010-841-23-5305-LUP-2004-543 Application for Land Use Permit(*Shoreland*) 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 sVeam or within 1000'of a
flowage,lake or pond or has any of the above waterbodies located within -
the property's boundazies.
CONSTRUCTION SHALL NOT BEGIN UNTTL ALL REQUIRED PERMITS HAVE BEEN ISSUED.
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Owner Bmlder � �
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Mailing Address Mailing Address � p �
�o7�ilr� Ci//� ��¢� f��,ua.�d !J/ s�Y�'y3 �
Cit , tate,Zip City,State,Zip
��i,r� 6 34 7r�9 �3�l-�s��
Dayti e Phone Daytime Phone
6
Additional Information: Zone District: �/<-�
Lot Dimensions:
Date lot was created: ��- r/7 Acres: �;�,�
Is there wetland near the proposed structure?If yes,how far o e
Building Land Use Floodplain:O Yes O No �
( )New ( )Filling Chippewa Flowage:( )Yes ( ) No �
O Addition O Dredging Driveway access off oF a(Check one): �
( )Alteration ( )Grading ( )Private Rd ( )Town Rd. �
( )Moving On ( ) ( )County Hwy ( )State Hwy °Q
� ) � ) � �
Primary Structure Accessory Building Addition o 0
( )Dwelling �'Garage-attache detached ( )Deck � I
O Yeaz round O#of car stalls O Porch W ��
( )Seasonal ( )Storage Building ( )Enclosed �,
O Frame built on site O Screenhouse O Living room cc
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen �
( )Mobile/manufactured ( )Other ( )Bedroom 0 -
( )Other primazy structure ( ) ( )Relocate/enlarge p '
( ) ( ) ( )#of new p�
�
AdditionalInformation: � p
CI� �
0
Type of Construction: �
('�Q Frame ( )Log ( )Po1e/metal ( )Block ( )Concrete � ��
( )Other \ ,�
Construction Cost:Primary Structure$ ,.d d
Accessory Building:$�,Obb°= Addition:$ � �
�
�
x
Deed:Vol.��Pg c`j'7 Certified Soil Test# �3$-/z O � z
CSM:Vol�Pg /_�Lot#_� Sanitary Permit# �!7�rJ�" tl4 �
P1at Envelope i* 3�Z Or: b. �
Condo Vol Pg Yeaz Installed: c�,
"Loads and Flows": Vol Pg Owner When Installed: � �
ci
Previous office approvals/actions: V'
Variance:# LUP:# 9�-/��S SP:# CUP:# �
Inspection Report:# 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 story, each addition, each alteration in a separate column.
#1.lsRrA�.� #2. #3. #4.
Size 28 fr. wide ft. wide ft. wide ft. wide
3 2 ft. long ft. long fr. long ft. long
Floor azea 8 SG sq. fr. sq. ft. sq. ft. sq. ft.
Hgt from grade�to peak ft. hgt. ft. hgt. ft. hgt.
Stories � stories stories stories
# of bedrooms O �
Lake/Pond/Flowa e/River/Stream ame �6u+/c�.��G.- �So,73
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S6
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JcxiN� '-25� �I �i ��' �
; , .,e $2.x�� �,�o
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Fire Number and Name of Road /06 9-?i/(/ Lf�/��L ���d�
1. Enter lot dimensions and indicate north by arrow. Signature 0 r or horized Agent:
2. Indicate the location and size of the requested construction
activities. // S�e� �
PnntName: v��NT/� ����j
3. Also, 1ndlCate tlle IoCatlon and disY.allCE YO tl"le Well, The above cedifies thet the listed intormation and intentions are
We and corred.,ihat all work shall be pedormed in compliance
septic tank and dralnfleld, Wetland azeas, lot llnes, wim the requirements ot the Sawyer County Zoning ordinance
and Ne laws and regulations of ihe State of Wisconsin, and if
CCrit8711ri0 Of t110 I'Oad 3Sld W3202b0C118S. acting as ovmer(5)agent has the permission of the owner(s)to
pedortn the work requested on this application. The above
� personsls hereby give permission (or access to the property for
� � onsite inspeclion.
Permit fee: $ �D��
Total land area within 300' of the waterbody: (A) �{,�i,o�
Tota] impervious surface area [including this project] (B) '� :- `'
(B)/(A) x 100= % Used ��� `'o (Shall not exceed 15%[or 25% with a conditional use permit].)
Shoreline Vegetation Protection Area: Mitigation Required? O Yes �No
CP ra P�9�?nnL g ,����X�l'2t.1 -�(�ll.,l. ,�� �--
Issue Date Si nature of Issui A e t ��� ' �
September 29, 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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SHORELAND PRESERVATION AGREEMF.NT
(Shoreline Veeetation Protectioa Area)
Land Use Permit No. _ Qy-.Jy3 (To be entered by the Zoning Office) Index No. Q� - SY,�
WHEREAS, (list all owners) Vicentiu and Elisabeta Andrei
�
� 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.
� 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
� 35' landward from the ardinary high-water mazk of the waterbody.
� 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
'd' representatives of the Governmental Unit to enter onto the owner's property at the following description
-j 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 f1REA in accordance with Section 4A10 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,
�.. injunctive relief, restoration of said real estate, the revocation of said Land Use Permit and the removal of all
O 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.
Legal Description of Property: part of Government Lot 3 lot A of CSM vol 2 page �
map n�ber 312. Located in Section 23, T 41 N, R 8W, Tonw of Hayward, Sawyer
County WI 010-841-23-5305
Dated this � day of �r/ , �1��
(Owner (Owner)
(Owner) (Owner)
(Owner) (Ownec)
This instrument was drafted by:
Sawyer County Zoning O�ce