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026-938-07-5301-LUP-2004-217 Application for Land Use Permit o o � County of Sawyer N � 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 APL�vE�SE BLACK NK OR PENCIL , � � r'� ` �fG��.luitc� �v��'�/�a�,�,�� /�ls�^ `'` � � � Owner % Builder �' , _ 1,� �i � , , '.r. �. ' � Mailing Address ` � � Mailing Address � � � ;, � ,�,1.� ,�, �/:. .�Di :. C;i , ,. City,�State,Zip City,State,Zip �, -: ,�, - � , � Daytime Phone Daytime Phone R R�� AdditionalInformation: ZoneDistrict `-r` i'.r���' '''b'r' Lot Size '�' ' Acres ��. ��`'� Is the property in a Shoreland District?(within 1000'of a lake or pond,within 300'of a river, creek or stream) If yes,how far from the shoreline&water name: ` � Is there wetland near the proposed structure?If yes,how faz � � � ,o Building Land Use �. (�)New ( )Filling Floodplain:( )Y'es (y)No # � Dred in � � ( )Addition ( ) S S � ( )Alteration ( )Grading Chippewa Flowage: ( )Yes ( )No ^ � ( )Moving On ('�_) _ ��'. '` � Driveway:( )State O County O Town Rd. s o O O ;,� w `... Primary Structure Accessory Building Addition 1- ` (i)Dwelling (r,)Gazage-attachedldetached (�)Deck � "; �; (�)Year round (�)#of caz stalls (�)Porch � � � Stora e Buildin O Enclosed I ( )Seasonal � ) g g � � Screenhouse O Living room o p�' (y)Frame built on site ( ) � - ( )Modular/manufactured ( )Greenhouse ( )Kitchen ( )Mobile/manufactured ( )Other ( )Bedroom O Other primary structure O O Relocate/enlarge A � � � � ( )#of new � � 0 Additional Information: ,.d � 0 � �:,. Type of Construcfion _ ;� c � (>�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete j� � ( )Other - �► � Construction Cost:Primary Structure$ 2<:� , �z Accessory Building:$ �- � Addition:$ � � 7� Vol Pg of Deed Certified Soil Test# �t'rl_y�l� o CSM Vol Pg Lot# Sanitary Permit# �'y -1��'' Plat Envelope Or: � Condo Vol Pg Year Installed Aff of ex septic Vol Pg Owner When Installed: Gard Gazebo Vol Pg LUp. Inspection Date: G'G�I'�f�o �\�� Previous Variance: ^� ��'la9 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. , ;t �` ° #2. / - ::� -.:.. �. ., ,, #3. j�'�rt��; #4. " #1. /�` -�•- _ ' ft. wide Size �'��` ft. wide ft. wide i `; ft. wide ` - �'��� ft. long .-�.�:: ft. long �. ft. long �'? '� , ft. long Floor area �'��:� sq. ft. � ,. sq. ft. �'� sq. ft. �-��` sq. ft. Hgt.finm gracie�to peak /:l ft. hgt. ft. hgt. ft. hgt. Stories � stories stories stories # of bedrooms � Lot Line or Lake/River name: , �u��, �����r �' `y �,� . ' '�` � , , ;- -� . � � ! y _. � s�. ��� � �_._�,-- - --�.._1"_ �� k otd�,� t i� �� _� -�-�-' . ---� ,� � _._. , , � ; � � � �, ' �f v t ,(�` ��, F-� b' � �,, o ' (� . ` , S � � ��,s • � ti ,�, �'" j� -- - � -� rt �� � � :. _ �, � 3 � _ , _. , > ' K� � y'1.� I ' � � ___ j . � � ' � , 36 io 1 �- .___.' ..r .� � f i/ � � F� .. G �F � � � � ��� .�,.���--'s' _ _ �/ �t:\J� 1�.� . . " r��� �. , � ! ." "_.-."1., Fire Number and Name of Road ,�-.�'}��'p''�:? :`f��� �'t 1. Fill in lot dimensions and indicate north by arrow. Signature of Owner or Authorized Agent: 2. Indicate location and size of existing and new structures. ��,�C yti f l�it.�u_�c a_�.t,� �� 3. Indicate location of well, septic tank, drainfield. 4. Indicate distance to existing structures, lot lines, septic system. 5. Indicate distance to the ordinary high-water mark of any lake, _ pond, river, stream, creek, and name the body of water. P��t NaR,e: '����7 r� ��'� ��%��%����( The above certifies that the listed information and�ntentions are 6. Indicate any grading or clearing in excess of the construction site. true and co�ect Tne a�o�e persons�s ne�eby 9�ve perm�ss�on to� access to the property for onsite inspection. 7. Indicate distance to any wetland. � �r n � er� w AC. a� d D ermit Fee: ���` '' � May 25 , 2004 ' Issue Date Signature of Issu A t May 2 5 , 2 0 0 5 ��,t���; ;�us S;;.�'r�c�� �/� , � 5°7a ; Expiration Date �t%� ci-+f'�'i /4'y �Q� Office Comments: , Inspection Date: 50% Rule Applies: Avg. Setback: I Restrictions and other information: I -„� ,�� S LAKE � � F AN D ;. 7 TW P 38 N. R.9 W. .__ _-_-_ _.___ ._._._ __ _ __ SISSABAGAMA LAKE � �:r� �4.1 � ����-�-� �� � � � �6.17 � �623 ��� � `�6.15 � I { �2.4 � ' � ^ �6.18 � ��.2 � / 8 `� 9 � (/ :6� 7 � �� � O �1.3 � :6.14 / :6\9 s �2.3 ` ���� 5 •6• \ O � � ` � 2 \ � , 3 � .1.3 � �6.1 � O . O , � C 25 � 4 .14 �� -� :6.3 '2•5 \� =6.12 =6.2 6.21 � � O :6.4 � � =6.24 � �2.2 � :c.lo :6.9 :6.27 � :c.�g O •2.1 =6.8 ..:b.z � -�` � � �3.3 �6.11 :3.4 �6. \, I 6 � :s.is •3. •6.7 i �3.5 � ,1 �'iss -6.6 � �.. i q� � / '��, :3� � / � �2� � � '9 �3.7 \ C \ � q �� � � .5.I � � � \� 1 �3. .5.2 �--�� � �. -� _ �_- - .6.2 7 3 � 3.02 � O .7.4 .7.2 � .6.i v \ � TOWN OF SAND r" - --_ SEC. 8 TWP 3� N. � � �—�_�_ —�-- I 1 ( � I � I 1 ( ouT �or i ,a..i2 iirn _�t �`��� .7���/ / � SISSABAGAMA LAKE :7.5 � � � �7.2 :t4 :Z3 ��\�� 1 ` � � ` :9.1 1 �� � � /� � � /� 10.3�� �;�� ���_-�,� 0 • 1 C � �io.2 �I \ . \ �� :10.4 � , � � ,� �, � �, �L�=� ! � -�- � :2.5 `�� , , � 1 ao.5\ i� I /1 • �10.1 / � .,, ' / \� � , , Z1 ��� � .io.e 1 ,� r.=. .,y g o \� ( m o+ � N �2.1 / � n N N � \ I 't N O 1 \ b � � 3 � \ :10.7 � .�� :�ro � _ �� �� � .i�n� 21 1 �� .;�. �� �p� I '�.. � 1 ' �� � ��, � :�::�;: \ i � ZONE X f� � � �� � � 31 �. �' 32 � 33 . �' `:��. i � �V%�'�' I ; ;..1:•:•. i .' � � Sissaba,;ama��'��' I i Creek ��� �:�:; I .�:�:�::.. i ::� � � i ..,...... ;�_::: � T 39 N ^• `•� .:�.•. i _- . _ _-- ...�. .._ _—__ _�.— ---_.. i - _ _ __ __ i i 38 N. - -- --- ------------ � I� �: Q ;..; I � ;�:� -`� ZONE X�.;;:..:. � .�, � m�i � � :�:�:�: � � .,:.:.. , � :�`::�: �I � �'�:�» 'i ! >- I b ;���'��_ _ I � d ��I' /.�= �_ I ,��,�_J 5 I Z' ,,;. � � ` __= '-_== . .�':'::':.:::':'.{':.,; ..:. :.::':.::.:..:.:. ... �� •.. � � , � � �`--�----�---.�. . \ U � II �i��� ,7�, ��,� � � ��. n . � � �� • � � �� � � �� � � j �. �� � i � � . �� :��: � �� --_ � � � .. , `j� � :...:.•:.:.:...: ,:,...��. .......:....................�.,...,.:�:�»:'. . ,.. .�;�:._:� i 1/ ___ � ...... .. . . 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I , . � . :�LA�K�E�:: � I o , ` � � �- `;, � �� �� - ,� ,, � ,��;`.• �� p , i;• _ I ����� i ��� � , � � ���, � i >:�>:�:, . � 4 i , : / � � , � , i >��::�?i�':�>:��':�:�>��:������?���v���:�:�:���:���>:�:�:�:�:•:; � �� � � ; � � \ ((, ' I.�::::::::::::i::::::::::::::::::':;:::<::::;:..:.�:::::::::::::::::::::::::::::::::::::: :::::::::�� I i �, � � , _� �, , � � ZONE X � �. . e ����::.::�::��>�'��������������::;:.:.:�:�:.:.: �i�� ��� �, �� � > �� ; � � _;: �� �� CRAN6ERRY �, ���������r��'�'•'. fl.:�:??::�:<�>:�:�:�>:�':�:�>;:�:�: •.. . � BOG � _ Ik�;:�;':,:,::`:.?:.:.:;??`:�:: ' I� \ -- _� .. . .. . .:. . ... . .:. . . �� ���r " �_ ,�..:•:>:•:<•:•:•:::•:•:•:•: :•>;: I �1 �/ •..•.•.•.•.•.•. .•.•.•.�.•.•. .•.�.•.•. _ �� � � .`�:�� - - - --- ----- :.��'�-� � , � - - ----- � .. ::::: : :::: � , --� __ ___- � ��� �:�:: :::: . ... .... . : . -_-_ �. .....:.:.......:::.: :: � �, ; -__ � � �_� „ � �— ; , % } } �� � _�� � � � � � � j 11 � ':::`;::::��`::: .. z z - I� � �_-1 ��� �.:..;:;.;... :: > > ' � o' y : � 0 0 ' O� � _ _ - � , , , ,: � � "' � �� , �--__ �, , �� ::� �� � ,� � '� �'`� �, �' � ll �� ��� � � ; � � u 16 � � � � � �� �8 � (I _ � » i���1�j �' Mu D � � � �' I) �= � �\✓,�/ �I LAKE . t ' // �j � Q ll � � � � SADDLE� �� � � � � LAKE iai/11 \ � � � � _� � ;�^� � �i� „ �� O o --- Q � �' _�_ --- , _---- ----- ,; � ,- -- - ,��� �- �I _ _ _ -� !�I � � a ��� ��� I f r� ll � � ` ' � I , � �� , '�� // � �� I �� , ���i �� ` ����j UTTLE SISSABAGAMA �i ii � � ' �� � (l a LAKE � �, ��. � � �f� 21 �. 19 � 20 ; �� � r� � � C'_�_� I > // I /, � , �J � - o � � �� � �- �=- � )f ��,`� � � �, �_ � r �`� ' � ' � % � � - -- �,� U II i \ � � / BUFF ;� �-��p ��� � / LAKE / . � � � \ �° �� ` ' ��� � --- ,--� _ �__ .�__Jl � _ �-- ---- ----- . �,�,.�,..��.��a , SHORELAND PRESERVATION AGREEMENT (Shoreline Veeetation Protection Area) Land Use Permit No. �/ - / �/ (To be entered by the Zoning Office) Index No. �-�� � WHEREAS, (list all owners) /C o���.e�_.- v2�r- �c ���� i� r:.� - '�.t=��'�t a�i ,iv ' r _ � � � � —� � 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 Perxnit, that he SHORELINE VEGETATION PROTECTION AREA on said real estate is intact to a minimum dPgt!: of 35' landward from the ordinary hi�?:-vrater mark of Uie 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 aliow authorized � representatives of the Govemmental 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 deternune if the SHORELINE — VEGETATION PROTECTION AREA exists and that it is being preserved. This authorization shall terminate C� on the date of expiration of the land use permit. However, the owner's obligation to maintain the SHOREL[NE i 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 Q 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 strvctures 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: � � F a 7 � � ���'1 ,.�� �7 g ` ;,a.-us, ..,.f �:�:,�.-c � L�n`c � Lot 1 of CSM vo1 20 p� 105 _ nart of Gov ' t 1ot 3 _ _ i Dated this �,2/ day of CC'�.4�.(i , �tJ o�/ � ��c�t � �c�-r_�«�.._,�_� — � (Ownex) �� (Owner) I � � CRa.�' b��cT CE�arc � � � wner) (Owner) (Owner) (Owner) This instrument was drafted by: Sawycr County Zoning Office