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010-941-16-1107-LUP-2004-438 / • Application for Land Use Permit(*Non-shoreland*) o o � , County of Sawyer � - �� PO Box 676 -Hayward WI 54843 715/634-8288 � *Properiy that is not located within 300'of a creek,river or stream or within 1000'of a � flowage,lake or pond or does not have any of the above waterbodies located within � � the property's boundaries. r� CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUER PRINT-USE BLACK INK OR PENCIL ,,�'- � � J ❑ �Eninii=-ri�I7,vvc�i= �/Ri�si�y /3r/SS .S�l��"N a�. .� Owner Builder <' ���v;a /ia�-� i✓o. ,S.R, 77 90-3� �.. ��� Ij °� �� � Mailing Address Mailing Addr ss � �g_.�y,- r /d/ �/�X H 3 �-�H YC.ci/{�Z 1J i Gt/% �`�� '1 � �u � City,State,Zip Ci�ty,State,Zip 7/ti" / 3y ti-?J��' 'i�loa�.�— h�/ 7/J - � Daytime Phone Daytime Phone i �. Additional Information: Zone District: �-� `�� 1 � � � Lot Dimensions: J f f% '� S'j'� � // , � . � Date lot was created: 5 % ' /`J`.��' Acxes: `�. 7 t�� ����`�i�'� o � Is there wetland neaz the proposed structure?If yes,how faz J1f@ b � �; Building Land Use Floodptain�� j Yes (�No :° = ( )New ( )Filling � �� (�Addition O Dredging Driveway access off of a(Check one): �; � ( )Alteration ( )Grading ( )Private Rd �_.�Town Rd. . � o ( )Moving On ( ) ( )County H (�State H�vyi< � '� ; � ) � ) �� o � t� Primary Stnxcture Accessory Building Addition /� �'� 2� �f � o �Dwelling ( )Garage-attached/detached ( )Deck ��'`� '`` �,, ( )Yeaz round ( )#of caz stalls ( )Porch = O Seasonal O Storage Building O Enclosed � (�Frame built on site=��s fi.�4� )Screenhouse �Living room — ( )Modulaz/manufactured ( )Greenhouse )Kitchen � ( )Mobile/manufactured ( )Other ( )Bedroom � ( )Other primary structure ( ) ( )Relocate/enlarge � � ( � ( )#of new � �- Additional Information:`i,i� r{;, , ���;;r.�C, r�. .�i _, ;i�r �t�'i.+�r>� "' � > ��t-r��:;�-c, � , G�•�-�,+<��:�F� ��ll-� , .-9-r. � 3�7''-i'�,.Y-iF c�, ;��c ;cC..�/(, � � �f[l L'�C I S'% i n7 c; . �� 0 Type of Construction: ' � �Frame ( )Log ( )Pole/metal ( )Block (�j Concrete c ( )Other .,y � Construction Cost:Primary Structure$ f r �- ��( � � � �Accessory Building:$ �./5�'>i�/C Addition:$_��� ���.'�� � Certified Soil Test# /-O'7/ °Q Deed:Vol ro z5 Pg !5 9 —`� " z CSM:Vol�_Pg << (�Lot#�_ Sanitary Permit# 9/-��� b� � Plat Envelope Or: N �'� � Condo Vol Pg Yeaz Installed: � r, Aff of ex septic Vol Pg Owner When Installed: '-' � .� ,^_ (�,.� ���� Previous office approvals/actions: 00-0$7 Variance:# LUP:# `�/'/zv SP:# CUP:# Inspection Report:# Change of Zone District: � �� �L/ 1110� l � 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. #2. #3. ,-t/_)t:;� �zio ,� #4. Size ft. wide ft. wide i2 ft. wide ft. wide ft. long ft. long ��� ft. long ft. long Floor area sq. ft. sq. ft. ��,, sq. ft. sq. ft. Hgt.from grade to peak ft. hgt. ��ft. hgt. ft. hgt. Stories stories �_stories stories # of bedrooms °'� i>'0�� /'"��'�� Rear Lot Line � �-�_ �/ � -y C t� /_- i� � �,�� v �_J= /' %� �-' Fire Number and Name of RoadX !i � �"`i /✓ S R 7 7 1. Enter lot dimensions and indicate north by arrow. S' natu e of 0 Autho�iz Agent: 2. Indicate the location and size of the requested construction � ` L;° � �'>,_,c � S'gnaN activities. ��' PtlnWame: �1.��5� L< < '" !� �, �;�+ J 3. Also, ]nclic8te tlle IoCatlOn 8nd diStanCe to tlle WC�I, The above ceNfies ihat the listed infortnation and Intentions are We and covect.,Mal ail work shall be pedormetl in compliance septic tank and drainfield, wetland azeas, lot lines and to the with the requiremenis of ihe Sawyer Counry Zoning Ordinance and the laws and regulations of the Shate of Wisconsin, and if Centei�lne Of the LOad. acting as ovmer(s)agent, has the pertnission of the owner(s)to peAortn the work requested on this application. The above persons/s hereby give permission for access to the properry for onsiteinspec6on. Permit fee: $ August 16, 2004 - Issue Date Signature of Is 'ng ent August 16, 2005 50% Rule: Average Road Setback: Expiration Date Office Comments: / f /) /1 1 ��;7 ��'' F � C� � � � � �1 �� fs� -� � _ .���. % `f � `fa�'� SAYVYER COUI�TY GERTIFi�D SURVEY MAP �}'�-NH}� seo. �6� T. �t 1[.. lt. 9 �t. ; f/ l �o'� S.�oZ� ��"yy � Mw ti�i fat. K.t��s H �aor��o� � 993 37 ``� ��Qal� , uT "eA°28'�i T � . U� `�(� 11�� �� '-T� V K .� V l— � � I � .� .� cL n�4,9z� :r. � c � � -'x 9.98 a. ���__., �� 1/0 ` :. \�i � �� . J' � � �� '� _ �v� ��. � �.� � � � _� 1-h ~ , h b � c�. �'� ��d c�,� p� � X D � _ �� � f2X41� 0 � �� 3 p . .�.��_,��� L� a �=���,� � A � b .�• ;r � � �, N H7dpr'3o`w afj . . ry\ �%J� + � � � S60 02' � �Rk,�' ;� ♦ � , e � r j z ? ' b l= , ... '( � a� S$8°3Tilt'� �n o ! _ 'S� ; S ° .S� --3 � 2 �. �9�.i1�._._. '� �84,144 si. � . wr t� .�� �c�,�/� POWER OF ATTORNEY Know all Men by these presents,that 1, ' , -- �- (')tt i-�.s �a� _, property owcier, Town ef�,ra,,,,�i_,e , Sawyer Caunty, Parl of Govemment Lot _�, ��1/4, Ni, U4, S ��_, T �// , R v✓ , State of Wisconsin, have made, consiituted and appointed j�d; s c Sr„ ;��e of in the County of . State of Wisconsin, my true and la�vful agent for me and in my name, place and stead to do any and all things necessazy for the apptication for, negotiation of, or obtaining of state, county and local permits with the Caunty of Sawyer, Wisco�sin, giving and granting hereby unto said agent full power and atithorize to do so and perform a[i and every act and things whatsoever required and necessazy to be done in about said premises, as fully to all intents and purposes as i might and cuuld do if personally present, reserving full power of substitution and revocation, hereby ratifying all that my said agent of his substitute shall lawfully do or cause to be done by virlue thereof, In witness whereof; l have hereunto set my hand and seal this �0 �N= Day of �j�� v _, 2004. � � <-/'��� �� /L 1�L"`1 _ Owne[ Notary: �✓c�-r i �^I �c e/%.�., State of: �� �l'�.�.r�-l�i,,.c. ' —. � County of: ��c��'� � � Personally came before�rne this �__ '��day of_ / , 2004, 1'he abuve named � -��;�,�fi� ( ����.�=��to ' e to be the person who executed the foregoing instnunent and acknowled d the same. % � �j^�� `�/`�f�' , /�i...� � x/�.��,�u��at'�� Notary Public County State My Commission expires:_ � �- n ��U� / r� ,�,` e . SAWYER COUNTY CERTIFIED SURVEY MAP N�'4-NE�, Sec. 16, T. !�1 N. , R. 9 W• ,� �� N � .�?�6 f p.5��' S � II �W Na, lin� S�<. 16,Bas� of B�arinqs 993.37 358.98 mea. 360.00�Wat 588°2B�11 W I o 434,927 sf. � 9.98 pc. E = � - o pj M n � M �j O 0 � .:�/1 .�_.:�i 3 ip � r- _ H N 3 e 'a � � a m � - N 87°pl'S4'�W 860.02' °o � > 3 z z =� J QJ � � U EXISTWO � pfiNEW�V — is' S88°3741"w 310.66 meo. p ' 132.45� � S H5°02.5� W I t} M 484,44 sf. t 443.11� II.II OL. QOq _o �� �� W n O `�Py�� I ,� � � 4 -v N 22�632 sf. � ",� g a 5.22 ac. v� ya o , � ° ° - N � � � 3 Q M S 87°01�54'E 857.56' Z o ' pO.l �n Pdi•� O �m' LI bPy� DRNEW T� o Qac 58e�arso�•w is' 3 n �m _ _� 175.30 ► n^� 345.40� _ -4-47:tt=' 00 21H,323sf. N N88°42�30"E 788.SI� '� ;c, ^ 5.01 ac. ; ; ::'.�M ��•a;: 788.SIplat . , �, �b:a c'I� `J � ' .a � O SET �4�X24�REROD,wt. 1.50 Ibs/ft. F� ♦ v � • FD. 1�� IRON PIN o °p N 88°41'SO�E 508.27.' Z Z '�° SCALE i�.= 200� 0 200 400 SDRVEY FOR: CRAIG HANSON A part of the Northeaet Quarter of the Northeaet Quarter, Section 16, Townehip 41 North, Range 9 Weat, Town of Haywar,d, County of Sawyer, State of Wiaconein. , � .�' , � y � ��� :�,C •_ ''���'c �L!t t•�'fi- L � . . 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