014-941-04-5214-LUP-2004-441 Application for Land Use Permit(*Shoreland*) o o '
County of Sawyer N � -.
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 Z
flowage,lake or pond or has any of the above waterbodies located within �; �
the property's boundaries. �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. � �-
PRINT-USE BLACK INK OR PENCIL y �
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Mailing Address Mailing Address � O
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Cit ,State,Zip Cit ,State,Zip �
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Daytime Phone Daytime Phone �
Additional Information: Zone District: � /C - � �
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Lot Dimensions: �d� X �D � O
Date lot was created: ��` ��� Acres: o [� � �
Is there wetland near the proposed structure?If yes,how far S/1'/j��/��/_= o �
Building Land Use Floodplain:O Yes �No �0�5� �
l�New O Filling Chippewa Flowage:O Yes O No c� Q�
O Addition O Dredging Driveway access off of a(Check one): �
( )Alteration ( )Grading ( )Private Rd ( )Town Rd. �
( )Moving On ( ) �County Hwy ( )State Hwy "� �
� ) � ) � `,�
L, r
Primary Structure Accessory Building Addition o 0
( )Dwelling �Garage�detached ( )Deck � �
O Yeaz round O#of car stalls O Porch W
( )Seasonal ( )Storage 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 �
�0 �
AdditionalInformation: \ p
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,�Ty e of Construction: �
Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �� �
( )Other .�r� y
Construction Cost:Primary Structure$ �� ro �
Accessory Buiiding:$ l� DO(/ Addition:$ � `�
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Deed:Vol�vZ� Pg�� Certified Soil Test# �3 —/7/0 � z
CSM:Vol�Pg��Lot# � Sanitary Permit# �.i - � /O 0° 7y
P1atEnvelope '� ���� Or: �, �
Condo Vol Pg Year Installed: �;,
"Loads and Flows": Vol Pg Owner When Installed: c�'o �
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Previous office approvals/actions: }ti
Variance:# LUP:# b3-3y0 SP:# CUP:# �
Inspection Report:# Change of Zone District: �
�, ��jp�
�'155�
Describe the construction using these columns. List the dimensions of each structure in a separate
�
column. List each stozy, each addition, each alteration in a separate column. _
#1.E�x � #2. #3. #4.
Size �- ft. wide ft. wide ft. wide ft. �n'ide
�ft. long fr. long ft. long ft. long
Floor azea �pa 'E sq. ft. sq. ft. sq. fr. sq. ft.
Hgt from grade to peak ft. hgt. ft. hgt. fr. hgt.
Stories 1 stories stories stories
# of bedrooms_�
Lake/Pond/Flowa e/River/Stream Name
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Fire Number and Name of Road U 1' �- ��9� '✓
1. Enter lot dimensions and indicate north by azrow. S'gnat e of ner o A horized Agent:
2. Indicate the location and size of the requested construction
ignature
activities. 1
Pnnt Na � v /=/ ����
3. Also, indicate the location and distance to the well, The above cerfifies Ihat ihe list d information and intentions are
hue and conect,Nat all work shall be performed in crompliance
septic tank and drainfield, wetland areas, lot lines, with Ne requirements of the Sawyer County Zoning ONinance
and ihe Wws and regulations of the St2te of Wisconsin, and if
centerllne of the road and waterbodles. acting as owner(s)agen4 has the pertnission ot the owneQs)to
pertortn the work requestetl on ihis application. The above
personsls hereby give permission for access to the property for
onsAeinspectian.
Permit fee: $ ��(�) ' � �
Total land area within 300' of the waterbody: (A) Z�, DU'1
Tota] impervious surface azea [including this project] (B) 2,�y`/
(B) / (A) x 100 =% Used 7, 9°7n (Shall not exceed 15%[or 25% with a conditional use permit].)
Shoreline Vegetation Protection Area: Mitigation Required7 O Yes O No
AuQust 18. 2004 —
Issue Date Signature ofI in gent
Augsut 18, 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
aF LEN ROOT
TW�/P. 41 N . R. 9� W. � �
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SHORELAND PFtESERVATION AGRE�MENT
(Shoreline Vc2etation Protection Arca)
Land Use Permit No.�(To be entered by the Zoning Office) Index No. O�I - y L�
-p WHEREAS,(list all owners) I�f�� ��y1�,u?�{h ("y�r�q��I ����v�Q S
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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.
r-�j NOW,THEREFORE,the owner(s)hereby certifies that,as a condition of issue of said Land Use Perinit,that
�'� the SHORELINE VEGETATION PROTECTION AREA on said real estate is intact to a minimum depth of
� 35'landwazd from the ordinary high-water mark of the waterbody.
�
U The owner(s)hereby agrees to comply with the shoreland vegetative protection azea requirements of Section
� 4.410 SHORELAND VEGETATION PROT'ECTION AREA,Sawyer County Zoning Ordinance,in effect on
� the date that the land use pernut is issued by the zoning office.'I'ke owner(s)fiuther agrees to allow authorized
s. representatives of the Govemmental 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 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
I 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,
Sinjunctive relief,restoration of said real estate,the revocation of said Land Use Permit and the removal of all
struchues approved by the issue of said Land Use Permit and the revocation of any other uses approved by the
-J issue of said Land Use Permit. All arties a ree that this A reement shall be filed with the Sa
-� P g g wyer County
�- Zoning Office.
O LegalDescriptionofProperty: Lot # 8 of CSM vol 24 page 120, Govt lot 2 part of
the SW NW of Sec 4, T41 N, R9 W, Town of Lenroot, Sawyer County, WI.
D ed 's 8 d of Auqust 2004
��� (Owner)
(Owner) (Owner)
(Owner) (Owner)
This instrument was drafted by:
Sa�ryer County Zoning Office