026-938-07-4404-LUP-2004-429 Application for Land Use Permit(*Shoreland*) r � . �
County of Sawyer � �
PO Box 676 -Hayward WI 54843 ;
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 REQUIF2ED PERMITS AAVE BEEN ISSUED.
PRINT—USE BLACK INK OR PENCIL �
3��,J u c°1���1� ������ ��' �,�;�,�sa�,/��r,� ,��� � �
Owner uilder CU,,,�t� a �
l�s .So..�� �,eow� kc� ✓1�66 2a G�KI .�'/ S� �
o�
Mailing Address Mailing Address � O
/d..�� L��� i/�/� �J�.� �'fG.�� L-.9�tL Lli� �%f76 c�o �
City,State,Zip City,State,Zip �'
�S�-y�3-loa'J �es-2��� Ectc ��99-z�c(
Daytime Phone Daytime Phone �
�
Additional Information: Zone District: ���� �
N
Lot Dimensions:
Date lot was created: 9-r/-8y Acres: � 02
Is there wetland near the proposed structure?If yes,how faz o
Building Land Use Floodplain:O Yes O No G
( )New ( )Filling Chippewa Flowage:( )Yes ( ) No �
�Addition O Dredging Driveway access off of a(Check one): �
( )Alteration ( )Grading ( )Private Rd ( )Town Rd. ?
( )Moving On ( ) ( )County Hwy ( )State Hwy "�
� ) � ) � �
Primazy Structure Accessory Building Addition o ,°r..
(�Dwelling ( )Garage-attached/detached ( )Deck �
( )Yeaz round ( )#of caz stalls ( )Porch W
(�Seasonal ( )Storage Building ( )Enclosed �,
O Frame built on site O Screenhouse O Living room � �
( )Modular/manufactured ( )Greenhouse ( )Kitchen ,•`_', ��
( )Mobile/manufactured ( )Other (`�Bedroom �
( )Other primazy structure ( ) �( )Relocate/enlarge J�}
� � ( ) (�)#of new
��l �\
Additional Information: �
�
�
0
Type of Construction: � I .�
(�j Frame ( )Log ( )Pole/metal ( )Block ( )Concrete � CV
I
( )Other y
0
Construction Cost:Primary Structure$ ,d �
Accessory Building:$ Addition:$ SC��OG� `� � vJ
x �
Deed:Vol�_Pg /8v Certified Soil Test# y/-L'�� � z
CSM:Vol /D Pg�/d Lot# / Sanitary Permit# !�/ z^g/ "� �
Plat Envelope Or: �
Yeaz Installed: n� �
Condo Vol Pg �
�"�3 p�� Owner When Installed: �,
"Loads and Flows": �e�--I'g �
Previous office approvals/actions: _.
i
Vaziance:# LUP:# �]'/-/��_SP:# CUP:# I,
�.
Inspection Report:# Change of Zone District: �/a�/�
���aa
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. F1D,0:1�u #2. #3. #4.
Size Z U ft. wide ft. wide ft. wide ft. wide
Z 2 ft. long ft. long ft. long ft. long
Floor azea yYU sq. ft. sq. ft. sq. ft. sq. ft.
Hgt.fromgcade !Y'6 �topeak ft. hgt. fr. hgt. ft. hgt.
Stories � stories stories stories
#of bedrooms ►
�brecE's w F(ou,> a -fFa< �eo1
Lake/Pond/Flowa e/River/Stream Name
,S %SSa �.af .am+.� L.k/ft
/
76
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y� zo
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56 /���
�_.1 70 '
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Fire Number and Name of Road y/'y'`I /1/ �Ce i1C� ��
1. Enter lot dimensions and indicate north by arrow. Signat �Ow�Authorized Agent:
2. Indicate the location and size of the requested construction
Signature
activities. y� /
PriniName: J//a.C�/I .Q•'L�J�
3. .`�lso, IndlCate the IoCatlon and d1StanCe to the well, The above ceNfes that the listed intormation and intentions are
true and corted.,that all work shall be performed in compliance
Sept1C t3I11C and CIT'ainf eld, wetland aT'eas, lot lines, w�t� �e requirements of the Sawyer County Zoning Ottlinance
and lhe laws and regula6ons of the State of Wisconsin, and if
centerline of the road and waterbodies. actlng as owner(s)agent nas the permission of the owner�s)ro
perform ihe work requested on this application. The above
personsls hereby give permission for access to the properry for
onsife inspection.
Permit fee: $ '7� u0 "`� �
Total land area within 300' of the waterbody: (A) C� 9�/�o r
Total impervious surface azea [including this project] (B)�'x�
(B)/ (A) x 100 =% Used a�y% (Shall not exceed 15%[or 25%with a conditional use permit].)
Shoreline Vegetation Protection Area: Mitigation Requixed? O Yes (�No
Issue ate Signature ofIssu' g g nt
August 13, 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
l6)a r.�,o, s�„�
H Tr'21I2�E^� 11 : 5� i15�F,527F�1 F'F;GE 02 ,
P�W�R t7F ATTQ�tNEY
Kn.ow all Mez► by fih�s� pz�es�nts, that I,i�,..�..� �('� �+P ��'-5-� � �S
. property orvner, Town af � ,'� �, , Sa�yer Coun.ty, Part of G�vernment �t
—' �� �/`�, -�-�-�J`�, � —, T , R �_, State Qf �Visconsin, have
made, co�stituted and ap�ointed `�SQ�r-,� af� Tv�L �_.4��
�,� the C�tu�ty of�,�l�:S�v�_, Sta.te of V�'isronsin, r�y true a�d la�I agent �ax
zne and in my name, ptace and stead to da any and a�l things z�eeessary far the a�plieation
for, ne�otiation of, or obt�ining of state, couz�ty an.d Iocal pennits with the County a2'
5awy�r, WiscUnsin, givin� and �rantin.g hcreby tuito s�tid agettt full pQvver and authorize
to do so and �,e�rf"arm a1i anc� evety act and things whatsoev::� required and necessary to be
done in about sa,id prernises, $s f`ull.y to alt intents and purposes as I tni�t and cvuld do if
persona�ly present, reserving fuIl power af substitution and revocation, hereby ratifyin�
all thst my said agez�t of his substitute shall lawfuliy� do ur cause to be don� by vi�rtue
thereoF,
ta witness whereof, I have her�ut�ta set rn}� hand �nd seal this � � L`7a3'
o�_�y,� , 20p4_ ---_.__
�.��sZ� �s`'� ��`3�F �`�
Owa�er
�v�r�: �-_�� '��J �`� �
State of: ���,��--��C,__'_:- -
Gounty uf: L�;1\���5�+�
;.'�tsanally came befc�re nxe this __��__-- day of--���--��, , '?OQ4,
The abave named . `�i�5�� � to nae �e; #i�e pecsnn who
executed the fc�regoing instrunient and ac uwied�ed the sazne.
� F ��
� `� ��
I�'otary gubTi�; unty State
hiy Com.mission expires: _�C_-?1�����\ ��-� `-�
�
�� " ELIZABETH J CASSELBERR'Y
� � � �� Notar P
�a.��� �r y ublic
�:�,_.� Minnesota
dviy Commission Expires Jan. 31 , 2008
SAWYER COUNTY ZONING ADMINISTRATION PAu�. cHzsseR
SAWYER COUNTY, WI
REGISTER OF DEEDS
Statement of POWTS Capabilities 3 2 3 9 5 7
(Private Onsite Waste Treatment System)
O8/10/2004 8:00 AM
I(we���..Y� �. T��8�3-IaL G�� RECORDING FEE 13.00
undelrs�tand th/e�POWTSL�serving the{struj/cture located at
�3/y7/t% iC"fii-+'��i .cc�� S,� •' L/l�CC i:.s� S`/iil6 Pages Z
was designed for the following capabilities:
Treadnent Tank(s)Approx. �{5 O GPD
Soil Absocption Cell(s)Peak 3o d GPD Average GPD
220 mg/L BOD 150 mg/L TSS 30 mg/L FOG
Pemtit Number_9�-G9�___Year installed 7-�2�q�
The POWTS serving this shucture is presently sized to
accommodate a total of_�people,in a dwelling Retum To: Sawyer County Zoning �z
PO Box 676 J
containing 3 bedrooms. FX Z��add�N9 Hayward WI54843
3"� Bedcoow�.
WI Dept.of Comm 83.54 outlines the management
requirements for these POW"TS and I agree to Tax Parcel Number: OZlo-9 3A-b'�- Y/�`�
comply with those maintenance provisions as they apply to this system.
Should my use of the structure described above increase flows above the capacity of the POWTS,
I agree to upgrade my system to meet the standards required in WI Dept.of Comm 83.
Should my POWTS fail,as defined iu Section 145.01(1�R'isconsin Statutes,I will obtain the required
permit for the installation of a code-compliant POWTS with the iastallation completed as ordered.
LEGAL DESCRIPTION-See aKached page
SIGNATURE(S) ��,cc � Ii�1 �_�•,n��� sL
*Tvpe or print name here. JeaII M. K2'OgnOs s
DATED THIS�DAY OF����2.ne,� ,
ACKN WLEDGMENT
STATE OF:(�lY�'fl COUNTY OF: �'�o ANGELA L.BARBER
Subscribed aYnd�swom to before e by the above named � �NOTnav eueuc-MiNmesora
on this ��p� day of�1�`� ,ZO�� �,a,,, My Comrr�.Exp.Jan.at,z0o7
Ir"Yr l{��..� ��1��QI L nt+�^mr�v�t.�.tia trra�
NOTARY PUBLIC �, p i/_J „
*Type or print name here: �) Cp��
MY COMMISSION EXPIRES: ��yg ��. �C`uu�✓ 1
*Names ofpersons signing in¢ny capacity must be ryped or printed below their signature.
THIS7NSTRCJMENT 1VASDRAFTED BY.• Sawyer Caunty Zonirig Offiee;PO Box 676,Hayward IV[54843,715/634-8288
SISSABAGAMA LAKE 1
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SCALE: I INCH=400 FEET FOR ASSESSMENT USE ONLY NOT
DRAWN BY:R.V.H DATE :7/09/87 INTENDED TO SHOW CONCLUSIVE
COLON (:) INDICATES GOVT. LOT EVIDENCE OF OWNERSHIP OR
BOUNDARY LOCATIONS
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Register e OtHce
CERTIFIED SURVEY MAP s73 �9
Sawyer Counry � � 8 5 3 PART OF THE SE I/4 SE l/4 � SEC. 7�
Be�ei�ed tor record t}ie � FlaY b1 7 3 8 N � R 9 W � S A W Y E R C 0 U N T Y W I .
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��; '�4,� i 1 DETERMINE EAST LINE OF SEC 7, T38N,
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SE Cor. $ec.7,T38N, R9W f---�
FdI�� IronPipe/ 3�� BrossCnp � 8 � 7
(Sae County Cor. fle:lorotion Index J 3)
PAGE I OF z PAGES
: ,., ,,,.w, �,� �.��a a o ��o
�
SI�QRELA.ND PRESERVATION AG'�EEMENT
(Shoreline Ve�etatian Protection Area)
L�r�d Use pexmit Na. �— yi��1 (To be entered by the Zonir�g Office) Index No. �'y - "7��
WHEREAS,(Xist all ownexs} /YI ,�e /� .
,
own.s real estate within Sawyer Cotmty that is subject to the Sawyer County Shareaand Re�ulatians, and
WHEkEAS, in order to seeure�Land Use Permit.
NOW, THEREF0�2E, thc owner{s) heaceby cezti�ies that, as a condition o�`issue of said Land Use Permit, that
� the SHORELTNE V�,GETATTON PROTECTION AREA on said real estate is intact to a minimum depth of
,_,_ 35' landwaxd from the ordinarp kligh-water mark of the watezbody.
The awzxer(s) hereby agrees to cvmply with t�e shoreland vegetative protection area requaxements of Sectic�n
4.410 SH(�RELAND VEGTTATION FROTECTI4N AREA, Sav�ryer County Zoz�ing Ordinance, in eff�t oz�
� the date that the land use permit is issued by the zo�it�g of�ice. The �wner(s) fuxthex agrees to allow authorized
representatives o£ the Governmenta3. Unit to entez anta the awuer's property at tJhe followi.ng description
� between the hours of 8:Op A.M. and 6:�U�.M. [Section 9-a3(1) POWERS, Sawyex Cc�unty Zoning Chdi.mance]
to iunspec�t the structure(s) oz uses authorized by said Land Usc �ermit and to detemiiu�e if the S�ORELINE
h V�GFTATION PROTEGTI4N AR.EA Gxists and that it is being preserved. This aut�orization shali terminate
on the date of expiratiun of the land use permz� Hr�wever,the owz�er's abligatian to mainta.iz�the SHURELINE
� VEGET?iTTON P1tOTEGTI�N A,REA in accordance witJ� Section 4.a 10 SHORELAND 'V�EGETATION
� PROTECTION AREA, S�wyer C`_aunty Zoning Or�inance remains in effect. Violation af ttxis Agzeement wi�l
� authorize, in additi�n ta other penalties and relief required under the Savryer County Zot�ing Ordinance,
oinjunctive relief, restoration of said real estate, the revacatio�'of said Land Us� Permit �nd tk�c removal o�'a.il
� structures ap�roved by the issue of said Land IJse P�nnit and the revocation of any othez uses a�proved t�y the
issue of. said La.nd Llse Penmit. A,�l paxties agree tha.t this Agree���t shall l�e tiled with the Sawyez Count.��
Z.aning Office.
� Legal Descriptian of�roperty: � � �`� _5� �`{ _��'C � _�t,�,.., �r> !� � �1 �
�
1
�. _
Q Dated this G t?'�� day of ��_ , [;X
((�wz�ex) (Ovv�iea)
�� � ��.�c �
�o�ez, co�,�r.�
(Owner j . (�wner)
._._,_�. , � .
This instrument was drafted 6y: ' .' . _ • . .' : ' '
Sav+yer County Zoning�ct _ . ' .
; " :,. �