024-641-14-3105-LUP-2004-626 �
Application for Land Use Permit(*Shoreland*) o o
County of Sawyer y �
PO Box 676 -Hayward WI 54843 �
715/634-8288 c
*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 �
the property's boundaries. 1
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMTTS HAVE BEEN ISSUED.
PRINT—USE BLACK INK OR PENCIL �-
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l3erv�rzvc� S�ti�w�u✓1 � �adY�i �✓��9 � � �
Owner Builder °� o- �
7c12� 1�/ M�vs� �K. �� l�I Xf�DJ� �oa� �"y �� � �.
Mailing Address M iling Address � O
f�-vu/aV�i U�% SN�'fi3 t�lu/e�v� W.�. S�fS'�3 � �
City,St�} City, tate,7ip �
i��s-�iS�-�7s? �is- �ti�z- 3��5 ��
Daytime Phone F���5/ zyl-z�[�/ Daytime Phone S
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Additional Information: {}'77�t/ �,Ynn ,�one District: �
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$ek�►"'' Lot Dimensions: 3 �`d/iC �3�i l`
Date lot was created: � b O Acres: %�R I`7
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Is there wetland near the proposed stnxcture?If yes,how faz o �
Building Land Use Floodplain:O Yes �No`z•;c55/ ot y-5/`_: � �
�New ( )Filling Chippewa Flowage:( ) es �i(� No � �,
O Addition O Dredging Driveway access off of a(Check one): � S
O Alteration �Grading O Private Rd QCZTown Rd. �
O Moving On O O County Hwy O State Hwy tl0
0
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cn
Primary Structure Accessory Building Addition o
Deck N
�yQ Dwelling Q�Garage-attached/� ( ) � �
I�QYear round (�#of caz stalls O Porch �.,
Stora e Buildin ( )Enclosed = �
( )Seasonal ( ) g g
O Frame built on site O Screenhouse O Living room �o �"„
�Modular/manufactured ( )Greenhouse ( )Kitchen � �
( )Mobile/manufactured ( )Other ( )Bedroom p 1+�
( )Other primary structure ( ) ( )Relocate/enlazge � �
� � ( ) ( )#ofnew �
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AdditionalInformation: � >
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Type of Construction: �+ I<.
�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �
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( )Other ,�
Construction Cost:Primary Structure$�1 D(� U ,z7 �
Accessory Building:$ Addition:$ � -�
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Deed:Vol z 7� Pg 3�c.> Certified Soil Test# �i� -���� ; z
tio �
CSM:Vol Pg Lot# Sanitary Permit# G��-�/`7�5 �
Plat Envelope Or: � ��
Condo Vol Pg Yeaz Installed: N
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"Loads and Flows": Vol Pg Owner When Installed: �
ci
Previous office approvals/actions: .p
Vaziance:# LUP:# SP:# CUP:#
Inspection Report:# Change of Zone District: �10�
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aNao3
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Describe the construction using these columns. List the dimensions of each structure in a separate
column. List each story, each addi�n, each alteration in a separate column.
#1. `� or #2. Z S f�7�'y #3. �-�� � #4.
Size �j�de �=ft. wide _J._�fr. wide ft. wide
5�,�5/ ft. long iL•� fr. long Z�% ft. long fr. long
Floor area 1�'Z� sq. ft. ��sq. ft. ���sq. ft. sq. ft.
Hgt.from grade to peak�_ft. hgt. � �r ft. hgt. ft. hgt.
Stories � stories stories stories
#of bedrooms_�
�C � ��. Lake/Pond/Flowa e/River/Stream Name
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Fire Number and Name of Road��� Q'1/J �1 G � ti Pi �u�<G I<-
1. Enter lot dimensions and indicate north by arrow. Signature of w�eP or�uthorized Agent:
2. Indicate the location and size of the requested construction
activities. �
PnntName:
3. Also, indicate the location and distance to the well, The above ceAises that the listed iniormation and inten6ons are
irue and cortect.,Mat all work shall be pedortned in crompllance
Se t1C t21]IC anC�ClTainf eld, wCtlalld 8ie8S, lot 11nes, with the requirements o(the Sawyer County Zoning OMinance
P and the laws and regulations of the Sfate of Wisconsin, and if
centerline of the road and waterbodies. acn�y a5 owner�s>a9e�i,nas me Pem,�ss�o�or me ow�e�(5)to
pedorm the work requested on this application. The above
personsls hereby give permission for access to ihe pmperty for
onsiteinspection.
Permit fee: $ �-�J� , ��C� �-y
Total land area within 300' of the waterbody: (A) � LJ ��� V S`�. ��
Total impervious surface area [including this project] (B) ��� 3 59.{G�
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(B) / (A) x 100 = % Used • 3 5 (Shall not exceed 15%[or 25% with a conditional use permit].)
Shoreline Vegetation Protection Area: Mitigation Required? O Yes (J�No
November 2 , 2004 �A A .� 1v -�t-�� �- _—
Issue Date Signature ofIs in gent
November 2 , 2005 50%Rule: AverageRoadSetback:
Expiration Date
Office Comments:
SAWYER COUNTY ELEVATION SURVEY �
LOCATED IN THE WEST 1/2 OF THE EPST 1/2.OF � / I N I
, 7HE NE 1/4SW 1/4 6 THE WEST 1/2 OF THE FAST I/2 � � � —
OF THE SE I/4NW 1/4 OF SECl10N 14, T41 N, R6W, � �' � a �
TOWN OF ROUND LAICE, SAWYER COUNTI; WISCONSIN. � / � � W ��D
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S AIIN. WL 1.33//L1N. FT. � z o
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\ � P � / — I ,� � ` � BEARINGS AF2E RffERENCED TO m � W
!•,�\ THE NOR1H-SOUTH 1/4 LINE I '
I � `V` � N7g41 2��E Z � SEC110N 14, T41N, R6W � O1 � '
� � a ASSUAIED TO BEAfi ELEVAilONS ARE BASED UPON I
� QQ 34�•g6 � THE CHIPPEM/A-FLAMBEAU IMPROVEMENT C0.
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1 4't � � � ` 'G - / n� � BRASS CAP IN THE NW WINC WALL OF THE �
\ �� — � � N ,p, MOOSE LAKE OAM. ELa1376.34' NGVD29.
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� NO2'02�27"W / ���---777 � hIE 1361' ELEVA110N REPRESEMS I
33.04� � � � / ` iHE NEAREST UPSTRFAM F1.000
j FRINGE ELEVATION.
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N89'34'13'W 2356.55' N89'34'13'W 336.65' / � � N89'34'13'W 336.65 ��."`Go���'%,,, - -
TO W1/4 14-41-6 N. LINE NE-SW ;��5 ,,.. /�S��'/
FND. 2 7/2' B.C. / / " s
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m \�� � TOP OF WELL S�Y� C��T�: ��q SURv �p�` .
N °'. �= 1363.53' �' '� W. u��K WISCONSIN REGISiEREO LAND SUIt�hlR;�11EaEaY I
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o CEHIIFY THAT I FWYE SURVEYED, MID MMPED A PLAT OF SURVEY
� ,o N LOCAIED IN THE W 1/2- E1/2 OF 1HE NE 1/�-SW 1/1 k 7HE .
F.E. °4� wcsr �/z oF n+e � �/s ov n+e se �/4-nw 1/4 OF I
1361 R. � 1w / o SEC1�aN 14, T41N. NfiW, TOWN Of ROUNO WC� S�WYER CWNfY,
APF�CSURVEYING �"o } <„ r�i��rn� oesaaeeo r� conrnms ii.is �s oF uno Mor� � -a � '
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HAYWARD WI S4E43 � N.L fASENINTS AND RESEfNAT10N5 OF RECORD. N 1�1 p .
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7159342739 FAX C P W u WI4C�NSIN ADNINISTRAThE CODE AND T11E IUP 5 A CORRECT � � I
� C T Y W REPRESENiA710N OF THE SURJE'! MrDE TO THE BFST OF AfY N �'
CLIEIVT:
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BERNIE SCHUAAAN �'90 � �o �' -' cNi�
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SHEET 1 OF 1 \ o
APIX 20111 1 I/27/00 i
REVISED 09/10/03 N89'30'42"W 336.73'
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SCALE: I IN�� 400 FEE
DRAWN BY: �
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Sent By: SAWYER COUNTY Zoning; 715B38 3277; Oct-28-04 8:17A�; Page 2/2
SHO LAND YRFSERVATION AGREENiENT
(Shoreliae Vc�etation Protection Areal
T,and Use Permit No. 05�-(02/� (To be ente�ed by the Zoning Office) index Na. OS� -�z�
l
WI�LEREAS,(list all ownen) f
owttis m.at estate within Sewyer Counly tl�at is subjcht to the Sawyar County Shoreland Regulati0ns, and
WF�EltEAS,in order to secure a I.and Use Permit.
� NOW THEREFORL,the owner(s)heteby cartifies that,as a condiGon of issue of said Land Use Permit,ihat
t the SHOK1sLINE VEGETATION PROTECTION AREA on said real estate is intact to a miaimum depth of
C3 S'landward fmm the ordinary high-wate�madc of the waterbody.
�
� The owne�{s)haeby agrees bo comply with the shoreland vegetative protection azea tequiremeuts af Section
� 4.410 Sf�Oi�LAND VEt3ETATION PROTEC'ITdN AREA,Sawycr Cownty Zonin6 OrdiaaacC•in effcd on
'the date that the land use pem�it is issued by the zooing office.11►e owner(s)fiuther agcees to ullow sut}iorizcd
� r�t�e+►tatives of the Govexromental Unit to euter oato the ownet's propa'ty at ihc foUowing dexripaon
betwaen the hours of 8:00 A.M.and 6:00 P.M.[Scdiou 9.13(1)POWF.RS,Sawyer Co�artY Zo������
to inspxt ihe structiue(s)a uses authorized by said land Use Pe�it and to d�tem►ux if the SHORELINE
VECrETATiON PROTEC'CION AREA exists aad that it is being presetved.71us suthori�tion sball te�mmmate
(n on the date of expication of the land use paraiit However,the owner's obligation to main�n 1�SHORELINE
VEG�I'ATIDN PROTECT[ON AREA in accordaace with Swtioa 4.41� SHORLLAND VEGE'1'A'CION
�9 PROTECTION ATtEA,Sawyer Cownty Zoning Ordinance remains in effect•Violation of this Agreema►t wil1
(� suthorizs, in addition to other peoalties aad relief ra(uired under the Sawyex County Zoniag Ordiaance,
� injun�ve t+elief,testoration o£said real estate,the rcvocatioa of said Land Use Permit end the reanoval of all
` strucwres approved by the issue of said Land Use Peirnit and the revocation of any other uses approved by We
�- isaue of said I,and Use Perrnit. ALl parties agroe that this Ageement shall be filed w�th th�Sawyer County
O Zoning O�ice.
I,egalAescriptionofPxope►ty: Part of the NE SW Sec 14 T 41 N
024-641-14-
Datedthis $ day f October . 9M�
���" Y �
(bwner) (Ow�r)
�Qµa�� �OWRCC�
(Owmer) (Owner)
lhis�strumeut was dratt�d by:
sa�coun�y z��og ot�