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014-942-27-1309-LUP-2004-233 � Application for Land Use Permit(*Shoreland*) � 0 0 County of Sawyer � PO Box 676 -Haywazd 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 1 the property's boundaries. � � CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. ` {�u¢h/epn P re�s� PRINT-USE BLACK INK OR PENCIL * 12��L�� � �c��,q h �-�e�sS��S cro � LonS�. ��-C � � c Owner Builder a � I�SOS I$I sI� I�Je. I Cv l�`t lJ �nd��S v.. 0 O N s� Mailing Address Mailing Address � O d �a I ��z t�'1�\\1 S S-3 v9 f��.,���_r�A i� s s't�'`t�3 � City,S ate,Zip C ti y State,Zip �� 3- z�3- �s�2 -��s-��r������� ��( - Daytime Phone DFL�ce'v'763-6Ba-�3� Daytime Phone Gi4F� 7G3-L8a•�37o � Additional Information: Zone District: �/ !�' � / `� Lot Dimensions: /�' y' �� % /p - j05� � Date lot was created: / /�U Acres: � Is there wetland near the proposed structure?If yes,how faz ��i} o � Building Land Use Floodplain:O Yes O No � � O New O Filling Chippewa Flowage:O Yes � No �o M (�Addition O Dredging Driveway access off of a(Check one): � � O Alteration O Grading .(�Private Rd �(}Town Rd. � x ( )Moving On � ����^ e..t 13���.Men�( )County Hwy ( )State Hwy °° � O O � S � r Primary Structure Accessory Building Addition o 0 ( )Dwelling ( )Garage-attached/detached ( )Deck � � O Year round O#of caz stalls (�Porch �, F�Seasonal O Storage Buiiding O Enclosed � 41f Frame built on site O Screenhouse O Living room co (n ( )Modulaz/manufactured ( )Greenhouse ( )Kitchen � � ( )Mobile/manufactured ( )Other ( )Bedroom ( )Other primazy structure ( ) ( )Relocate/enlarge \ ( � ( ) ( )#ofnew R 7 � Additional Information: > � � � � Type of Construction: ;S �� (�)Frame O Log O Pole/metal (�Block (�Concrete J ( )Other � ,� Construction Cost:Primary Struchue$ :j c,s e ;h e�� �[�U G 3,v v ro � Accessory Building:$ Addition:$ I 3��J�' ^ 0 sar m� 79a P3��b � � Deed:Vol_��Pg �� Certified Soil Test# 9 0 � a► � � z CSM:Vol��Pg_��Lot# �� Sanitary Permit# � / " � � � "� � Plat Envelope Or: o� Condo Vol Pg Yeaz Installed: � '2—�1� N "Loads and Flows": Vol Pg Owner When Installed: � � Ste��e �ci�h�lsh� l�. `" Previous office approvals/actions: � Variance:# LUP:# SP:# CUP:# Inspection Report:# Change of Zone District: �,il p`� 5�` I ��foo 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. Lc, b�n #2. ��n #3. #4. � Size ZTde I d , ft. wide ft. wide ft. wide �ft. long I Z` ft. long fr. long ft. long Floor area �9ro sq. ft. �sq. ft. sq. ft. sq. ft. Hgt.from gade%G���� to Ixak / �G " ft. hgt. ft. hgt. _ ft. hgt. Stories r __�stories stories stories # of bedrooms 2 Lake/Pond/Flowa e/River/Stream ame _ .. ____ (_ _._. . •L. �_ � � . _ � . _ ._- � 10�{���,J�� _� -7 �"�F� �..CG'�� � C� .��'� / .Z 7 a�U� � . ��.���' 30 �o N.1. / � ��, u O �1 � _ — ^ I/ C4�w �. �1 I ` � r---�-7 w b ��`,yr \�1� �, \{ , � �,Jfl,�l � , ! b,r� � _�— p �t. , — Z2.�`' � �or^ 2' I �� �af� p�/� / ���t' 9���,, �w�`� � ` \ ` � �� `� � \�l�� � G` __ _—� Fire Number and Name of Road � ,S� 3� CJ � 4 /�c (., .�-,� � ��.,�r 1. Enter lot dimensions and indicate north by arrow. Sign�f Q Agent: 2. Indicate the location and size of the requested construction igna u activities. � Pdnt Name: t�J "� S S� 3. Also, 1nQlCate 1.Ile loCatlon aT1C�d1StanCe to the well, -Z z�G� The above cefifies that the listed information and intentions are true and conect.,that all work shall be peAortned in compliance Septic tHDIC anCl CII'alnflelC�, wetland 3T'eBS, lOt 11nes, S z'���\� L�� with the requiremenLs ot ihe Savryer Counry Zoning ONinance and Me laws and regulations of the Shate of Wisconsin, and if centerline of the road and waterbodies. a�n�e as owner�s�a9e�t nas me���55�on or cne ow�e��s�to pertortn ihe work 2quested on this application. The above persons/s hereby gNe permission for access to the property for onsite inspection. Permit fee: $ 2' �U�_ Total land area within 300' of the waterbody: (A) �1 (� �� Total impervious surface azea [including this project] (B)�( � r" _ , ''G F� (B)/(A) x 100 = % Used 3, �s � (Shall not exceed 15%[or 25% with a conditional use permit].) Shoreline Vegetation Protection Area: Mitigation Required? O Yes �f No June 3, 2004 — Issue Date Signature of Issui g en June 3, 2005 50% Rule: Average Road Setback: Expiration Date Office Comments: _ENROOT � 42 N . 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Y+- z: � , 4 i A�. . �� , x !" �a ��.v ,;: ...LW:.: SHORELAND PRESERVATION AGREEMENT (Shoreline Veeetation Protection Area) v � Land Use Permit No. �y'a��(To be entered by the Zoning OFfice) Index No. �-�3 � WHEREAS, (list all owners) �� �� C1La'L/6/�C � � � �1�� S5 , L � 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' landwazd from 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) further agrees to allow authorized � representatives of the Governmental Unit to enter onto the owner's property at the following description � 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 struchue(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 shali terminate J' on the date of expiration of the land use permit. However, the owner's obligation to maintain the SHORELINE Q 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: �T� � SLI��� �(/E � . S�er- Z.7' T N �/Z N ;� ,•--•--=i�D �e—�.� �/ ��rz�� t�/. i� > Dated this 2 day of _G;5%� Z7 5�a. 9 . 3. / T���- (Owner (Owner) ��cf�t.-� C�e-�l�r� �.�i�.✓ s�r�us � — (o,�,e�) (o�e�) (Owner) (Owner) This instrument was drafted by: Sawyer County Zoning Office