032-338-27-5406-LUP-2004-416 i �
Application far Land Use Permit(*Shoreland*) o �
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 boundazies. � �
CONSTRUCT[ON SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED.
PRINT-USE BLACK INK OR PENCIL '
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Owner Builder \ a �
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Mailing Address Mailing Address � O
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City Sta�Zip City,State,Zip
��,�) 3�d - �,34� ���51 ���-3a-�� .
Daytime Phone Daytime Phone �-
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AdditionalInformation: ZoneDistrict: 'Y��'-� '�
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Lot Dimensions: � `�( 3a S �
Date lot was created: Acres: �•J7 . 75 -
Is there wetland neaz the proposed structure?If yes,how faz 1�d o ""
Building Land Use Floodplain:O Yes OO No � -
O New O Filling Chippewa Flowage:Qc)Yes � No �o
O Addition O Dredging Driveway access off of a(Check one): �
(�Alteration ( )Grading ( )Private Rd ( )Town Rd. �
( )Moving On ( ) (�County Hwy ( )State Hwy °Q �
� ) � ) � �a
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Primary Structure Accessory Building Addition o °
Qc)Dwelling ( )Garape-attached/detached (X)Deck � �
O Yeaz round O#'oPcaz stalls (1Q Porch W
(�Seasonal ( )Storage Building ( )Enclosed �,
O Frame built on site O Screenhouse O Living room �
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen �
( )Mobile/manufactured ( )Other ( )Bedroom o �
( )Other primazy structure ( ) ( )Relocate/enlarge �
� � � � ( )#of new �
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AdditionalInformation: d' p
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Type of Construction: � 7'
QC)Frame ( )Log ( )Pole/metal ( )Block ( )Concrete p �
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( )Other � �
S7 6��' �
Construction Cost:Primary Structure$ .ti
Accessory Building:$ Addition:$ � ``'
c,'�z za � �
Deed:Vol 3� • Pg �� Certified Soil Test# � z
vo ,�
CSM:Vol Pg Lot# Sanitary Permit# �
Plat Envelope Or: , o`
Condo Vol Pg Yeaz Installed: ��ti�� N �
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"Loads and Flows": Vol Pg Owner When Installed: �
WRL t�, f��u�� �,
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Previous office approvals/actions: �
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Variance:# LUP:# 97'59$ SP:# CUP:# o
Inspection Report:#_ Change of Zone District: � �I�Ib�
5`
3a`��3 �
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Describe the construction using these columns. List the dimensions of each structure in a separate � . `
columa List each story, each addition, each al�eration in a separate column. .
#1. ��' "i�- #2. l.J . L�-=�' #3. '�. �,��e.,� #4. -�"r`y' "" �,j n
Siz � ft. wide fr. wide � �`f ft. wide _�_ft. wide j�:.�:
,��ft. long �ft. long �/i�� � � fr. long 5 ft. long
Floor area �,l lP sq. ft. 35� sq. ft. �r 3� � sq. ft. CJ sq. ft.
Hgt from grade to peak fr. hgt. ��� ft. hgt. fr. hgt.
Stories stories stories stories
# of bedrooms
Lake/Pond/Flowa e/River/Stream ame
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Fire Number and Name of Road t� 3°F'' t �"'��� �"�}
1. Enter lot dimensions and indicate north by arrow. Signat�ye of�(�el'or�;+ 'i�ed Agent:
2. Indicate the location and size of the requested construction (���ewn� 6'�`^� • �2�i� �'`^"^'
SignaNre
activities. /� �
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Print Name:� �� 6'�� �� ��
3. Also, 1ndiCate the IoCatlon and d1StanCe to the Well, The a6ove certifes that the listed informalion and intentions are
We and cortect.,that all work shall be pedormed in compliance
50pt1C tdillC 1lld dTalnfleld, wetland azeas, IOt I1nCS, with Ne requirements of the Sawyer County Zoning Ordinance
and ihe laws and regulalions of the State of Wisconsin, and if
centerline of the road and waterbodies. ac��n9 as owner�s�a9ent nas cne�erm�ss�o� or me ow�e��s�co
perform Ne work 2quested on this application. The above
personsls hereby give pertnission for access to the properry for
onsite inspection.
Permit fee: $ ��i_�_
Total land area within 300' of the waterbody: (A) '�4 � A`"�
>
Total impervious surface azea [inclu1ding this project] (B) ( W to `�
(B)/ (A) x 100 = % Used � rl'" (Shall not exceed 15%[or 25%with a conditional use permit].)
Shoreline Vegetation Protection P,iea: Mitigation Required? O Yes O No
August 9 2004 ' —
Issue Date Signature ofIs in ' gent
August 9, 2005
50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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SHORELAND PRESERVATION AGR�EMENT
(Shoreline Veeetation Protection Area)
Land Use Permit No. Oy- yl� (To be entered by the Zoning Office) Index No. O y - y�
WHEREAS, (list all owners)_ ���,+�rpC�S 4/ Y\U'F h �yY.� t�.�
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, 'I'HEREFORE, the owner(s) hereby certifies that, as a condition of issue of said Land Use Permit, that
�. the SHORELINE VEGETATION PROTBCTION AREA on said real estate is intact to a minimum depth of
� 35' landwazd from the ordinary high-water mazk of the waterbody.
�
� The owner(s) hereby agrees to comply with the shoreland vegetative protection azea requirements of Section
� 4.410 SHORELAND VEGETATION PROT'ECTION AREA, Sawyer County Zoning Ordinance, in effect on
S the date that the land use permit is issued by the zoning office. The owner(s) fiirther 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
4 VEGETATION PROTECTION AREA exists and that it is being preserved. This authorization shall terminate
� on the date of expiration of the land use pemut. 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 Ordinance remains in effect. Violation of this Agreement will
.S authorize, in addition to other penalties and relief required under the Sawyer County Zoning Ordinance,
� mjunctive relief, restoration of said real estate, the revoca6on of said Land Use Permit and the removal of all
�' 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.
LegalDescriptionofProperty: Part of Gov't Lot 4, Section 27, T 38 N, R 3 W
Town of Winter, Sawver County Wisconsin
Dated this 4th day of August 2004
r (Owner)
d,^'� .
(Owner) (Owner)
(Owner) (Owner)
This inshument was drafted by:
Sawyer County Zoning Office
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