026-939-22-5504-LUP-2004-247 Application for Land Use Permit(*Shoreland*) o o -�,
County of Sawyer �
PO Box 676 -Hayward WI 54843
715/634-8288 O
*Property that is located within 300'of a creek,river or stream or within]OQO'of a �
flowage,lake or pond or has any of the above waterbodies located within � �
the property's boundaries. p p
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. �- ,
PRINT-USE BLACK INK OR PENCIL — � �
�/2-C�/tFT �f �,��'1 t]'I /�%t S(r lrz c-� j-�✓c- � �
Owner Builder o, �
��(0�8 �i-L2no�a�.e /dtc�i �� � /�v/ �' �
o�
Mailing Address Mailing Address � O
SAvf}frr �/LI.v SS378 5h'� La�e , G�,� S5`b'7� � �
City,State,Zip City,State,Zip
95�- �io-fsc�� 7�S- 63y-��9r �
Daytime Phone Daytime Phone
Additional Information: Zone District: /L/L /
Lot D'unensions: a So n i o 9 a `
Date lot was created: 3��,U a' Acres: s,'7 7 f�c. L . 1`>� n
Is there wetland neaz the proposed structure?If yes,how faz �� o
Building Land Use Floodplain:O Yes (X)No G
(X)New O Filling Chippewa Flowage:O Yes (� No c��o
O Addition O Dredging Driveway access off of a(Check one): x�
O Alteration O Grading O Private Rd O Town Rd. �
( )Moving On ( ) Oc)County Hwy ( )State Hwy °'
� ) � ) �
0 0
N �
l n r"'
Primary Structure Accessory Building Addition o 0
(X)Dweliing ( )Gazage-attached/detached (X)Deck �
O Yeaz round O#of caz stalls (X)Porch W �
( )Seasonal ( )Storage Building (X)Enclosed
O Frame built on site O Screenhouse O Living room m
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen ",
( )Mobile/manufactured ( )Other ( )Bedroom \
O Other primazy structure O O Relocate/enlazge w
( ) ( ) ( )#of new �
�l`-
AdditionalInformation: W „'
� �
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4� �
Type of Construction: a' y�
(k)Frame ( )Log ( )Pole/metal ( )Block ( )Concrete � 9.j
( )Other o �
Construction Cost:Primary Structure$ �S,o 00 �� 'C �
�d
Accessory Building:$ Addition:$ �
���a3 � �
Deed:Vo1-�'�' P � Certified Soil Test# p�1�/�O �
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CSM:VoI a3 pgj,yy-/BlLot# / SanitaryPermit# dy-�-�`� °O 7y
P1atEnvelope �SM (c�388 Or: �`Z o,
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Condo Vol Pg Yeaz Installed: i;, �
"Loads and Flows": Vol Pg Owner When Installed: �
�
Previous office approvals/actions: �
Vaziance:# LUP:# SP:'#' CUP:# �
Inspection Report:# Change of Zone District: �
�'�
aa835
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. iv�J �L:��- #2. O��n l�c�clL #3. �„c�.�-,<.C ,��� #4.
Size �(v ft. wide t3 ft. wide 1 Y ft. wide ft. wide
�� ft. long y� ft. long �ft. long ft. long
Floor area 9 k3a sq. fr. �33� sq. ft. i`"'I� sq. ft. sq. ft.
Hgk from grade � 7 to peak sS ft. hgt. /S ft. hgt. ft. hgt.
,
Stories / � stories _�stories stories
# of bedrooms�_
Lak /Pond/Flowa e/River/Stream Name �Oa°�/� ��'«Y Lj4"��
�Z� � .—
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� � 7 �
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Fire Number and Name of Road La--U--�y 1�^' '-� � ,�_��t
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1. Enter lot dimensions and indicate north by arrow. Signature of Owner or A� ori ed @
2. Indicate the location and size of the requested construction + -�
/' �S�ature
activities. C
PnnlName: 5lt'�i� rf�z�pS/-lul'1�
3. Also, 1ndlCate the IoCatlon and Cllstance to tl"le well, The above certifies that the iisted intormation and intentions are
true and conect.,that all work shall be pertormed in compllance
Septic tanlC anCl C�rainfleld, wetland &T'eas, lot 11nes, r f with Ne requirements of the Sawyer County Zoning Ordinance
�V 7 and the laws and regulations of the State of Wisconsiq and if
CentETllne of t}le r03d 3nd WateTbodles. acting as owner(s)agenL has the pertnission ot the owner(s)to
pedortn the work requested on ihis application. The above
personsls hereby gNe permission for access to the pmperty for
� ansile inspedion.
Permit fee: $ �-}S7� n��
Total land area within 300' ofthe waterbody: (A) 75ioov
Total impervious surface azea [including this project] (B) u �a
(B)/(A) x 100=%Used 1,S°Jfl (Shall not exceed 15%[or 25% with a conditional use permit].)
Shoreline Vegetation Protection Axea: Mitigation Required? O Yes ( No
June 9, 2004 - � _
Issue Date Signature ofI ui gent
June 9, 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
TOWN OF SAND
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SAWYER COUNTY CERTIFIED SURVEY MAP o- :
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THE NORTH 500' OF THE SOUTH 750' OF GOV'T. LOT 5, SECTION 22, T. 39 N. , R. 9 W. , �
LYING EAST OF OLD COUNTY TRUNK HIGHWAY "E", NOW KNOWN AS RUNZEL ROAD, IN
THE TOWN OF SAND LAKE, SAWYER COUNTY, WISCONSIN.
GrJ
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HEARTLI'' 7l(E'NOR7H �
� S 89'4}'39' E 1092.04' � i �
� 809.56' � °� � 207.80' t'�+ �� a f � �
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SURVEYm'COF HaYIYnRD,dYC OIJROT 1 �J. � �
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� o.4e �c. Y ;; � sat,�oo sa. Fr.f ��U i �, UPPER
2 =; � S I � ti �c' s C/l ]0' wIDE ACCE55 6.T7 AC.f � � �
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- ��.j � �' 8 �,�,�o. �� �„� o, �,�. �,� ' �, HOLLY
y �'`-� ; E - w I/� LME 0�SEC1qN IT 0.�ARwC N B97J'15'w � �p � a a 5 85a379' E 1121 Aa' �'* 1 1
� •� - m I ISJ.69 ]]. 1' � N OTIS'00' w 89�.3a' 1 , LAKE
� C p� UNE BFMING D�STANCE "' 4 , !� N �6ppp E Z�.�' � �
.. �.� D o ll N 20'06'l2' E 16.82 w� N �,` `� � � ��
�.. � � p y L2 5 J2Q'17' E 78.45 Z q :y "� I 1 �
-, Qf m m � LJ 5 2T}5'00' E 97.92 �I N s „ �. LOT 2 's � '
` . r; v z �4 s zsroioo� E >>.e3 � � � OlJTLOT 2 =,� �'a 230.800 SQ. FT.t ��e � '
G : ` o b ,� �s N zsroroo• w 79.96 � � 61.7?b SQ. FT. S�'� $- 5.30 AC.f '��� � �
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4 . � � F l7 N 2T35'00' w 9J.50 �
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i. m �� U ...,-�,�,uYl•��q,; � 756]S' )0 2' BI].90' SHEO �g�t ' 1
q N B9'43�39' w 114�.85' i
¢ Vl 4 ����'�t����v�. _�r�. 7J' � 1
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IOTAL AREA . •� %� ;' as.4�e sa. �r.
�J9�.ZB7 SQ. FT.�� % h a 0.84 AC, NOTE: OU7LOT5 1 AND 2 ARE SUBS7ANDARO LOiS M1D SHALL BE
CONVEYED WITH LOTS 1 ANO 2 RESPEC�NELY, ANO NOT SOLO SEPARATELY
13.58 AC.t ��, !� '= $� CA
' � ELS N �7= � �0
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_ p$H �� _; EASf — WESf 1/4 L1NE $EC• �
i� � �`(y' — z�4.eo• siiz.sa' u.c. i�ez�s' E 1/4 COR. �
� SURVEY � ' '�"�` N 85O'10' W i ���.� � N 8443'39' w t- /i � � N 8433'�5' W ]' vavEo Kuu. ud�.
� LARRY T. (4c,LSON — RLS��'1_� SCALE: 1 INCH = 200 FEET Z
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� 200 0 200 400 �
� �EGE�m.wtHt �s worca. ran+o : IMRK fER57EAb1�
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p cc�. t•x/w rornwcNrza wrna r7oo) x a.•rra+rrr. wc-r.��//rr. air.� z/ze/na sncn i or z SURVEY/NG OF HAYWARD, /NC. �„�w�,;��.�� O v
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