014-941-12-4204-LUP-2004-660 Application for Land Use Permit (*Non-shoreland*) o o �
County of Sawyer � � � � '� `
PO Box 676 - Hayward WI 54843
715/634-8288
*Property that is not located within 300' of a creek, river or stream or within 1000' of a �
flowage, lake or pond or does not have 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
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Owner � Builder �:
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Mailing Address Mailing Address O
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City, ate, Zip City, S ate, Zip f
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Daytime Phone Daytime Phone ' .
Additional Information: Zone District: �2.�7 �
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Lot Dimensions: � �
Date lot was created: Acres: �� � 7 0 "''
Is there wetland near the proposed structure? If yes, how far � �
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Building Land Use Floodptain:� ��j�I�es (� j�No ����
�New ( ) Filling �
O Addition O Dredging Driveway access off of a(Check one): �,
(- ) Alteration O Grading O Private Rd O Town Rd. o
�Moving On ( ) ( ) County Hwy ( ) State Hwy ,;;
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Primary Structure Accessory Building . Addition � °
'�Q Dwelling (�c) Garage-attached detach ( ) Deck W
� Year round O # of car stalls O Porch �
O Seasonal O Storage Building O Enclosed �
O Frame built on site O Screenhouse O Living room � �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen �
( ) Mobile/manufactured ( ) Other ( ) Bedroom � ��
( ) Other primary structure ( ) ( ) Relocate/enlarge �" ,�
� ) ( ) ( ) # of new ..;: � _
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AdditionalInformation: � �
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Type of Construction: � —
� Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete �
( ) Other �
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Construction Cost: Primary Structure $ �� � :� ' — �
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Accessory Building: $ c��-�-� Addition: $ � '`;
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Deed: Vol " P ` Certified Soil Test# ��/- `lf='i � z
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CSM: Vol�_Pg�'�Lot# J�' Sanitary Permit# �}�/— 5���� a, �
Plat Envelope �5�� �r� N �-�
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Condo Vol Pg Year Installed: c�
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Aff of ex septic Vol Pg Owner When Installed: "
Previous office approvals/actions:
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Variance: # LUP: # SP:#< CUP: # �
Inspection Report: # Change of Zone District: � �I u� ��
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Describe the construction using these columns. List the dimensions of each structure in a ,�eparate , :
column. List each story, each addition, each alteration in a separate column.
#1 . fftz�-� #2. (:�-� �'',� c--,= #3. �.�� ��"• #4.
Size� ft. wide Z v ft. wide �_ ft• Wide 'r t ft. wide
y�� ft. long � ft. long I �� ft. long • ft. long
r `� �� s ft. �, t-? sq. ft. sq. ft.
Floor area /G sq. ft. � q• � ,
Hgt. from grade � to peak �� ft. hgt. ft. hgt. ft. hgt.
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Stories � �_ stories stories stories
# of bedrooms �_
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Fire Number and Name of Road -- , , `� � ' � �'�
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1 . Enter lot dimensions and indicate north by arrow: Signat, f Owner r orized Agent:
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2. Indicate the location and size of the requested construction � —
Signatur
aCt1V1t1eS. PrintName: f��'��i�� � � `�J � —
3. Also, indicate the location and distance to the well, The above certifies that the listed information and intentions are
true and correct., that all work shall be performed in compliance
with the requirements of the Sawyer County Zoning Ordinance
septic tank and drainfield, wetland areas, lot lines and to the and the laws and regulations of the State of Wisconsin, and �r
acting as owner(s) agent, has the permission of the owner(s) to
centerline of the road. perfo�, the work requested on this application. The above
persons/s hereby give permission for access to the property for
onsite inspection.
Permit fee: $ � � s� �
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NnvPmhPr 1 Fi � 7QQ1E
�t`h�, � ��.,�i�%' ��%��Y
Issue Date Signature of Issuing Ag ne t
No�vember 16 , 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments: �%-(S -,�Gfl�_ ���/��S.S rc:r7���G'1.G1 /-�I��b�i�?,r,�i�y7�.�.
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GRAPHIC SCALE TAX ASSESSMENT PUF
�soo Information contained on
�o o soo +oo aoo odvisory. Map accuracy i
quality of the public recc
was prepared. It is not i
( IN FEET )
substitute for an accurai
1 inch = 400 ft.
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SAWYER COUNTY CERTIFIED �URVEY MAP
PART oF THE NEI /4- SEI�/4 . THE Nwl /4- SEI /4 . SEC . 12
T . 41 N . . R . 9 W.
SET PK FROM
[� � COUNTY TIES
I\\l EI /4 COR . SEC . 12
. . . . . . .. . . . . . . . . . . . . . .. . . . ... . . . . .. . . . . . . . . . . . . . . . .
BEARINGS REFERENCED TO THE ea.00• o
EAST � INE SEI /4 SEC . 12 pr� N ee•az•so-w �
(ASSUMED S00° 29 ' S9 'W ) � ioz�.�3• � '
SCALE f ' - 200 ' o�� . � °`
.� � 0 EAST LINE SEI/4 —� �
P� ,��Q O`� SEC. 12 Q m
� SET 3/4' X 24 ' REROD . �°�' p� �o "' m
WT . I . 50 LBS/FT . ` Q FD 2 - CAPPED I . p . " �
P O
(oe C� �� SE COR . SEC , 12 0
R . A . RECORDED AS �Qo?6� yc ,,,
POP.' ^�� �
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OO�' S 89' 42'S0"E 61�.56 '
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`'0 '� LOT 4 �
y� y� <
� ry 166 . 078 SF . M �
aa � 3 . 81 AC . � ^
52 .45' Y
�r1, O N 89• {2'S0'W 711 .93 ' �
�h� N
.�� ??4•?9 • c°�i
y0 LOT 5 m o
,,� 380 . 561 SF . Q y
'r 8 . 74 AC . N
NB9•34' 14'W 1062.80'
SOUTH LINE NEI/4-SEI/4 ��
RAD . TAN . ARC . CHD . CHD . BRG . DELTA
A TO B 60 . 00 ' 195 . 16 ' 224 . 29 ' 114 . 70 ' S69' 07 ' 11 " E 214' 10 ' 45"
B TO C 60 . 00 ' 28 . 03 ' S2 . 45 ' S0 . 79 ' N21 ' IS ' 01 'W 50° 04 ' S4"
A TO C 60 . 00 ' 66 . 33 ' 276 . 74 ' 88 . 99 ' N85° 50 ' 22 ' E 264' IS ' 39 '
SURVEYORS CERTIFICATE
I . LYLE L , ELLIOTT . REGISTERED LAND SURVEYOR HEREBY CERTIFY THAT BY THE DfRECTION OF
TOM FOSS . I HAVE SURVEYED AND MAPPED THE LAND PARCEL WHICH IS REPRESENTED BY THIS
CERTIFIED SURVEY MAP .
THE EXTERIOR BOUNDARIES OF THE LAND PARCEL Sl1RVEYED AND A�APPED IS DESCRIBED AS FOLLOWS .
A PART OF THE NEI /4- SEI /4 . AND THE NWI /4- SEI /4 . SEC . 12 . T . 41 N . . R . 9 W . . TOWN OF
LENR00T . SAWYER COUNTY. WISCONSIN . AND MORE PART { CULARLY DESCRIBED AS FO�IOWS :
COMMENCING AT THE EAST dUAR7ER CORNER SAID SEC . 12 . THENCE S00• 29 ' S9 'W 66 . 00 FEET :
THENCE N89° 42 ' S0'W 1027 , 73 FEET : THENCE S37` 58 ' Il 'W 1004 . 08 FEET 70 THE POINT OF
BEGINNING : THENCE S89" 42 ' S0' E 614 . 56 FEET : THENCE 500' 29 ' S9 'W 477 . 29 FEET : THENCE
N89' 34 ' 14-W 1062 . 80 FEET : 7HENCE N37' S8 ' 11 ' E 350 . 72 FEET : THENCE ON AN ARC OF A
CURVE TO THE LEFT 276 . 74 FEET AND WHOSE CHORD BEARS N85" 50 ' 22 'E 88 .99 FEET : THENCE
N37' S8 ' Il ' E 240 . 30 FEET TO THE POINT OF BEGINNING . SAID PARCEL CONTAINS 12 . 55 ACRES
MORE OR LESS . AND SUBJECT TO ANY EASEMEN7S OR RESTRICTIONS OF RECORD .
I HAVE FULLY COMPLIED wITH THE PROVISIONS OF SECTION 236 . 34 0� THE WISCONSIN REVISED
STATUTES AND THE SUBDIVISlON ORDINANCE OF SAWYER COUNTY IN SURVEYING AND MAPPING SAME .
I HE EBY CE�FY HAT TH�URVEY iS CGRRECT TO THE BEST OF MY KN4W�F�DGE AND BELIEF .
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LYL . ELL I OT . RLS 1300 � :' � �' •. %
DATE : SEPTEMBER 25 . 1995 `_�� Ll'LE !. EL�IOTT.�� I"
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NOV-10-04 09:38 qM RIGLEMON APPRRISRL SERV. 608 378 3023 P.01
SOnt By; SANNER COLNTY Ioning; 715638 3277; Nov�10-Oa f0;28AM; Page 1/1
9oa•yar Coun�y 7nnlaY Adm�nlatrallon
PO Sox 676
Haywatd, WI 54943•0676
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