024-741-34-1304-LUP-2004-676 A lication for Land Use Permit *Shoreland* � � � �
PP � ) o 0
County of Sawyer � �
PO Box 676 -Hayward WI 54843 �l
715/634-8288 �"
*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. `
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. �
PRINT-USE BLACK INK OR PENCIL
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'�oY � k���a�wa � �
Owner Builder Q-: �
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�33°l'1 �AN o�-A- �2. o.
Mailing Address Mailing Address � �
I,.�►-►�sT�� , M►� S 5��-IS �
City, S��cte, Lip City, State, Zip �
6S 1- 2S'1 -i�-z-�
Daytime Phone Daytime Phone -�
Additional Information: Zone District: %� - ,r �
I P R�.�b''
Lot Dimensions: Z �6�9Z�C Z3�
X 3�1 �
Date lot was created: Acres: Z-. Z-
Is there wetland near the proposed structure? If yes, how far IJo 0
Building Land Use Floodplain: O Yes O No � �
( )New ( ) Filling Chippewa Flowage: ( ) Yes ( ) No i �
�j Addition ( ) Dredging Driveway access off of a(Check one): � �
( ) Alteration ( ) Grading ( ) Private Rd (�Town Rd. � �
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy � �
� ) � ) � �
�•, r
Primaxy Structure Accessory Building Addition o I�
�Dwelling l ) Garage-attached/detached �Y�, Dec.k �
( ) Year round ( ) # of car stalls ( ) Porch W
� Seasonal ( ) Storage Building ( ) Enclosed �
�
� ) Frame built on site ( ) Screenhouse ( ) Living room � �
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen � �
( ) Mobile/manufactured ( ) Other ( ) Bedroom (�j
( ) Other primary structure ( ) ( ) Relocate/enlarge = A
� � ( ) ( ) # ofnew Z
rn
AdditionalInformation: � A
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Type of Construction: �'
�(Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete �
( ) Other y
Construction Cost: Primary Structure $ ,� �
Accessory Building: $ Addition: $ �, � �
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�eeu: `J�i 7/ Yg�l� Certitied Soil Test# � �Z
CSM: Vol Pg Lot# Sanitary Permit# °G �
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Plat Envelope Or: o,
Condo Vol Pg Year Installed: UN��� �,
"Loads and Flows": Vol Pg Owner When Installed: c� �
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Previous office approvals/actions: a�;
Variance: # LUP:# SP: # CUP: # �''
Inspection Report: # Change of Zone District: W �(
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a��ys
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. #3. #4. _ � �
Size� ft. wide ft. wide ft. wide ft. wide
,�.� ft. long ft. long ft. long ft. long
Floor area 50`'+/ sq. ft. sq. ft. sq. ft. sq. ft.
Hgt from grade to peak ft. hgt. ft. hgt. ft. hgt.
Stories stories stories stories
# of bedrooms ..
Lake ond/Flowa e/River/Stream Name ����' �rl P�''�
3�l6� CM� D�,C.rrJb,.,
9�{
� $ Y�
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92.'
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Fire Number and Name of Road `19 31 � G�-Pr4dPt r-' �^�,IL�'.-- '�C�A�
1. Enter lot dimensions and indicate north by arrow. Sig tur of Ow er or Authorized Agent:
2. Indicate the location and size of the requested construction
Signature
activities.
PrintName: ROY flHA 1�
3. Also, indicate the location and distance to the well, The above ceRifies that the listed information and intentions are
true and correct., that all work shall be performed in compliance
septic tank and drainfield, wetland areas, lot lines, with the requirements of the Sawyer County Zoning Ordinance
and the laws and regulations of the State of Wisconsin, and if
centerline of the road and waterbodies. a�t��9 as ow�er�s� a9e�t, has the permission of the owner(s) to
perform the work requested on this application. The above
persons/s hereby give permission for access to the property for
onsite inspection.
Pertnit fee: $ 15,�
Total land area within 300' of the waterbody: (A) � q O�CX�
Tuiai irripervious surface area [inciuding this projectJ (B) jj�
(B) / (A) x 100 = % Used L- 2-`�0 (Shall not exceed 15%[or 25% with a conditional use permit].)
Shoreline Vegetation Protection Area: Mitigation Required? O Yes �, No
December 6 , 2004 ` -
Issue Date Signature of Iss ng ent
December 6 , 2Q05 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
31d71aNl �:, No,o� TOWN OF ROUND LAKE
�va • �e Nnndao SEC. 34 TWP 41 N . R , 7 W.
133 =H�N1 I .
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SHORELAND PRESERVATION AGREEMENT
(Shoreline VeQetation Protection Areal
Land Use Permit No. Qy�(p '7� (To be entered by the Zoning Office) Index No. �-_��
WHEREAS, (list all owners) ��,o�{ W, '[aj�pµ��(„{� �' �!,(�J L �j�ij}{ACA (,�,1-�
,
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.
� NOW, THEREFORE, the owner(s) hereby certifies that, as a condition of issue of said Land Use Permit, that
s the SHORELINE VEGETATION PROTECTION AREA on said real estate is intact to a minimum depth of
� 35' landwazd from the ordinary high-water mazk of the waterbody.
"L)` The owner(s) hereby agrees to comply with the shoreland vegetative protection area requirements of Section
7" 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
p 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
ro 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,
� m�unctive relief, restoration of said real estate, the revocation of said Land Use Pernut 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
Q Zoning Office.
LegalDescriptionofProperty: f�AR�-�-L. I^� sw ��'-� �� ��� SE-C- �''� T�I '�,
Dated this day of ��suJ+.�w�5�ti ,
(Owner) (Owner)
(Owner) (Owner)
(Owner) (Ownec)
This instrument was drafted by:
Sawyer County Zoning Office
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