024-641-24-2105-LUP-2022-454 SUBMITCOMFLEfED RVPUCATION AND 9J
FEE To: APPLICATION fOR LAND USE PERMIT l
SaxryerCounty SAWY R �0135(N �'� �J
Zoning 8 Conservatlon Depart. � .� �.�
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1O610Main5tSmtea9 � �'"�0'��'•�f '.� Ua�F_�°�13 a"a �
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HaYward,WI 54843 I� �O� �'
(715)634•H168 SEP 2 7 2022 ����� chk#�._...... '�
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iNsrnuc.ioms�.nove,mte.wmn��::��a�ma.nk�:n.�o•�d. SAN/YERC•r"-� _ VY�L-F
Checksaremad�DMbleto:5awyerCo�nry2aning0epertment ZONIN� "-"' �'
�OrvOrSiaRicorvsiau[ri0rv�.irvilLnt.vENMITSHaVEeEENi55_UED�onvctiCarvT OriginalApplicationMUSTbesubmitted FILLOUTININK(NOPENQL)
s�om�voai or m�s aoo'���.,no,„,���r�o�oi ier.me:�o<<a,sr�r��«pP,mrt�.��:r��e.
Owner�s)Name: Contnctar{s�Name
�-a�'a
����c�,S n f1 �V,�co�t,i�' C'oc1g�'rUctle�
Mailing Addrtss: �� ` Mailing Address: 1_
'��a�7 �'— �'f, Cv��h be:�an��� '2 3 O S �<ry���FP pi Cb,'m rr
Phone:�1� �7, ��(9(� —... Q Chorre: `��� ' �1,�E 28'�
Email: ��,t� l9` , � l`�D�.�-Oi'h Email: , \ �`�e0 �Y���Ce-���1,a�0(1�
SiteaEdfnf: .V f'� �4 M�AA��1 OrDa4aPPlledlor: _
Ll6ac PINk ��a�"�`�I-.�`�-3105 �~gU� Townol: �
PermittllllVeryMNhod �l�ellOwner LMailOwner �CaliContractof :'MailContractor
� Is ProDerty/Wnd within 300 feet ot River,SVeam i���n. Distance Structure is from Shoreline: Is Your aroperry
�nu�m��ia��l � inF�00d0�din AreWetlands
[reek or W ndward slde of Floodplaln? i/yes--continue �� �eL Presenc?
,�horelind _.. _ ._.____. zone?
Is Vroperty/Land wi[hIn 1000 feet of Lake,Vond or Flowage Disbnce 5vucture is from 5horeline: Yes �No
ifyes--continue—► feet 1(No
..!Non-Shoreland
Describe Pro)ect rowl p of
valueaenmeo/ p�ojecttype foundation WhatType&Capacityisthe
compledon Numbei bedrooms
,o� i� �House,garege,sbed,deck, p{Storfes (Basement, Sewer/SanitarySystem�s�
,.. Post
nmP&mater�al Addltlon,etc...) [rawlspi ce, <onstruction
Ustseparately Slab
5 SCcC�� �o<•� J2 ���h ��ecS 1}Y�, � Ur� �oc+ (Y� ?
Zo � . e ' ��
Dwcllln�
�F �,\ ���� ��" p �
�e:'S .\
5 �Q�r�,A
acceawry Bldg
5�S 000
naemm��nma.noo
Hetght:
7otal5quare Lowest
Proposed Ux � Proposed Structure Dimensions Footage Grade to
(multlplyper Highest
ztory) Peak
Residence � x �
Ft.
with 2n°story or loft � X )
Ft.
with Basement � x �
Ft.
Attached Garage ! ( x �
�Residential Use Ft.
Aecessory Strueture(exvia�nl ( x �
m.nm.a ea••a.•.•n.a.,w,�ne��.:..��t Ft.
-_l Agritulturol _.
Use 7emporary Gues[Quarters ar Bunkhouse(o.cierype) ( X �
Ft.
u X p
LI COmmEfdal/ x Deck orch Patio �� �Y.�,��, �L ( 1 1 1O 2k0 Ft. �O
Industrial Use �
X (z^d� eck orcn/ratio ��'\ o� et..l� � X\� ' 16 rj Ft. �Z NI ii
e, . Z c�
J Municipal Use ( x �
Other�e.Pia��1
Ft.
^ Other ( x �
PIInCiPdl SIn1CiUff(AgricWwral,Commertlal,Munlclpal,Etc) Ft.
( X )
Addition/Alteretioe(apia��l Ft.
Total habitable zquare feet: — � Total Non-habitable square teet: 5}
decks, atios,garages,sheds,storage area&other structures) �j U�
Original Application MUST be submitted
Attach a Plan or Sket<h your Property on 9.5"x 11"or 8.5"x 14"paper:•MusN Indude loatlon and setback of proposed and axlfting structuras,rwds,
Idriveway,sanitary components,well,lake,river,stream,and wetlands.
Oescription $e��� Dexriptlon Setback
MeasuremeMs Meawremmts
Set6ack from the Centerline of Platted Road and/or I Feet Setback from the Lake(ord�m�v n��n.w,ve,m,rk) `j Feet
Setback(rom the Established RighFof-Way - �} Feet Setback from the River,Stream,Creek Feet
Set6ack from the BIuH a,poiK•nie Feet
Setback(rom the North Lo2 Line \pp '� Feet
Setback from the South Lot Line }'� Feet Setback from Wetland Feet
Setback from the West Lot Line lJv' Feet Slope within area of constmttion/disturbance '��y} %Slope
Setback from the East Lot Line ' Feet Elevation of Flaodplain ��� Feet
Setbackto5epti<7ankorHoldingTank Feet Set6acktoWell Feet
. Sethackto Orain Field Feet
'�. Set6ack to Privy(Portable,Composting) Feet
. i � .u r , �m e th f�e(51 f e o �M1e i�m �. _d �etb k,fi _ ��ary I�, 4o'n wM1ich the setbacF musibe measvee mun be visihle from one
V�� ��� e ._i �o� �p'o�ouslVmrveyeOn.,.ic .ark�tl�yab. u �,� ai 1'eo�+n �senpeu�_
P -rt t�e�fs, t� _�c�bu . . fasinr.t� � � rettanf�ejS�feetb�tlessRe ten�]Olfeet(mmt�eminlmumr�amredse�back,enebo�n4aryllne��omwM1irht�esetbackmustEe
.�_ e[I!'Iv�S' �I 1lcl�.on p .-p .:��s�r� y' JCO�'1P".Otn. Y¢ 02v�iouSly � C)C[� _ lne�olV2'fd�l¢OytIIPUCpartmpnt�yuSL`OfaCpf'2C�ed[Ompa3Sfi0ll�eknOwntO��i¢!
tM1 WOfeetof� p�opose�s� he im�m .ustbema,Me�by- Gcensetlsurveyora��Feownersexpense-
ICalculate impervious surfaces.(Raofed,concrete,paved,and other surfaces that water cannot Oenetrate.The Zoning Office un he10 You detarmina H a
, wrface is considered impervious)
II Galculatelotarea:
Indicate lot size from CSM or OVUS ircle one): 7.� �� Acres;Multiply hy 43,Sfi0=Lot area: � y� S'Z S Square footage
Calculate impervious surtace area: � �a1�P�� �'a' ` '�'��
cY� � . �,..� —��+T+'i -�_��K�j$Se�eE„ i'n^r•h� "'�- �'-t.c�bin 76B
Determine the total size,in square feet,of your projeRs listed above(indude eaves): -`ti'7�.�. sq k. '�u m e µb 4 se 1 �O
I Determine the total size,in square feet,of all eaisting roofed structures(indude eavesl' � �J 2 sq h. �-�,\CK�f� �,'cQ o� 6p
Determinethetotalsize,ins uarefeet,ofalleaistin �� S�d�0.9L �q��30n4��Jf�
q g paved/bricked/blocked sur(aces: �� sq ft.
q t�s;a�sa of.y� ���
Addthesemeasurementstodeterminetotalimpervioussurfaces: � 1 Z � �aft. �x�s���ng �0^pe
19 �r
Calculate impervious lot per<entage
q P � [
7otal impervious surface:���+Lot area�Sq k.X 100=impervious surtace l e �� y, e(� � � �� �1
�MitigaOon is reduirctl if mol exceMs 15%)
•"Notice a separate grading permit needs to be abtained if disturbed area is within the Shoreland distric[as indicated on previous page and meets criteria bebw••'
Grading on a slope greater than 20% � Grading of more than 1,000 Sq.Ft.on 12%-20%slapes
I Grading of more than 2 000 Sq.Ft.on Slopes less than 12% � Grading is� exce s of 10 000 Sq Ft
Fql W RC 10 OP�TAIN A VLRMI�or SiqR7iN6 CONSiRUC110N bV1iHOVT�VMMIT W ILL flCSL1LT IN PCNALTIFS �
I(we)dedare that this application(induding any accompanying Information)has been examined by me(us)and m the best of my(our�knowledge and belief it is vue,corrett anC
comvlete. I(we�acknowletlge that I(we)am(are)responsible for the detail an0 acaracy of all informaHon I(we)am�are)provlding and that rt will 6e relieE upon by Sawyer
Counry in determining whether to issue a permi[. 1�we)further accept liabiliq which may be a resWt of Sawyer County relying on this information 1(we)am(are)D�ovlding In or
with thls applica ioo.I(we)mnsen[4b munty officials charged with administering mvnry ordinances to have access to t�e above Cescribed property at any reasomble time tor the
pur se of inspectioa�dditionally,the undersigneE person(s�hereby give permizsion for accers to the pro0erty for onslte insD�«ion by MUNtlpal Ofliclals.
Owner Owner
� Signature Ptinted name �A,C u J O��Sp!1 pg�a q—'27 ,�1 2
�q�gn.err... . �. ._, ... i_ _ ,eat
NOiICE �HI Lni d�s-PE-nni!s Lrp�e��nc iL vea�iro�NP 0ate of lsoinnra
F-r �_ � �ructu i O�New Cm 4-w��' nJy C�welhng N L Mi„iapaLtle Are ReQuireC Tc Enic¢e ThF�n`p«r pwclbne Cade.
'hs roa�-owr,State m Fetleral agenc�es msy aao reoutrr parmr,s
Vou are responsible for mmplying with Me requirements of�he Sawyer Cowting Zoning Ordinances and law and regulatlons of the State o(Wisconsin.You are also res0onslble for
! complying wkh State and Federal lawz mncerning construction near or on wetlands,lakes,and streams.Failure to<omply may resWt in removal o�modi0cation of construaion
that violates the law or other penalties or msts. For more infarmation,visit the department of natmal resources weNanOs identlfication web page or contact a department of
natural resourres service center�fi08)26�d125
Issuance Information(County Use Only) Sanitary Number p of betlrooms:
Vermit Denied(Date�: Reason for Denial:
Permit#: Issuing agen/�7� Date:
�a-y sy ; �_
10 ��3 ���
Is Parcel a Sub-Standard Lot �.:�Yes loeetl of newrtll ?c No
Mitigation FequireE �'Ves o
Is Parcel in Common Ownership 'yLYes (Fused/Contiguous Lorysp '�No
Is Strucmre Non-Conforming "�Ves �,� Mkigatian Attached '�' Yes .�No
Granted by Varian<e(B.O.A.� Gronted by Conditional Use
';Ves �No UseM: �:Ves _'No GseM:
Was Par<el Legally Created r-Yes C'�No Were Vroperty Lines Aepresented 6V Owne� Yes No
Was Proposed Building Site Delineated �Va U No Was PropeM Surveyed �Yes No
Offi<e Comments: . Zone Distritt: Fee: '7
,�sPec+;or - irvs �a -o�ta s
�-(� � � �C��°��S��I
HoldForSanitary'. MOIEforTBA: HOIdPorAffidavi:: HoldFarFeeS'.
OF�p20�1
9/15122, 1:44 PM Novus-Wisconsin Access rev. 13.1108
Real Estate Sawyer County Property Listing PropertySta[us:Current J
Today's Date: 9/15/2022 Created On: 2/6/2007 7:55:41 AM �
�Description Updated: 1/Il/2022 �Ownership Updated: 1/11/2022 �
7axID: 24480 GARVJOHNSON CUMBERLAND WI
PIN: 57-024-2-41-06-29-2 01-000-000050 C� \
Legacy PIN: 024641242105 Billing Address: Mailing Address: � �
MapID: .5.5 GARYJOHNSON GARY]OHNSON �
Municipaliry: (024)TOWN OF ROUND LAKE Z677 8TH ST 2677 BTH ST
STR: 524 T41N R06W CUMBERtAND W1 54829 CUMBERLAND VJI 548Z9 I
Descrip[ion: PRT NENW LOT 4 CSM 4/292#825 LOT O
8 CSM 4/294#826 � Si[e Address 'indicates Private Road
Recorded Acres: 2.170 10873N DEER W * HAYWARD 54843 �
Lottery Claims: 0 G
First Dollar: Yes U da[ed: 7/16/2019
Wa[erbody: Moose Lake � P�operty Assessment P
2oning: (RRl)Residential/Recrea[ional One 2022 Assessment Detail
ESN: 402 Code Acres Land Imp.
G1-RESIDENTIAL 2.110 201,400 211,600
�� Tax Districts Updated: 2/6/2007
2-YearComparison 2021 2022 Change
1 � � � State of Wismnsn Land: 201,400 201,400 0.0%
57 Sawyer County Improved: 211,600 211,600 0.0%
024 Town of Round Lake Total: 413,000 413,000 0.0%
572478 Hayward Community School District
001700 Technical College
.� Recorded Documents Updated:8/8/2014
"I.�Property History
0 WARRANTY DEED N�A
Date Recorded: 12/17/2021 436570
O TRANSFER ON DEATH DEED �?�- �, �Cv��
Date Recorded: 1/11/2019 416151
0 TERMINATION OF DECEDENTSINTEREST
Da[e Remrded: I/I1/2019 416150 ��. ��
� CERTIF7ED SURVEY MAP
Da[e Remrded:9/ll/1976 156805
O CERTIFIED SURVEY MAP
Date Recorded: 9/ll/1976 156804
O WARRANTYDEED r-\t•'�v`-�1v� C�`�a��,QiO\�
Date Remrded: 8/19/1976 L56458 273/415 \` M _
O CERTIFIED SURVEY MAP C�� 'RW f`� � ) �[�-��jt_,�,_�
Date Remrded: 6/18/1976 155590
O CERTIFIED SURVEY MAP �
Date Recorded: 6/18/1976 155589 �f,.,����j�c� ����_ �_1 �
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