026-182-09-0100-LUP-2004-446 ,
- Application for Land Use Permit(*Shoreland*) r ,� �
County of Sawyer � �
PO Box 676 -Hayward WI 54843 V �
715/634-8288
*Property that is located within 300'of a creek,river or stream or within 1000'of a t �
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.
�R S �(�- PRINT-USE BLACK INK OR PENCIL � �
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Owner p� L2Kp roper��aS Builder p-
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Mailing Address Mailing Address � O
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City,Stat ,Zip City,'State, ip �
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Daytime Phone Daytime Phone
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AdditionalInformation: ZoneDistrict: �R-1 � '� �
Lot Dimensions: �ti�,. �i�' �
A
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Date lot was created: rU:;,� i j lC' Acres: , 6 3 V ' �6
/ �Is there wetland near the proposed shucture?If yes,how faz 7� o
Buil 'ng Lan Use Floodplain:O Yes ( No G �
( New ( Filling Chippewa Flowage:O Yes (�No c��o �, �
O Addition O Dredging Driveway access off of a(Check one): s� (
( )Alteration (�Grading ( )Private Rd (1�'Town Rd � _
O Moving On O O County Hwy O State Hwy 00
� ) � ) � � �
0
N S
Pri ary Structure Accessory Building Addi on o �
('�Dy'�lling (�)Gazage-attached/detached (�Deck �
(�'jYear round O#of car stalls O Porch �,
( )Seasonal ( )Storage Building ( j Enciosed =
O Frame built on site O Screenhouse O Living room �o
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen "
( )Mobile/manufactured ( )Other ( )Bedroom
( )Other primary structure ( ) ( )Relocate/enlazge \
( ) ( ) ( )#of new
AdditionalInformation: � „
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Ty of Construction: �� �
(�ame ( )Log ( )Pole/metal ( )Block ( )Concrete �
( )Other � �
Construction Cost:Primazy Structure$ /7����� „d d
Accessory Building:$ � Addition:$ � t.t
C�>f 1' z '4 =- �O
3-� t`� x�
Deed:Vol yo8 Pg� Certified Soil Test#��I-(l�� � z
ao �
CSM:Vol Pg Lot# Sanitary Permit# D�l-�y S -
Plat Envelope Or: b,
Condo Vol Pg Year Installed: N �
"Loads and Flows": Vol Pg Owner When Installed: � �
ci
Previous office approvals/actions: �
Variance:# LUP:# SP:# CUP:# �
Inspection Report:# Change of Zone District: I�
$� 1
�`�o�s
Describe the construction using these columns.List the dimensions of each structure in a separate
column.List each story,each addition,each alteration in a separate column.
#1. 'c�-`/Z- {�-':• #2. f�'c,l #3. #4.
Size Z[: ft.wide _ '�i ft.wide ��' ft.wide fr.wide
�i2, ft.long _��Z-_ft.long a3 `� ft.long ft.long
� �7 2
Floor area I(��� sq.ft. �'�� �.fr. ��` sq.ft. sq.ft.
Hgt from gade Z Z-� to peak_1�fr.hgt. ft.hgt. ft.hgt.
Stories � �stories stories stories
#of bedrooms.�__
Lake/Pond/Flowa e/River/Stream Name
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, Fire Number and Name of Road /�3f`� I/.c ittiy �,��� �i��
��' 1. Enter lot dimensions and indicate north by arrow.
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Sign �of Owner uthorized nt:
2. Indicate the location and size of the requested construction X� CCii
ignaNre
activities.
PrintName:� �,�.L��= � ���9�v
3. Also,indicate the location and distance to the well, The above certites that the listed intormation and intenticns are
We and cortect.,ihat all work shall be pedortned in compliance
septic tank and drainfield,wetland areas,lot lines, with�he requiremenLs of Ne Sawyer County Zoning Ordinance
and the laws and regulaGons of the State of Wisconsin,and if
centerline of the road and waterbodies. ac��o9 as ow�er�s�a9eot,na5 me Pe�n�ss�oo or me ovmeq5�co
pedorm Me work requested on this applicatioa The above
personsls hereby give permission for aceess to ihe property for
onsiteinspection.
Permit fee:$ ��'�'
Total land area within 300'of the waterbody:(A) .S 7 �7U�
Total impervious surface azea[including this project](B) ?5(,-��
0
(B)/(A)x 100=%Used (�o¢ lG (Shall not exceed 15%[or 25%with a conditional use permit].)
Shoreline Vegetation Protection Area:Mitigation Required?�Yes O No
AuQust 20 2004 � .�I- � �'uQ`2,�,1 -��.�.f �
Issue Date Signature ofIss g ent � Q
August 20, 2005 50%Rule: Average Road Setback:
Expiration Date
Office Comments: �CLS.�--i�G� ��,'e."t� �- �-m0-�-�• �
U
JAN-01-1900 00�04 P.02
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August 18, 200a
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Please be advised that the authorized signatures for Hansen l.,ake Properties, LLC, are as
follows:
Any of the following:
�
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Barbara Petersen �G��t�.a _, .,_
, .
� Diane Sheppard �-�-�u-C� ` u-°
� David Hansen , `�^��
G`-u ��GZ�Z �i�-- .—
' Harold Hansen
' �L��1-�c,���,
Victoria Hansen
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� rnTAi P.c,�
VIC;TC�Y H�IVH I 5 -
TOWN OF SA�!, �
PART OF GOV'T. LOT2 SEC. 2 �
PART OF GOVT LOT2 SEC. 3 F
TWP39 N.
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COURT ��'�
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MUD BAY
SHORELAND PRESERVATION AGREEMENT
(Shoreline Ve2etation Protection Area)
Land Use Permit No. �-�ily(a (To be entered by the Zoning Office) Index No. Qy -��
WHEREAS, (list all owners)�nSli1 �,4./��P �►^o��r��pS , ��C�..
^J�k't�u�� d C��c�r��, ,n a� ►�i n�n� ,�AoTa�f�,�X
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J owns real estate within Sawyer County that is subject to the Sawyer County Shoreland Regulations, and
J WHEREAS, in order to secure a Land Use Permit.
J
� NOW, THEREFORE, the owner(s) hereby certifies that, as a condition of issue of said Land Use Permit, that
o� the SHORELINE VEGETATION PROTECTION AREA on said real estate is intact to a minimum depth of
L35' landwazd from the ordinary high-water mazk of the waterbody.
w
�
The owner(s) hereby agrees to comply with the shoretand vegetative protection azea requirements of Section
(.3- 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) fiuther 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
9� VEGETATION PROTECTION AREA exists and that it is being preserved. This authorization shall terminate
�� 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
PROTECTION AREA, Sawyer County Zoning Otdinance remains in effect. Violation of this Agreement will
� authorize, in addition to other penalties and relief required under the Sawyer County Zoning Ordinance,
T injunctive relief, restoration of said real estate, the revocation of said Land Use Permit and the removal of a11
>- 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
'- Zoning Office.
OLegalDescriptionofProperty: Lots 1 fi 2 Block 9 Victory Heights Subdivision
Section 3, T39 N, R9 W Town of Sand Lake Sawyer County, WI
026-182-09-0100 —
Da this �� day of , Z���
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(O ) . (Owner)
(Owner) (Owner)
�.c,��'o-�u.e� �rz�-z.a,e�,/
(Owner) (Owner)
This instrument was drafred by:
Sawyer County Zoning Office
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