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010-145-00-1902-LUP-2004-640 i - Application for Land Use Permit (*Shoreland*) ' C" H �/ , County of Sawyer °, � '`� � � PO Box 676 - Hayward WI 5484�E� ���.��� ����EN�.� 715/634-8288 + ? *Property that is located within 300' of a creek, river or stream or within 1000' of a r, r.. flowage, lake or pond or has any of the above waterbodies located within 'r '�' , f�� �k7 the property's boundaries. .n "' �-; CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. p " , PRINT—USE BLACK INK OR PENCIL i4nnQ and �L�;l l ic�rv� �'�;Ibct�i�� �Icn ��lln sor� � Owner Builder ?- ���+� C,cs-�ti�rc' ��� �'.c�, �x �c� �. °� � Mailing Address Mailing Address � � �L'c��c��)��f�l , 1�� N 5� 1�5 ��z�s�n �lL"�� �yol�� �, `� City, State, Zip City, State, Zip � �;S► - �� I � C{Ir 1 �115 -3��-:�a�� �' � Daytime Phone Daytime Phone �� � �r2-�( � Additional Information: � Zone District: ,O ? � � � Lot Dimensions: ;c�x ���n �v°r x ��S� � Date lot was created: 8-/D- �7� Acres: •�t`� ; �a Is there wetland near the proposed structure? If yes, how far %G�C' ��� o ') Building Land Use Floodplain: ( ) Yes (�)No�5C�5'i/ Uc�:���/b � �j 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 � ) � ) 0 4� 0C N ,.} � r Primary Structure Accessory Building A�ddition o 0 (� Dwelling �Garage-attached/detached :���eck � ( ) Year round (7)# of car stalls Porch W �Seasonal ( ) Storage Building ( ) Enclosed � � ( ) Frame built on site ( ) Screenhouse ( ) Living room � ( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen � ( ) Mobile/manufactured ( ) Other ( ) Bedroom O Other primary structure O O Relocate/enlarge C> A ( � ( ) ( )# of new � � Additional Information: E,�;5} ;�� 4��,�.�c�u te.- � A � � c�Q.ti'1CtiS���'C,1 � ct��i Type of Construction: �� -�- ,�Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete ' --� �� ( ) Other � � Construction Cost: Primary Structure $ ��,�,%-C� � b Accessory Building: $ 1���'���' Addition: $ � � �t 3�2�035�� � ---� Deed: Vol Pg Certified Soil Test#��- �// � z CSM: Vol (o Pg��Lot# Sanitary Permit# Dy- 'y� �" %� Plat Envelope '10k��z Or: o, oq Condo Vol Pg Yeax Installed: �, "Loads and Flows": Vol Pg Owner When Installed: � � � .� 1 �\ Previous office approvals/actions: (� �`zariance: # LUP:# SP: # CUP: # o n Report: # Change of Zone District: � �.9 I�� ��� 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. NctiSu #2. �:�r�A�z U�,�.� #3. (��_�' #4. 1�-Quc Size �� ft.wide � ft.wide !.. �ft.wide �ft.wide � �fr.long �.�fr.long � ft.long .5� fr.long Floor azea I�--�IK sq.ft. �`i� sq.fr. g�� sq.ft. ���:� sq.fr. HgC from grade ay, to peak I�� fr.hgt. fr.hgt. ft.hgt. � Stories�_ stories stories stories #of bedrooms � � ` 3';CL'�� �, Lake/Pond/Flowa eBiver/Stream ame hCLff�t �`���� �� , —----- r ��r,�� /�� � f , � + , ��e,, f- , �, '� ( � � ��I °� � � � —/cr` _— � � s } i \`, ^ ' � o � � � � �I . :� � �� � � '` ,� ��l ��/ �.� �_,'_ � ��-=j---_..�� ( ,�f'`SS�' � _ "; - Fire Number and Name of Road �C��1�}� L�r�l E�� ��ci . 1. Enter lot dimensions and indicate north by arrow. Sig t er or Authorized Agent: 2. Indicate the location and size of the requested construction / SignaNre activities. A PnntName:/1�i IIIGVN /1!,�hc1 tfP� 3. A�So,1ndlCate the locatlon and CI15taI1Ce to Ylle well; The ahove cerliUes that Ne listed intorma6on and intentions are _. We and conect.,Mat all work shall be pedormed in crompliance _._::.-:._ .._... �septic tank\ drainfield,wetland areas,lot lines, with ihe requlremenLs of the Sawyer Counry Zoning Ortlinance and ihe laws and regulations of the State of Wisconsin,arid if centerline of the road and waterbodies. aa��y as owoer�s�a9e�i,na5 me�erm�ss�o�or tne ow�eq5�to peAortn the work requested on Nis appiication. The above personsls hereby give permission for access to the property for onsite inspection. Permit fee:$ �i.:.,�`�'�' Total land area within 300'of the waterbody:(A) '�I 3�+ Total impervious surface area[including this project](B)��I.� � c- (B)/(A)x 100=%Used_ �:1��t (Shall not exceed 15%[or 25%with a conditional use permit].) Shoreline Vegetation Protection Area:Mitigation Required?QO Yes O No November 8, 2004 �� n,`l.l ,�-� n r �Q �-� ��" Issue Date Signature of Is in gent November 8, 2005 50%Rule: Average Road Setback: Expiration Date Office Comments: ��v� ��(7,�� � ��'�� �'����� ��!M��-2-FQ�I�CXY��.���� y!" /1�3�O�f �J SHORELAND PRESERVATION AGR�EMENT (Non-Intact Shoreline Vegetation ProYectioo Area) Land Usc Permit No. �/ - (p y� (To be entered by the Zoning Office) Index No. �-�j�_ WHEREAS, (list all owners) _��� �\;c�n•� �, �n„Q '�,��;1 bqa„qe(� � G � `�' £ 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. � J 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 shall be restored in accordance `with the Mitigation Plan and Implementation Schedule approved by the Sawyer County Zoning Department. � d The owner(s)hereby agrees that at all times in the future, the real estate subject to this Agreement shall comply -fl with all shoreland vegetative 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 Governmental Unit to enter onto the owner's property at the following description to inspect the structure(s) or uses authorized by said Land Use Permit and to determine if the SHORELINE Q VEGETATION PROTECTION AREA exists and that it is being preserved. 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 a11 i structures approved by the issue of said Land Use Pemut and the revocation of any other uses approved by the �' issue of said Land Use Permit. All parties agree that this Agreement shali be filed with the Sawyer County O Zoning Office. Legal Description of Property: _ Sec1��e��. Iy Tw� . 1-1 l R. �� �-I �1C�P"l S� ��Jc�� 'aIn✓1 �/4- !V5 - 00 - l9-� �-��! �c� � �srn h�3�� Ik i��. Daterl this a� day of (���ab e�` �C> � � � UiYlix� � (Owner) (Owner) (Owner) (Owner) (Owner) (Owner) This instrument was drafted by: Sawyer County Zoning Office � �— _ . _ _ . _ �— � . . , � � , . i � � � � — Z • a � � . p � •5 we � > 2 � o n O N O y y�'y9 �L ? k c X � p 'O 4N� O I�I ,,�,6�' r m � w ° a r x Z .. � < � w a4 �. A � ° >f � 2 0 � `: �r� �+ Y � r � $ � � ° .• O p � 0 ~ � � �' O � gZ O� � ° ti 2 . � � � � ? � 2$ S t� � � .� m � � � � .Bh;S£;S6 � ^�i � � � � y � ti o � n �f � � . ���. To4, � l�1 C o � �. `�r. 8�',r. 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