008-937-08-5211-LUP-2004-622 � ��'
Application for Land Use Permit(*Shoreland*) V� 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 REQi1IItED PERMITS HAVE BEEN ISSUED. �, �
PRINT—USE BLACK INK OR PENCIL �
��✓�,�Yeado�/s,LL�_ J�1w�l� �o.,if+/uc,� a:✓ �
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Owner Builder ( / a i r
���7C'� �/1�0�7��1"c-� f����` �V /�%'.I �r� �i L� .J�IrfL'1� �+�
Mailing Address Mailing Address � � �'�
��:; �cVar� l�/I S`i�'i� Er'� l�'lourr�, �'✓i �'-�"739
�
City,State,Zip City,State,Zip
�
67�- �J7� ��
9:�1- �-%l- i >
Daytime Phone Daytime Phone �
Additional Information: Zone District: �1'Z•� �
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L�c��./���_f= /`��'f Lot Dimensions• I/l t'�^�r '�r r�S cc J�a:✓r�
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Date lot was created: �/3''���� Acres: ;-35
c] t
Is there wetland neaz the proposed structure?If yes,how faz �� z' 0 1'-
Building Land Use Floodplain:( )Yes ( )No�pi o3•0(3 b �
QC)New O Filling Chippewa Flowage:O Yes O No c�o
( )Addition ( )Dredging Driveway access off of a(Check one): �
( )Alteration ¢n Grading ( )Private Rd ( )Town Rd. �
( )Moving On ( ),�t�iacJ l0,00046 ( )County Hwy ( )State Hwy o 0
� � � � N S
� r
Primary Structure Accessory Building Addition a �
Qn Dwelling ( )Gazage-attached/detached ( )Deck � �„
�)Year round ( )#of caz stalls ( )Porch W
� �S�o�( ( )Storage Building ( )Enclosed
(k)Fratne built on site ( )Screenhouse ( )Living room �u
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen �
( )Mobile/manufactured ( )Other ( )Bedroom �
( )pther primary structure ( ) ( )Relocate/enlarge ��
� ) � ) ( )#ofnew �� I
I
AdditionalInformation: �,-;' p
�
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Type of Construction: �� I o�
(�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �
c;
( )Other y' �
�
Construction Cost:Primary Shucture$ ;'nD -�D' �
ro
Accessory Building:$ Addition:$ � W
v
Deed:Vol � �Pg�r Certified Soil Test# �`�y��- �; z
CSM:Vol ✓' �' Pg ��E' Lot# i� Sanitary Permit# �y�79 °O %°
�1�°�� �.
Plat Envelope Or: ?` ��
Condo Vol Pg Yeaz Installed: N �
�
"Loads and Flows": Vol Pg_ Owner When Installed: �
�
Previous office approvals/actions:
Variance:# LUP:# SP:# CUP:#
Inspection Report:# Change of Zone District: p�
,a��,,
�ai�
Describe the construction using these columns.List the dimensions of each structure in a separate
column�.�.List each story,each add/ition,each alterafion in a separate column.
#1. //L�N.S-/.'��d �.'���/ #�L. //�G:�Jt'-�o�'� #3. �.
Size :�`'`1 ft.wide !/':;" ft.wide ft.wide ft.wide .
��"�- R.long %�%��'� ft.long ft.long ft.long
Floor azea �E� sq.ft. �`�y sq.ft. sq.ft. sq.ft.
Hgt&nm grade /`1 to peak ft.hgt. ft.hgt. ft.hgt.
Stories � stories stories stories
#of bedrooms�_
' U Lake/Pond/Flowa e/River/Stream ame
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Fire Number and Name of Road �r/9���'!<<'�' �-"'�'' caal,�o;��� /o/3i
l. Enter lot dimensions and indicate north by arrow. Signat� of Ow r Authorized Agent:
2. Indicate the location and size of the requested construcrion �ti-" �'�'�
SignaW2,:
acdvities. �-- ��/
PrinlName: i�'l- �//�Ar.7"t i
3. Also,indicate the location and distance to the well, rne aeove�msc me Infom�ation and inEentions a2
true and carecL,that aB vro�k shall be peAom�ed in mmpliance
septic tank and drainfield,wetland azeas,lot lines, wnn me rec��n�a me saw�co��ry zoovg ad�nsnce
and tlre laws and 29ulations of tha Stale ot Wisoonsin,a�'rf
centerline of the road and waterbodies. �e��(s��e�t na�me nemmssbn a me owneqs�m
peAortn Ihe wak requesBed on Nis applica6on.The above
Petsonsls he�ebY 9ive pdmissbn br aocess to ihe property for
ansiteinspecfion.
Permit fee:$ �7S `'
Total land area within 300'of the waterbody:(A) �y t�'%
Total impervious surface azea(including this project](B) �E� �8�
(B)/(A)x 100=%Used %. (Shall not exceed 15%[or 25%with a condirional use permit].)
Shoreline Vegetation Protection Area:Mitigation Requited?( )Yes (y)No
October 28 2004 - �
Issue Date Signature of Iss ' g ent
October 28 2005 50%Rule: Average Road Setback:
Expirarion Date
Office Comments:
SHORELAND pRESERVATION AGREEMENT
(Intact Shoreline Veeptallon ProtecNon Areal
Land Use Permit No. oy�oz z (To be entered by the Zoning Office) Iudea No. d S� - �O.Z.z
WHEREAS, (list all owners) �r/� !�'i P,� �o�til L. LG �
owns real estate wiflrin Sawyer County that is subject to the Sawyer County Shoreland Regulations, and
;} WHEREAS, in order to secure a Land Use Pemut.
1
J, NOW, THEREFORE, the owner(s) hereby certifies that, as a condition of issue of said Land Use Permit, that
� the SHORELINE VEGETATION PR01'ECTION AREA on said real estate is intact to a minimum depth of
35' landwazd from the ordinary high-water mazk of the waterbody.
yThe owner(s) hereby agrees that at all times in the future, the real estate subject to this Agreement shall comply
L with all shoreland vegetarive buffer requirements of the 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 to
�_ inspect the structure(s) or uses authorized by said Land Use Pernrit and to determine if the SHORELINE
VEGETATION PROTECTION AREA eacists and that it is being preserved. Violation of tius Agreement will
c� authorize, in addition to other penalties and relief required under the Sawyer County Zoning Ordinance,
nt injunctive 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 revocafion of any other uses approved by the
� issue of said Land ilse Pemut. All parties agree that this Agreement shall be filed with the Sawyer County
o Zoning Office.
a
Legal Description ofProperty: �-G>'� r�, C3`/�'1 /�Jt7 ��7D �—e c cvz�tc� �1�3���0�
VC�uM� aG __�� -� /OL 58 � 73�N� 'K4lJ
own o� 6d �o,��- u W • 0 - 5 N
Dated this � �' , day of ��G�� � h �f �}'U � �%
(Owner) � � a<<Av�'I, LL c (Owner)
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(Owner) (Owner)
(Owner) (Owner)
This instrumen[was drafted by:
Sawyer County Zoning Office
FROM : ;�dve Rieder, LS FRX N0. : 715-354-3380 Oct. 07 2004 03:08PM PS
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��N PAULA CHISSER
� SAWYER COUNTY, WI
p��F. REGISTER OF DEEDS
� R�� « 325479
_�; S•1737 09/30/2D04 1: 30 PM
5 BIRCHWOOD
VVI �
� RECORDING FEE 13.00
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