024-741-15-3212-LUP-2004-061 Application for Land Use Permit o 0
County of Sawyer �, �
PO Box 676 -Hayward WI 54843 �
715/634-8288
The undersigned hereby makes application for a Land Use Permit and agrees that all work
shall be done in compliance with the requirements of the Sawyer County Zoning Ordinance �
and the laws and regulations of the State of Wisconsin.
NO CONSTRUCTION MAY BEGIN UNTIL ALL PERMITS HAVE BEEN ISSUED.
PRINT-USE BLACK INK OR PENCIL 1
J�OTAD� f� � � O
To µ , A ¢ !U A-D�ue k- �1£5»wl �oA.tes ��:� a
Owner Builder �
�3So4 /v�'�' l�� Pe fia�( 2�3 0� �
Mailing Address Mailing Address � ��
��Al'iC �`�1�'�r, �'��I S�3(c`7 1�2h121E �'vCke�; U.'i j38L1 ,��,
City,State,Zip City,State,Zip �
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Daytime Phone Daytime Phone �
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Additional Information: Zone District t21
- -�y� -----—y O
� i, Z�N' Lot Size �
�347
Date lot was created 14�t Z Acres Z�� P
Is the property in a Shoreiand Dishict?(witnin IO"v0'oi�iaicz or pond,�:1ir.�CO'of a river, I Z
creek or stream) If yes,how faz from the shoreline&water name:7��F� �n r F��w�r�c _ p
n..
Is there wetland near the proposed structure?If yes,how faz 7�i�' Nc�• � �
Building Land Use 'c3
❑
�New ( )Filling Floodplain:( )Yes ( )No # �
( )Addition ( )Dredging � �
( )Alteration ( )Grading Chippewa Flowage: ( )Yes ('X}No �
( )Moving On ( ) o
( � ( ) Driveway:( )State ( )County ( )Town Rd. -C
I���.iv�tre Kc�ro
Primary Structure Accessory Building Addition �
(X)Dwelling ( )Garage-attached/detached (�Deck �
� �
(�i)Yeaz round O#of caz stalls O Porch �
( )Seasonal ( )Storage Building ( )Enclosed �
( )Frame built on site ( )Screenhouse ( )Living room � �'
(X)Modular/manufachued ( )Greenhouse ( )Kitchen �
( )Mobile/manufactured ( )Other ( )Bedroom � �
( )Other primary structure ( ) ( )Relocate/enlarge
� � ( ) ( )#of new >
�
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Additional Information: `�
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Type of Construction �
(�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �
( )Other ` �
Construction Cost:Primary Structure$ iv&`r SS 2 � �
AccessoryB�.iildinR:$ ^.�1di±ior_:� ,Svc '�O �
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Vol `��� Pg -��ofDeed Certified Soil Test# q$- Sl5/ 9?'��(�
CSM Vol�_Pg��4z- Lot# l0 Sanitary Permit# Q�-d/�] J
Plat Envelope �r� �
Condo Vol Pg Yeaz Installed
Aff of ex septic Vol Pg Owner When Installed:
Gazd Gazebo Vol Pg
Previous Variance: LUP: Inspection Date:
�
�{y�08
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. #2. �o�r /��� ' '" #3. D��� #4.
Size Z� ft.wide 2� ft.wide �Z�ft.wide ft.wide
4�- ft.long '2 Z- ft.long t� ft.long ft.long 7
Floor area l�7� sq.ft. ��Z sq.ft. 3$4 sq•ft• sq.ft.
Hgt.from grade�_to peak 2 Z ft.hgt. S ft.hgt. ft.hgt.
Stories � r stories �_stories stories
#ofbedrooms �.
\"� Lot Line or Lake/River name:
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Fire Number and Name of Road C rZ Nti'� C�ti'�
l.Fill in lot dimensions and indicate north by arrow. Sign e f Owne,orAuthorized Agent;
2.Indicate location and size of existing and new structures. � � /
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3.Indicate location of well,septic tank,drainfield.
4.Indicate distance to existing structures,lot lines,septic system.
5.Indicate distance to the ordinazy high-water mazk of any lake,
pond,river,stream,creek,and name the body of water. Print Name: Jo„ti A s/��+���� k .T�.r,�nE_
The above certifes ihat ihe listed informa�on and intentions are
6.Indicate any grading or clearing in excess of the construction site. we aod�o��ea.rne a�o�e Persoo5�5 nereby yive Pem,�ss�o�ro�
access lo the property for onsite inspection.
7.Indicate distance to any wetland.
Pernut Fee: �
2 Lt%
April 14 2004
Issue Date Signature of Issuing Agent
April 14, 2005
Expiration Date
Office Comments:
Inspection Date: 50%Rule Applies: Avg.Setback: Within Reservation boundaries:
Restrictions and other information:
WORKSHEET
The followine stens shoul'd be followed to address the IMPERVIOUS SURFACE issues
related to vour rn operty. Not all lots aze rectangulaz in shape. For those lots that are
irregulaz in shape,the lot azea should be determined as accurately as possible. (Note:
Length x Width=Area.)
1. Determine the lot dimensions.
Length= �7�i;`i2'from the ordinary high-water mark to the rear lot line.
Width= /�� 'between side lot lines
2. If the lot is a river lot,determine the lot area only for that part of the lot that is 300'or
less in depth.
Area= squaze feet.
Multiply this amount by 15%.
Area x 0.15= squaze feet. This is the maacimum impervious
surface area that is allowed without obtaining a Conditional Use Permit
3. If the lot is a lake lot and is less than 300'in denth determine the lot azea.
Area= square feet.
Multiply this amount by 15%.
Area x 0.15= squaze feet. This is the maximum unpervious
surface azea that is allowed without obtaining a Conditional Use Pemrit
4. If the lot is a lake lot and is greater than 300'in deoth,deternune the lot azea for that
part of the lot from the ordinazy high-water mazk to a depth of 300'and for that part
of the lot from 300'to a depth not to exceed 1000'.
(a)Area= .�q ��� squaze feet to a depth of 300'.
Multiply this amount by 15%.
Area x 0.15= �`b9 S square feet. This is the maacimum impervious
surface azea that is allowed without obtaining a Conditional Use Permit.
(b)Area= 5� I"1�w squaze fee from 300'to a depth not to
exceed 1000'.
Multiply this amount by 30%.
Area x 030= /�6�$',$ square feet. This is the maximum impervious
surface area that is allowed from 300'to a depth of no greater than 1000'.
5. Provide a detailed drawing on the application for land use permit that cleazly
indicates the impervious surface azea.
Page 3 of 4
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SGAIE: IINCH=4v0 FEET FOR ASSESSMENT USE ONLY
DRAWN BY: DATE: INTENDED TO SHOW GONCLU
COLON (:I INDIGATES GOVT. LOT EVID�NCE Of OWNERSHIP OR
arniunenv i nren�uc
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SAWYER COUNTY CERTIFIED SURVEY MAP �
w�+�. Part of the NI�SSW� 2iD�-SW� Sec. 15 7
sec.rs a�sa.sa• � � • , T. !�1 N., E. W.
n B � ALUN.NON.
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5 HEET I OF 2 PAGE I OF 2
SHORELAND PRESERVATION AGREEMENT
(Shoreline Ve�etation Protection Area) �
Land Use Permit No.��--�( (To be entered by the Zoning Office) Index No. �_- �(�1
WHEREAS, (list all owners) ���,.r�, q J�.T��� N�}�+N s � Tc T��E
,
owns real estate within Sawyer County that is subject to the Sawyer County Shareland 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' landward from the ordinary high-water mark of the waterbody.
The owner(s) hereby agrees to comply with the shoreland vegetative protection area 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 structure(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
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: /� �1Z S ix° i�4 5��. 1S rw n 4 I ,2 7
�1`� ��'F 1.1� ��y- 5'w!�- $`'I 5 i�F 1 27 trS w r I C �
Dated thi 3b�' day of 11�j�,R.�t� , 2e��4
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(O er _ �Gwner j
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(Owner) (Owner)
(Owner) (Owner)
This instrument was drafted by:
Sawyer County Zoning Office
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