008-937-18-5105-LUP-2004-513 C� �
Application for Land Use Permit(*Shor;,land*) o 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 I �
the property's boundazies.
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED.
PRINT—USE BLACK INK OR PENCIL .-
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Owner Builder � ¢
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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 j -
Additional Information: Zone District: �(L�(
Lot Dimensions:
Date lot was created: Acres: ��o
Is there wetland near the proposed structure?If yes,how far �'�� � o
Building Land Use Floodplain:O Yes (;�No �
( )New ( )Filling Chippewa Flowage:( )Yes (� No ;o
O Addition O Dredging Driveway access off of a(Check one): �
( )Alteration ( )Grading ( )Private Rd ( )Town Rd. �
( )Moving On ( ) (�County Hwy ( )State Hwy °'
1?�) ` ( ) o G� _
W o
N �.\'
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Primary Structure Accessory Building Addition o o _
( )Dwelling ( )Garage-attached/detached ( )Deck �
O Yeaz round O#of caz stalls O Porch W
( )Seasonal ( )Storage Building ( )Enclosed
O Frame built on site O Screenhouse O Living room c�
( )Modular/manufactured ( )Greenhouse ( )Kitchen �
( )Mobile/manufachzred (y�Other � � ( )Bedroom �
( )Other primary structure ( )f'n�hi � , +.� ' -. � ( )Relocate/enlarge
� � ( � ( )#of new
Additional Information: �'; ��_���{ J , ��-=� ,.;- , �.�,� �o ��'� � �
-� ;c_�� i .°�_ ,1���!' , ,. . . . _ � � � % � m
' _ _ �
I'ype of Constructioa. ��. � �� • —
(�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �
( )Other _ y
Construction Cost:Primary Structure$ .,y� �
Accessoxy Building:$l�������-_ _ ���,i/;,' Addition:$ �
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Deed:Vol (08`� Pg Z?! Certified Soil Test# ." � �z
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CSM:Vol --�" Pg �` Lot# — Sanitary Permit# �
P1at Envelope — Or: �
Condo Vol --- Pg Year Installed: -- N �
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"Loads and Flows": Vol -- Pg Owner When Installed: �
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Previous office approvals/actions:
Variance:# LUP:# SP:# CUP:#
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Inspection Report:# Change of Zone District: qf�y 1�
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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.%';F,.,� -: <. ; —t�: #2. #3. #4.
Size ft. wide ft. wide ft. wide ft. wide
ft. long R. long ft. long ft. long
Floor azea ' ' sq. ft. sq. ft. sq. ft. sq. ft.
Hgt from giade /^ , to peak ft. hgt. fr. hgt. ft. hgt.
Stories__L stories stories stories
# of bedrooms�_
Lake/Pond/Flowa e/River/Stream Name
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Fire Number and Name of Road � � �- � i� �� % ,- �� % �
1. Enter lot dimensions and indicate north by arrow. S�tl�ure of Owner or Authorized Agent:
2. Indicate the location and size of the requested construction � 1 Q ��
SignaN
activities.
PrintName: � /NnA- � � ��/�-�-�'£�
3. .`�lso, 1nalCate the locatlon and dlstanCe to tlle well, The above certifies that the listed intormation and intentions are
We and correct.,ihat ali work shait be peAormed in crompliance
septic tank and drainfield, wetland azeas, lot lines, with the requirements of ihe Sawyer Counry Zoning Ordinance
and the laws and regulations of ihe State of Wisconsin, and if
centerline of the road and waterbodies. aa�o9 as owner�s)ayem,na5 me Per��ss�o� or me owne��5�ro
pedortn Ne work 2questetl on this application. The above
personsls hereby give pertnission for access to lhe property for
onsite inspection.
Permit fee: $ `���
.�/ �r,�.,�, +h4� 300' � ONWM
Total land azea within 300' of the waterbody: (A) 7�-
Total impervious surface azea [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 No
September 16, 2004 ��}—
Issue Date Signa e ofIssuin g t
September 16, 2005 50%Rule: AverageRoadSetback:
Expiration Date
Office Comments:
SHORELAND PRESERVATION AGREEMENT
(Shoreline Vegetation Protection Area)
Land Use Permit No. �5� (To be entered by the Zoning Office) Index No. � -���
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� WHEREAS, (list all owners) � 1 C�- � i� ��:, f t�J 'ru �� �Q/' bc� ]�, �U�0�4
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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 Permrt.
_�
NOW, THEREFORE, the owner(s) hereby certifies that, as a condition of issue of said Land Use Permit, that
..dn the SHORELINE VEGETATION PROTECTION AREA on said real estate is intact to a minimum depth of
C 3 5' landwazd from the ordinary high-water mark of the waterbody.
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�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
jy 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 permit. However, the owner's obligation to maintain the SHORELINE
VEGETATION PROTECTION AREA in accordance with Section 4.410 SHORELAND VEGETATION
Kl 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.
� �� � � � � .� z � �
Legal Description of Property: tF�``� �`� � � � . �
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Dated this � day of�� � , � �
�
(O er) (Owner)
(Owner) (Owner)
(Owner) (Owner)
This instrument was drafted by:
Sawyer County Zoning Office
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