026-939-13-5237-LUP-2004-689 Application for Land Use Permit(*Shoreland*) r �
ro Bo��6Tyx yW�a wI54843 S��O�F��� ° �� 1�.
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715/634-8288 � "��, �,r-
*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 boundazies.
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED.
PRINT-USE BLACK INK OR PENC[L ,
N%tr� �i e"/ Z /7"n,�Tir�o., /c.,s/r�t ''�nc. c �
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Owner Builder p-
CJ / / 1/ � �
1 7 �/� lf.r Su r SP 7� �u r f S ����/.+1� �t�i.i.r�(' �i�/P /)A O.
Mailing Address Mailing Address I� �
.5�c����- .lQ/�r Gt/ 5`�Y,'1(� .�a,o,-a f�'�� .7-Y�'7L� " �
City,State,Zip City,State,Zip
7is 36�--_ �/3 � "7/S�^ ��c__ :�S'�i 7
Daytime Phone Daytime Phone
Additional Information: Zone District: Ge le�
Lot Dimensions:
Date lot was created: /0-.Z9-9/ Acres: , �9
Is there wetland near the proposed structure?If yes,how far o
Building Land Use Floodplain:O Yes O No G
QQ New O Filling Chippewa Flowage:O Yes O No �
O Addition O Dredging Driveway access off of a(Check one): �
( )Alteration ( )Grading ( )Private Rd ( )Town Rd �
( )Moving On ( ) ( )County Hwy ( )State Hwy "'
� ) � ) �
0 0
N �
� ['�
Primary Structure Accessory Building Addition o 0
( )Dwelling (�Garage-attached/detached ( )lieck �
O Year round (�#of caz stalls O Porch �.,
Enclosed �
( )Seasonal ( )Storage Building ( ) �,
( , Frame built on site O Screenhouse O Living room c�
()Modulaz/manufactured ( )Greenhouse ( )Kitchen ",
( )Mobile/manufactured ( )Other ( )Bedroom
( )Other primazy structure ( ) ( )Relocate/enlarge '^
� � ( ) ( )#of new
Additional Information: p
�
�
0
Type of Construction:
(�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete
( )Other ,�
Construction Cost:Primazy Structure$ � _n�� d
b
Accessory Building:$ �— ddition:$ �
�
Deed:Vol Pg Certified Soil Test# 92 -Q,Z/ �, z
CSD�:Vol Pg__Lot'� Sanitary•Perm:t# 9,2-Z5Z a' �
Plat Envelope Or: b�
Condo Vol Pg Yeaf�ti�st�ldl�i c;,
"Loads and Flows": Vol Pg Owner When Installed: � �
�
Previous office approvals/actians: "�"�`
9'/- �!d'v' f . ,
Variance:# LUP:# 92, -,Z.SZ SP:# CUP:�#_
Inspection Report:i� Change of Zone District: _____ n�
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Describe the construction using these columns. List the dimensions of each structure in a separate
colum}}yy���st each story, each addition, each alteration in a separate column.
#1._s�� #2. #3. #4.
Size_Q?�� wide ft. wide fr. wide ft. wide
� 8 ' ft. long ft long ft. long ft. long .
Floor area 7 sq. ft. sq. ft. sq. fr. sq. ft.
Hgt firom grade .�. � to peak ft. hgt. ft. hgt. ft. hgt. �
Stories ! '/� stories stories stories
# of bedrooms C�
Lake/Pond/Flowa e/River/Stream Name
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Fire Number and Name of Road /�/�,78 �' Su r� ���� ,��.� �
1. Enter lot dimensions and indicate north by arrow. Signature of Ow er r Au ed Agent:
2. Indicate the location and size of the requested construction .� ��-�� ��—
Signa
activities. (�I
� PrintName: C7 \ I c>�— � � G'P� ��
3. AISO, IndlCate tlle lOcatlon and dlstance to the well, The above ceN9es that the listed intortnation and intentions are
We and conect., that all work shall be peKormed in crompliance
Sept1C t8i11C 3rid dralnfle�d, wetland azeas, lot 11nes, with the requirements ot Ne Sawyer County Zoning O�dinance
and Ne laws and regulations of the State of Wisconsin, and if
CenteLllne of�'le road and wateTbodies. acting as ovmer(s)agent,has the pertnission of ihe owner(s)to
perform the work requestetl on this application. The above
personsls he2by give permission for access to the property for
onsiteinspection.
Permit fee: $ / '
Total land area within 300' of the waterbody: (A) � (c� :' '��
�
Total impervious surface azea [including this project] (B) �lo�
(B) / (A) x 100 = % Used _,5. 7 %6 (Shall not exceed 15%[or 25% with a conditional use permit�.)
Shoretir.e Vegetation Protection Area: Mitigation Required'? ( �j Yes O No
December 21, 2004 __ -
Issue Date Signature ofIss ing ent
December 21, 2005 50%Rule: AverageRoadSetback: _
Expiration Date
Office Comments: �.l�Q ��jp,��-�L° (�V�(1.p�, �� (� ���� ,
U ta//�l�
SHORELAND PRESERVATION AGREEMENT
(Shoreline Veeetation Protection Area)
Land Use Permit No. �y-(o S I (To be enteced by the Zoning Office) Index No. Q�-�9
WHEREAS,(list all owners) ��� �-� `l`-� V� O e��— _
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
the SHORELINE VEGETATION PROTECTION AREA on said real estate is intact to a minimum depth of
d 35'landwazd from the ordinary high-water mazk of the waterbody.
d
-_. The owner(s)hereby agrees to comply with the shoreland vegetative protection azea requirements of Section
Ct 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 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]
p 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
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
ap PROTECTION AREA,Sawyer County Zoning Ordinance remains in effect.Violation of this Agreement will
�g 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
7' structures approved by the issue of said Land Use Permit and the revocation of any other uses approved by the
Q 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: Lot 2 of CSM vol 14 pg 88 part of Gov't lot 2 Sec_
13, T39 N, R9 W, Town o£ Sand Lake Sawyer County WI
026-939-13-5237
Dated this — day of �� �(� �`�
Q..-�-e. '(�, -
(Owner) (Owner)
(Owner) (Owner)
(Owner) (Owner)
This instrument was drafted by:
Sa�ryer County Zoning Office
� ^ '
SAWYER COUNTY CERTIFIED SURVEY MAP �.�r,,.P
G.L. 2, Sec. 13, T. 39 x., R. 9 W. Ne.coa.
1324.72' �C.13
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$ 88° 58�50� W 22632� � � F n o
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� a � 34, 565 sf. m= i �a c�ola�. �
� ��' .79 aC. 'g SEC 13
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/ —33�—
� 40• N 88°5850�E 257.99�
SCA�E I'�= 60
O- SET 3/4��z24� REROD,wt.I.501bs/ft.
0 6 120
SIIRVEYOR'S CERTIFICATE
I, LZI,E L. ELLIOTT, regietered land aurveyor hereby certif�r that by the direction
of PAIII, BECKER, I ha.ve eurveyed and mapped the land parcel which is represented
by thie Certified Survey Map:
The exterior boundaxies of the land parcel surveyed and mapped is deacribed as �
followe: ,
Z
A part of G.L. 2, Sec. 13, m. j9 x. � R. 9 W. , Town of Sand Lake, Cowlty of Sawyer,
State of Wieconein, and more particulaxly described ae followa:
Co�encing at the Northeaet aorner said Sec. 13, thence S 1°05'S5" W 1521�.72 feet;
thence S 88°58'S0" W 2l��5.01 feet; thence S 1°1�6'S1" W 121.5l� feet to the point of
beginning;
thenoe S 88°58'S0" W 226.32 feet to the skiore of iJhitefish I,ake;
thence S 16�10�1�1��' W on a meander line of said I,ake 127.19 feet;
thence N 88°58'S0" E 257.g9 feet;
thence N 1°!�6'S1" � 12'1 .64 feet to the point o£ beginning, eaid parcel
containe .79 acrea more or leea, including a11 land from said meander line to the waters
edge, and sub�ect to an,q easements or restrictiona of record.
I have fully complied with the proviaions of Section 236.31� of the Wisconain revised
Statutes and the aubdivision ordinanoe of Sawyer Coimty in eurveying and ma.pping eame.
I hereby aertify that this survey ie correot �
to the best of cqy ]rnowledg�e and belief.
� 2 � 6025 . E��rr, �s ,300
Dates October 16� 7991
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TOWN OF SAND LAI�
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