014-942-25-3222-LUP-2004-392 Application for Land Use Permit(*Shoreland*) �
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County of Sawyer N �
PO Box 676 -Hayward WI 54843 'O
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 fo �
the property's boundaries. s
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. n ,
PRINT-USE BLACK INK OR PENCIL �
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Owner Builder ¢: �
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Mailing Address Mailing Address � O �
1Z��l,ti�'�� M N 559�o!� R ��k-�s'���_ M M Ss q o� �°�-. �
City,State,Zip City,State,Zip j ,{�
t— S�� — `2S6--Z`-63-I �—�oZ "_`FS/ —�'t31 �f p
Daytime Phone Daytime Phone T
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Additional Inforxnation: Zone District: R R— � N� �
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Lot Dimensions: %g�i/+-i��p��3b'f-%3�����N P.
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Date lot was created: Acres: Z .3 N �
Is there wetland near the proposed structure?If yes,how far �J O o s
Building Land Use Floodplain:O Yes �No �
(�i New O Filling Chippewa Flowage:O Yes I�Q No � p
O Addition O Dredging Driveway access off of a(Check one): � �
O Alteration O Grading �Private Rd O Town Rd. � F�
( )Moving On ( ) ( )County Hwy ( )State Hwy °0 �'
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Primary Structure Accessory Building Addition o .°r�
( )Dwelling (�(1 Garage-attached/ etache3 ( )Deck �
O Year round (�#of car stalls O Porch W
( )Seasonal ( )Storage Building ( )Enclosed �,
O Frame built on site O Screenhouse O Living room rn �
( )Modular/manufactured ( )Greenhouse ( )Kitchen � �
( )Mobile/manufactured ( )Other ( )Bedroom A
( )Other primary structure ( ) ( )Relocate/enlarge
� � ( ) ( )#of new �'
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Additional Information: p
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Type of Construction: �
�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete
( )Other ,�
Construction Cost:Primary Structure , ,.d �
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Accessory Building:$ .�� �i Z�i Z-' Addition:$ � �
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Deed:Vol �� Pg �� Certified Soil Test# 7 9'ZZ5 Ol-Oi3 �; z
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CSM:VoI��Pg3� _Lot# SanitaryPermit# 0!-pr3 � 7'
Plat Envelope Or: � �
Condo Vol Pg Year Installed: i� I�
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"Loads and Flows": Vol Pg Owner When Installed: �:
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Previous office approvals/actions: e�_vz7/�- C'
Variance:# LUP:# 97-/33 SP:# CUP:#
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Inspection Report:# Change of Zone District: o �I�ID�
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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. '
#1dFta,cl�� 6ara�-�. #2. #3. 5 d�+�no�' #4.
Size�ft. wide <�Coy�� � . wide � ft. wide
Z (o ft. long y� ft. long ��� 9 ft. long ft. long
Floor area GG z� sq. fr. �sq. ft. �/o.3sq. ft. sq. ft.
Hgt from grade�to peak ft. hgt. fr. hgt. fr. hgt.
Stories_� stories stories stories
# of bedrooms�_
Lake/Pond/Flowa e/River/Stream ame
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Fire Number and Name of Road 1 Z(c 3 d N T a. ..� na R d
1. Enter lot dimensions and indicate north by arrow. Signature of Owner or Authorized Agent:
2. Indicate the location and size of the requested construction �a,a--�
SignaNre
activities.
PnntName:
3. Also, 1nd1Cat0 the lOCatlon and dlStanCe to the well, The above certilfies Nat ihe listed information and intenlions are
true and conect.,that all work shali be perfortned in compliance
septic tank and drainfield, wetland azeas, lot lines, with the requiremenLs of Ne Sawyer County Zoning ONinance
and the laws and regulations of the State of Wisconsin, and if
centeriine of the road and waterbodies. a��9 as rnmer�5�a9ent nas tne�erm�ss�o� or me owneq5l co
perform ihe work requested on this application. The above
personsls hereby give permission for access to the property for
onsite inspection.
Permit fee: $ ] C�
Total land azea within 300' of the waterbody: (A) � • � � GK�S 6 9� o u c S 6:, F i,
Total impervious surface area [including this project] (B) a `� `h Sy � �T.
(B) / (A) x 100 = % Jsed '� . °1 `�a (Shall not exceed 15%[or 25% with a conditional use permit].)
Shoreline Vegetation Protection Area: Mitigation Required?�Yes O No
Julv 30 2004 �� ' O � � ��°��--
Issue Date Signature of Iss ' g nt ` v
July 30,2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments: l,.ao��'••�� w��` �a.le olson on S�t�i�'� 1��� reS�va.4�on ,
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F MERLY CON iDE II.I �— —__ — _ _ —_
SpUTH LINE �F SEC.2 ..�.� � ,�. •12.� .�2.�z =.�• .�2s _i — —
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REF�RENCES: SAWYER C0. DE�D RECORDS" i2.
AERIAL PHOTC) D3 — 1970
U.S.G.S. — HAYWARD SCALE: I INCH=400 FEE
DRAWN BY: KM �
COLON (:) INDIGATES GO
SHORELAND PRESERVATION AGR�EMENT
(Non-Intact Shoreline Ve2etation Protection Area)
Land Use Permit No. ny-�9,z (To be entered by the Zoning Office) Index No. Q�-3Q�
� WHEREAS, (list all owners) J erru �i nd fG,lh� pn �aC/YIUSS Pn
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� 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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LNOW, 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.
� The owner(s)hereby agrees that at all times in the future, the real estate subject to this Agreement shall comply
cq 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 Govemmental 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 detemvne if the SHORELINE
� VEGETATION PROTECTION AREA exists and that it is being preserved. Violation of this Agreement will
authorize, in addition to other penal6es and relief requued under the Sawyer County Zoning Ordinance,
injunctive relief, restora6on of said real estate, the revocation of said Land Use Permit and the removal of all
� structures approved by the issue of said I,and Use Pemut 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.
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Q I,egal Description of Property:
Dated this 2 (o day of �J�'L y z-o o� ,
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(��`^ - `�-/ (Owner)
77 �� _
(Owner) (Owner)
(Owner) (Owner)
This instnunent was drafted by:
Sawycr County Zoning Office