010-941-13-3215-LUP-2004-418 \
Application for Land Use Permit (*Shoreland*) 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 �
the property's boundaries.
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUEA -��
PRINT-USE BLACK INK OR PENCIL �-
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��1ot� C:� �J'��W���L C_ ���.�u�,ft��1� ��IoST��i i�- �,NST�l�,-����,� � �
Owner Builder �
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Mailing Address Mailing Address � O �
��� c��au� w 1 ��{�`�3 :S� �L C u (,� I S �(� ,��— � '
City, State, Zip City, State, Zip �
�7l �' (� � �{-- �IO�'�' 7/ S �J �f�l '5.���'?
Daytime Phone Daytime Phone •
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Additional Information: Zone District: �-�
Lot Dimensions: �`� � � `�00 �
Date lot was created: Acres: � • �
i
Is there wetland near the proposed structure? If yes, how far �3 0 �
Building Land Use Floodplain: ( ) Yes (D�No � �
( )New ( ) Filling Chippewa Flowage: ( ) Yes �C) No 0
�.Addition ( ) Dredging Driveway access off of a(Check one): �
( ) Alteration ( ) Grading ( ) Private Rd (o� Town Rd. �
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy �"
� ) � ) �
N
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Primary Structure Accessory Building Addition o 0
( ) Dwelling ( ) Garage-attachedldetached (,� Deck �
( ) Year round ( ) # of car stalls ( ) Porch W
( ) Seasonal ( ) Storage Building 64 Enclosed �
�
( ) Frame built on site ( ) Screenhouse ( ) Living room �o
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen �
( ) Mobile/manufactured ( ) Other ( ) Bedroom p
( ) Other primary structure ( ) ( ) Relocate/enlarge o A
� � ( ) ( )#of new 1
�
AdditionalInformation: � A
,
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Type of Construction:
� Fram��,,c,l� ) Log ( ) Pole/metal ( ) Block ( ) Concrete � �
(�Other �(�t,(�� �u u�^- �G v}55 S �� �;�% /�v M- �
1 y
Construction Cost: Primary Structure $ ,.ti �
Accessory Building: $ Addition: $ �`( .��-3 �
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Deed: Vol $�_Pg 3�� Certified Soil Test# ; z
CSM: Vol Pg Lot# Sanitary Permit# �' �
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Plat Envelope Or: o�
CondoVol Pg YearInstalled: (��u� � Iq(c�`r� �, �
"Loads and Flows": Vol_ Pg Owner When Installed: � �
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a
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Previous office approvals/actions:
Variance: # LUP:# � .U��. SP: # CUP: # Q
Inspection Report: # `��� G G 3 Change of Zone District: �, ° �`�''�
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Describe the construction using these columns. List the dimensions of each structure in a separate
column. List each tory, each addition, each alteration in a separate column. =
#1. �U�vR-Oo+ti ��CK #2. #3. #4.
Size�( _ft. wide ft. wide ft. wide ft. wide
/ � ft. long ft. long ft. long ft. long
Floor area /�p0 sq. ft. sq. ft. sq. ft. sq. ft.
Hgt from grade l� � to pealc ft. hgt. ft. hgt. fr. hgt.
Stories � stories stories stories
#of bedrooms �
Lake/Pond/Flowa e/River/Stream Name
� E� ,e-�T✓rc i{�.�
Fire Number and Name of Road �� � � 3� JU- %�i 5 3� az�= JZ�� ,
1. Enter lot dimensions and indicate north by arrow. Signat��-s of�wq��rar Aut,���r�ize,;d�,A�ge t:
2. Indicate the location and size of the requested construction �� �jiiy�,t,�����L�t-- �^'—"'`� o
�na e
activities. �����-
Prin�Name:
3. Also, indicate the location and distance to the well, The above ies ihat me listed iniormation and imentions are
We and cortect.,ihat all work shall be peAortned in compliance
Sept1C tank and dI'ainfield, wetland az'eas, �Ot 11nes, wim the requiremenis ot ihe Sawyer County Zoning ordinance
and the laws and regulafions of the State of Wiscronsin, and if
centerline of the road and waterbodies. aceny as owoer�s�a9e�t nas me�e��ss�o� or me owner�sl to
perform the work 2quested on this appiication. The above
personsls hereby give permission for aaess to the property for
onsite inspection.
Permit fee: $
Total land area within 300' of the waterbody: (A) �si ��
Total impervious surface azea [including t�s�project] (B) � 3 6 c� l3(,p
(B) / (A) x 100 = %Used �T `� � !� (Shall not exceed 15°/— o—�%with a conditional use permit].)
Shoreline Vegetation Protection Area: Mitigation Required? O Yes (rQ No
August 9, 2004
Issue Date Signature ofIss g nt
August 9, 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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SHORELANDPRESERVATION AGREEMENT �
(Non-Intact Shoreline Veeetation Protcction Areal ." •
Land Use Permit No. Oy' yI S (To be entered by the Zoning Office) Index Na �- y/� -
WHEREAS, (list all owners) l���vo(� E, � �%E�NB��! � C . �i C W �2 j
owns real estate within Sawyer CounTy tltat is subject to the Sawyet ComTy Shoreland Regulations, aud
WIIEREAS,in order to secure a Land Use Peitnit.
'� NOW, THEREFORE, the owner(s) hereby certifies t}tat, as a condition of issue of said Land Use Peanit, that
� [he SHORELINE VEGETATION PROTECTTON AREA on said real estate sLall be restored in accordance
� with the Mitiga[ion Plan and Implementation Schedule approved by the Sawyer County Zoning Depariment.
dThe owner(s)hereby agees that at all times in ihe future, the real es[ate subject to this Agreement shall comply
o with all shoreland vegetative buffer requirements of the Sawyer County Zoning Ordinance in effect on the date
o tLat the Land Use Permit is issued by the Zoning Office. The owner(s) further agrees to allow authorized
srepresentatives of the Govemmental Unit to enter onto the owner's property at the following description to
Q inspect the shucture(s) or uses authorized by said Land Use Permi[ and to dete�mine if the SHORELINE
— VEGETATION PROTECTION AREA eacists and tktat it is being preserved. Violation of tttis Agreement will
�' authorize, in addi[ion to other penallies and relief required under the Sawyer County Zoning Ordinance,
� injunctive relief, restorarion of said real estate, the revocaliou of said Land Use Pecmit and the removal of all
� sWctures approved by the issue of said Land Use Peemit and the revocaUon of any other uses approved by the
� issue of said Land Use Permit. All pazties agtee that this Agreement shall be filed with the Sawyer County
Zoning Office.
� n
�- LegalDescriptionofProperty: I`A(LeG(. � S�^ O(0 - Z yi -oy- �3-3 . IO -lS
�. 5� ( 3 T y C 2 � i.✓ Z , o ��ze�-
� 7 � uun
Dated 's � — 5 dayof us% , �g0
(Owner) (Owner)
(Owner) (Ovmer)
(Ovmer) (Ownet)
This instrumen[was drafteA by:
Sawyer County Zonirtg Ottice