010-941-23-4321-LUP-2004-639 Application for Land Use Permit(*Shoreland*) " ',v
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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,lalce or pond or has any of the above waterbodies located within �
the property's boundazies.
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. � 1
PRINT-USE BLACK INK OR PENCIL g
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Owner Builder �
(oS3�: N� i�,v�2-s�pL �h IZS�Sf �Tw��. l..�.ke
IZn � �
Mailing Address Mailing Address �� O
1-�/�t�;/t PJ'J V�+�l S���t 3 �u--a w�i-d�-�0 W l S���13 � �
City,State,Zip City,St e,Zip � "
Z�S -E3y -z5�tl 7� S t��2- �33� � 1�
Daytime Phone Daytime Phone '� ^
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Additional Information: Zone District: 2-( �
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Lot Dimensions:�J Zov�C �{00 � �
-C
Date lot was created: Acres: Z��6 � �
Is there wetland near the proposed structure?If yes,how faz n
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Building Land Use Floodplain:O Yes O No �u
( )New (JjFilling Chippewa Flowage:( )Yes (�No �
(�Addition O Dredging Driveway access off of a(Check one): s�
O Alterarion O Grading O Private Rd (�Town Rd. �n
( )Moving On ( ) ( )County Hwy ( )State Hwy °Q
� ) � ) � o
N ,�j
Primazy Structure Accessory Building Addition o 0
( )Dwelling ( )Garage-attached/detached ( )Deck N
( )Yeaz round ( )#of caz stalls ( )Porch `��„° �
( )Seasonal (�torage Building ( )Enclosed `" �
O Frame built on site O Screenhouse O Living room �
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen �
( )Mobile/manufactured ( )Other ( )Bedroom �
( )Other primazy structure ( ) ( )Relocate/enlarge �
� � � ) ( )#of new , t/1
Additional Information:
t I�l
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N �
Type of Construction: W "
(v�Frame ( )Log ( )pole/metal ( )Block ( )Concrete � �N
( )Other �
S
Construction Cost:Primary Structure$ �
Accessory Building:$ y�o o(� Addition:$ �
�, I-f.
Deed:Voi `/(o�pg /Z/ Certified Soil Test# �
CSM:Vol `D z
Pg Lot# Sanitary Permit# ?Q �
Plat Envelope Or: �' r�
Condo Vol Pg Yeaz Installed: � �
N
"Loads and Flows': Vol Pg Owner When�Installed: "' �
�
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;ous office approvals/actions: �
#,;' LUP:# 4�-294 SP:# CUP:# �'
port:# q(o-pyq Change of Zone District: p'�
l�1�1��
y�ai� ,
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 wlumn.
#1. Lee�-Eu �'.0 «urs.b�.9�j #2. #3. #4.
Size i Z- ft. wide ft. wide ft. wide ft. wide
2� ft. long ft. long ft. long ft. long
Floor area '��' 0_sq. fr. sq. ft. sq. fr. sq. ft.
Hgk from grade l�- � to peak ft. hgt. ft. hgt. ft. hgt.
Stories_�� stories stories stories
# of bedrooms C�
Lake/Pond/Flowa e/River/Stream ame
�
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Fire Number and Name of Road � 0 5�b N i��u ens,��c R�7
1. Enter lot dimensions and indicate north by arrow. Sig iature of Owner or Authorized Agent:
2. Indicate the location and size of the requested construction
Signature
activities. �'
Print Name: • ��� �--' � ���
3. Also, lndlcate the lOcatlon and distanCe to the well, The above ceAi ies that the Ilsted information and intenCion are
irue and correct., that all work shall be pedortned in compliance
septlC tBTIIC and dTalnfleld, Wet�and areas, lOt 11nes, with the requirements ot the Sawyer County Zoning Ordinance
and the laws and regulations of the St2te of Wisconsin, and if
COnteTllne of tllC rOad 2dld watOlbOdles. acting as owneY(s) agent,has ihe permisslon ot the owner(s)to
perform Ne work requested on thls application. The above
personsls hereby give permission for aaess lo the property for
onsile inspection.
Permit fee: $ _�7d
Total land area within 300' of the waterbody: (A) 6� �0 o v
Total impervious surface area [including this project] (B) t� Z�t � 1'�
(B) / (A) x 100 =%Used � (Shall not exceed 15%[or 25%with a conditional use permit].)
Shoreline Vegetation Protection Area: Mitigation Required? �Yes O No
n; ,. ,. �' - �j�-_
Issue Date Signature of Issui g ge t
�\�;;� � 50% Rule: Avexage Road Setback:
Expiration Date
Office Comments:
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SHORELAND PRESERVATION AGRTEMENT
(Non-Intact Shoreline VeQetation Protection Areal
Land Use Permit No. (��I - (o 'J` 9(To be entered by the Zoning Office) IndexNa. �-��
WHEREAS,(list all owners) Nina Gilberg
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 Pernut, that
- the SHORELINE VEGETATION PROTECTION AREA on said real estate shall be restored in accordance
� with the Mitigation Plan and Implementation Schedule approved by the Sawyer County Zoning Department.
�I The owner(s)hereby agrees that at all tunes in the future, the real estate subject to this Agreement shall comply
p� with all shoreland vegetative buffer requirements of the Sawyer County Zoning Ordinance in effect on the date
,Sj that the Land Use Pemrit is issued by the Zoning Office. The owner(s) further agrees to allow authorized
'—' representatives of the Governmental Unit to enter onto the owner's properiy at the following description to
1� inspect the structure(s) or uses authorized by said Land Use Permit and to detemune if the SHORELINE
VEGETATION PROT'ECTION AREA eacists and that it is being preserved. Violation of this Agreement will
authorize, in addition to other penal6es and relief required under the Sawyer County Zoning Ordinance,
� injunctive relief, restoration of said real estate, the revocadon 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 Pemrit. All pazties agree that this Agreement shall be filed with the Sawyer County
i Zoning Office.
T
Q LegalDescriptionofProperty: Part of the SkT4 SEw Sec 23, T 41 N', R 9 W, in the
Town of Ha ard, Sawyer County WI 010-941-23-4306
Dated��s a "�_day of_ pC'�v/,��- , ��,�, �
✓L��+�._�
(Owner) (Owner)
(Owner) (Owner)
(Owner) (Owner)
This instrument was drafted by:
Sawyer County Zoning Office
Owner: Nina Gilberg
10536 N Riverside Rd
Hayward, WI 54843
Phone: 715-634-8056 Home
715-634-2541 Work
Builder: Dave Peterson
12558 Twin Lake Rd
Hayward, WI 54843
Phone: 715-462-4330
Property Description:
SW '/o SE '/a S 23 T 41N R 09W The NoRh 200 feet of the South 500 feet
of said SWl/4SEl/4, lying West ofthe Namekagon River, Excepting the
West 33 feet thereof
Parcel No. 15.6
ParcelID No. 010-941-23-4306
Lot Area: 200 X 400= 80,000 sq. ft.; for purposes of impervious surface
calculation- 200 x300 = 60,000 sq. ft.
Impervious surfaces: Deck 24x12 ' ��Q
Deck 6x50 — 3pb
House 9x13
37x50
Garage 24�c28
Garden Shed 14x10
Utility Shed 26x12
Asphalt 15x10
40ac24
Proposed 12x20
Total 5029 Sq Ft �14Ni
5020/60,000 = 8% �'J,�I�70
Proposed building:
A lean-to frame constructed structure 12x 20 feet on the south side of the
property. There is no peak to this structure since it is integrated below the
level ofthe peak ofthe existing structure to which it is attached.
Cost: Approximately $4600
A certified soil test and sanitary permit should be on file from previous building.
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GRAPHIC SCALE
TAX ASSESSMENT PURPOSE
�� � 200 400 800 teoo Information contained on this r
advisory. Map accuracy is limit
quality of the public records fr
( IN FEET ) was prepared . It is not intende
substitute for an accurate fielc
1 inch = 400 ft.