012-740-08-5110-LUP-2004-333 . X�
Application for Land Use Permit(*Shoreland*) r y
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. F �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. �'�
PRINT-USE BLACK INK OR PENCIL
i � �J�-�et EJ ✓7av,ti C� C.tin�r,:i /1:'cR�ifru�ov -.��.-si.P�E,s c
Owner Builder a �
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Mailing Address Mailing Address � p
f�A�w�9/2,� Gu`.'� SY 9�� ��vw�J�d LxJ,�. J�b�i.j �
City,State,Zip City,State,Zip �
-<6�- 9�7y G,1�- .S9cc
Daytime Phone Daytime Phone �
Additional Information: Zone District: ��' '� �Z �
Lot Dimensions: � .�3 ,9 c2f s
Date lot was created: ? Acres: - 5"3
Is there wetland neaz the proposed structure?If yes,how far N� o
Building Land Use Floodplain:O Yes (�No G
( )New ( )Filling Chippewa Flowage:(�Yes ( ) No �o
O Addition O Dredging Driveway access off of a(Check one): �
( )Alteration ( )Grading ( )Private Rd ( )Town Rd. �
( )Moving On ( ) ( )County Hwy ( )State Hwy °Q
��anzre� ( ) � �
Primary Structure Accessary Building Addition o �
( )Dwelling ( )Garage-attached/detached ( )Deck �
( )Yeaz round ( )#of car stalls ( )Porch �;, ��
( )Seasonal ( )Storage Building ( )Enclosed �
O Frame built on site O Screenhouse O Living room cc
( )Modular/manufactured ( )Greenhouse ( )Kitchen �
( )Mobile/manufactured ( )Other ( )Bedroom
( )Other primary structure ( ) ( )Relocate/enlarge — \
( ) ( ) ( )#of new
I
Additional Information: �1
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Type of Construction: R
(X)Frame ( )Log ( )Pole/metal ( )Block ( )Concrete � °(�
( )Other
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Construction Cost:Primary Structure$ �- �
�i l,Sno �
Accessory Building:$ Addition:$ � �
:°
Deed:Vol C�'�% P YS � �
g� � � ��5�� Certified Soil Test# 9 q - o u-r 9/-(�U� z
CSM:Vol i v Pg .�r�io Lot# 1 Sanitary Permit# 9 4- ��ui 1�l-U38 °O 7y
�t 3:,;i •• �
Plat Envelope Or: �
Condo Vol Pg Year Installed: �,
"Loads and Flows": Vol Pg Owner When Installed: o �
�
eo
Previous office approvals/actions: �
`19-ii3
Variance:# LUP:# RI-30(o SP:# CUP:# � �
Inspection Report:# Change of Zone District: ��`�\d�
�
14R�3
Describe the construction using these columns. List the dimensions of each structure in a separate ,�
column. �,ist each story, each addition, each alteration in a separate column. . ', '
#l . G.�� � d � #2. #3. #4. o
Size % � ft. wide ft. wide ft. wide ft. wide
/ � ft. long ft. long ft. long ft. long
Floor area i �-� sq. ft. sq. ft. sq. ft. sq. ft. .
Hgt from grade i � � to peak ft. hgt. ft. hgt. ft. hgt. '
Stories � stories stories stories �
# of bedrooms
Lake/Pond/Flowa e/River/Stream ame
S �� � j7�c' /fFb
Fire Number and Name of Road / � �.� � �� �f�� f y /2�.
1 . Enter lot dimensions and indicate north by arrow. Sign ture of Owner or Authorized Agent:
2. Indicate the location and size of the requested construction �,�,,��. �,���,�,,�-
Signature
activities. C�
PrintName: �A� �� �� C- iv7� f �' 7—
3. Also, indicate the location and distance to the well, The above ceRifies that the listed information and intentions are
true and correct., that all work shall be performed in compliance
septic tank and drainfield, wetland areas, lot 1111es, with the requirements of the Sawyer County Zoning Ordinance
and the laws and regulations of the State of Wisconsin, and if
centerline of the road and waterbodies. a�t��s as ow�er�s� a9e�t, has the permission ot the owner(s) to
perfortn the work requested on this application. The above
personsls hereby give permission for access to the property for
onsite inspection.
r�
Permit fee: $ `�5 -
Total land area within 300' of the waterbody: (A) ^
Total impervious surface axea [including this project] (B) .� � � 5
(B) / (A) x 100 = % Used (Shall not exceed 15%[or 25% with a conditional use permit].)
Shoreline Vegetation Protection Area: Mitigation Required? ( ) Yes � No
July 7 , 2004 -
Issue Date Signature of Is ui Agent
July 7 , 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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State of Wisconsin\DEPARTMENT OF NATURAL RESOURCES
Hayward Service Center
Jim Doyle,Governor 10220N Hwy 27 S. �
Scott Hassett,Secretary Hayward,Wisconsin 54843
W� John Gozdzialski,Regional Director Telephone 715-6342688
DEPT.OF NANRAL RESOUiCES FAX 7156349232
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July 6,2004 !�
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Deb Hacnrnere] " - `""'"
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Permits Secretary '�_° x y.N..��.;,, r.;
Sawyer County Zoning
P.O.Box 676
Hxyward,WI 54843
Dear Deb,
I have reviewed the application subinitted by David and Joyce Emmert to construct a gazebo onto their
deck at their property located at 11722 W.Kelsey Rd.ou the Chippewa Flowage. The properCy is further
identified as tax id#012-740-08-5]10,pazcel 1.10,Govt.lot#1 section 8,Town 40 North,Range 7
West,Town of Hunter,Sawyer County,Wisconsin.
This property is not covered by a Chippewa Flowage buffer zone restriction.
Al]other county and state codes and permits apply to the subject properCy and must be applied for and
adhered to.
Please contact me if you have any questions.
Sincerely, ��
0`-�"�
�
Neal Kephart,
Chippewa Flowage Property Manager
CC: Steven Bade-Ashland DNR
Town of Hunter
Paul Bmggink-Woodruff DNR
www.dnr.state.wi.us Quality Natural Resources Management �
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SOLAR OBSERVATIONS OETERMINE THE EAST LINE OF J _
GOVT. �OT 1 TO BEAF 5 00'19'22' M. 1 W
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SHORELAND PRESERVATION AGREEMENT
(Shoreline Ve2etation Protection Area)
Land Use Permit No.(�-��—(To be entered by the Zoning Office) Index No.�-�
WHEREAS,(list all ownexs) S yc e � �R v�D �' � �ro�n�ev`�
—T
� 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.
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� 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'landwazd&om the ordinary high-water mazk of the waterbody.
,�
� The owner(s)hereby agrees to comply with the shoreland vegetative protection azea 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)fiirther agrees to allow authorized
� representatives of the Govemmental Unit to enter o�to the owner's property at the following description
� between the hours of 8:00 A.M.and 6:00 P.M.[Section 913(1)POWERS,Sawyer County Zoning Ordinance]
Wto 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 AREA in accordance with Section 4.410 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
'�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: G�v r .L�r / sFc b' %w��o n� ,� 4 4r _
Dated this /��'� day of �i..,2,� , �1 o n� �
� �—auc�� L„�
(Owner) (Owner)
(Owner) (Owner)
(Owner) (Owner)
This instrument was drafted by:
Sawyer County Zoning Office
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