has the pertnission of the owner(s)to
peAortn the work 2quested on this application. The above
personsls hereby give permission for access to the property for
onsite inspection.
Permit fee: $ � � �
Total land azea within 300' of the waterbody: (A) �17� 91(0
Total impervious surface azea [including this project] (B) z 38D
(B)/(A) x 100 = % Used y.9 �o (Shall not exceed 15%[or 25%with a conditional use permit].)
Shoreline Vegetation Protection Area: Mitigation Required? O Yes (�I No
�� zo� y �����'�, ��
Issue Date ' Signature of Issuing gent
g e0 ' _ 50%Rule: Average Road Setback:
Expiration D te
OfficeComments: �`Ql�c�y �'P� � � �.�
Ci�XccX.��,� c� (�- ���-5 � .
SHORELAND PRESERVATION AGREEMENT •
(Shoreline Ve�etation Protection Area) �
Land Use Permit No. �y-�7� (To be entered by the Zoning Office) Index No. � -�
WHEREAS, (list all owners) William and Joan Wuorenma
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.
h 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
I� 35' landwazd from the ordinary high-water mazk of the waterbody.
� The owner(s) hereby agrees to comply with the shoreland vegetative protection area requirements of Section
3 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 Govemmental 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]
L to inspect the structure(s) or uses authorized by said Land Use Permit and to determine if the SHORELINE
O 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
3 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,
� mjunctive relief, restoration of said real estate, the revocation of said Land Use Permit and the removal of all
� struchues 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
OZoning Office.
I.egal Description of Property: � d �I ,f D %�� - ��G- �y " � r� ' �
'ro�,n nf F.dgewater Sawyer County WI 008-938-34-5104 _
Dated this o2 � day of /4 J /:v S % , o� ��' �/
(Owner) (Owner)
C.J � �� � �//� �'���JG��P��/h �? _
(Owner) (Owner)
(Owner) (Owner)
This insttument was draRed by:
Sawyer County Zoning Office
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