032-114-00-1100-LUP-2004-671 ._ _--�-._.____�___��__. ' .
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Application far Land Use Permit(*Shoreland*) � �
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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 T '
flowage,lake or pond or has any of the above waterbodies located within � `
the property's boundaries. N
CONSTRUCTION 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 Mailmg Address ��
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City,State,Zip l.'�State,p � ��� �
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Daytime Phone Daytime Phone
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Additional Information: Zone District: �� J �
Lot Dimensions: �
.
Date lot was created: Acres: 2, Z
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Is there wetland near the proposed structure?If yes,how far n !�`�
Building Land Use Floodplain:O Yes O No � "
( )New ( )Filling Chippewa Flowage:( )Yes ( ) No °
O Addition O Dredging Driveway access off of a(Check one): �
( )Alteration ( )Grading ( )Private Rd ( )Town Rd. �o
( )Moving On ( ) ( )County Hwy ( )State Hwy °°
� ) � ) o a
N �
Primary Structure Accessory Building Addition � o
O Dwelling O Garage-attached/detached O Deck i',�, I�
( )Year round ( )#of car stalls ( )Porch � �
( )Seasonal ( )Storage Building ( )Enclosed �
O Frame built on site O Screenhouse O Living room �; �
O Modular/manufactured O Greenhouse O Kitchen � In'
( )Mobile/manufactured ( )Other Bedroom �
( )Otherprimary structure � (�,��,�� � � � �
� � ( )Relocate/enlarge ��-�
� ) ( )#of new
Additional Information: `
o a�
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Type of Construction: o
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(�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �N
( )Other �'
Construction Cost:Primary Structure$ — �
Accessor Buildin $ 2 '` �O
y g� • L�y: - Addition:$ �
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Deed:Vol �/3�� pg y3'7 Certified Soil Test# 81. l?3 � ��
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CSM:Vol Pg Lot# Sanitary Permit# A/-l y8 `"' ;v
Plat Envelope Or: "
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Condo Vol - Pg Yeaz Installed: N
"Loads and Flows": Vol Pg Owner When Installed: � �
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Previous office approvals/actions: �
Variance:# LUP:# g 1.-'15B SP:# CUP:# "
�
Inspection Report:# Change of Zone District: ,ST ,�
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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.
#L �2tdo #2. #3. #4.
Size�ft.wide fr.wide fr.wide ft.wide
�ft.long fr.long fr.long ft.long
Floor area 22S sq.ft. sq.ft. sq.ft. sq.ft.
Hg[.from grade�_to peak ft.hgt. ft.hgt. ft.hgt.
Stories�_ stories stories stories
#of bedrooms
Lake/Pond/Flowa e/River/Stream ame
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Fire Number and Name of Road �%y �: •v- � �'
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1. Enter lot dimensions and indicate north by arrow. Sig�n re of �er Authorited Agent:
2. Indicate the location and size of the requested construction ` ` F� 5 ay. tiM� _
Signature
activities. -T1 %
PrinlName: I/'niNn� � �✓��SO�t/
3. Also,1ndiCate tlle IoCatlon anC�CI15tanCe to the Well, 7he above certifes that Me listed information and intentions are
We and cortec[.,mat all work shall be performed in compliance
Sept1C t8I11C and C�Lalnfleld,wCtland 2leas,lot�InOs, wiN the requiremenGs ot the Sawyer County Zoning OMinance
and Ne laws and regulations o(the State of Wisconsin,and if
Centerline oPthe road and wateTbodies. acting as owner(s)agent,has the permission ot the owneqs)ro
perfortn the work 2quested on ihis appliration. The above
personsls he2by give permission for access to the prope4y for
onsite inspection.
pr
Permit fee:$ /�.
Total land azea within 300'of the waterbody:(A) t/6 2 Z y
Total impervious surface area[including this project](B) 22ST
(B)/(A)x 100=%Used �/, /�% (Shall not exceed I S%[or 25%with a conditional use permit].)
Shoreline Vegetation Protection Area:Mitigation Required?O Yes O No
November 29. 2004 - _�
Issue Date Signature ofIss g ent
November 29, 2005 50%Rule: AverageRoadSetback:
Expiration Date
Office Comments:
WORKSHEET
The followine stens should be followed to address the IMPERVIOUS SURFACE issues �
related to vour property. Not all lots aze rectangulaz in shape. For those lots that are
inegulaz in shape, the lot azea should be determined as accurately as possible. (Note:
Length x Width=Area.)
1. Determine the lot dimensions.
Length= � �� ' from the ordinazy high-water mark to the reaz lot line.
Width= 2�y ' between side lot lines
2. If the lot is a river lot, determine the lot azea only for that part of the lot that is 300' or
less in depth.
Area= �f 6 L 2-Y square feet.
Multiply this amount by 15%.
Area x 0.15 = S`,3/S7 squaze feet. This is the maximum unpervious
surface azea that is allowed without obtaining a Conditional Use Permit
3. If the lot is a lake lot and is less than 300' in denth determine the lot azea.
Area= y� z 2 y squaze feet.
Multiply sttu amount b 15%.
Area x 0.15 =�_squaze feet. This is the maximum impervious
surface azea that is allowed without obtaining a Conditional Use Permit
4. If the lot is a lake lot and is greater than 300' in depth, determine the lot area for that
part of the lot from the ordinazy high-water mazk to a depth of 300' and for that part
of the lot from 300' to a depth not to exceed 1000'.
(a)Area= squaze feet to a depth of 300'.
Multiply this amount by I S%.
Area x 0.15 = squaze feet. This is the maximum unpervious
surface azea that is allowed without obtaining a Conditional Use Permit.
(b)Area= squaze fee from 300' to a depth not to
exceed 1000'.
Multiply this amount by 30%.
Area x 030 = square feet. This is the ma�cimum impervious
surface azea that is allowed from 300' to a depth of no greater than 1000'.
5. Provide a detailed drawing on the application for land use permit that cleazly
indicates the impervious surface area.
ir+PerU,oa.t 5��764c ��,�
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SCALE: I INCH= FEE 20 FOR ASSES
DRAWN BY :
D TE � -�'2�' INTENDED
COLON (:) INDIGATES GO T. LOT gOUNDARY
SHORELAND PRESERVATION AGR�EMENT ,
(Non-Intact Shoreliuc Veeetation Protectioo Area)
Land Use Permit No. Qy'�o 7� (To be entered by the Zoning Office) Index No. Q�- (a']�
WHEREAS, (list all owners) �`j p yry,,�, � �..�5� _
1/i� �Gla �'�i�p Sr
1.J,�u kP �� l,J % .3�'.�/�' ,
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 shall be restored in accordance
� with the Mitigation Plan and Implementation Schedule approved by the Sawyec County Zoning Department.
�' The owner(s)hereby agrees that at all times in the future, the real estate subject to this Agreement shall comply
with all shoreland vegetative buffer requirements of the 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 Governmental Unit to enter onto the owner's property at the following description to
°1 inspect the structure(s) or uses authorized by said Land Use Permit and to determine if the SHOREL]NE
� VEGETATION PROTECTION AREA exists and that it is being preserved. Violation of this Agreement will
autttorize, 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
� 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.
O LegalDescriptionofProperty: �of /�:/Z �,,,,in�s ��/�_ ���! T,Q � 03L l�yC7o•i,o0
�nU LnT �ec 22 TLJN ��/✓ !K 3 � �'p[�)() 6.� �,�ZJ1�81� _
S�t1n��,�ri I.17
� Datedthis (� dayof � ��Q.,��(� o .,, , 2d� �
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(Owner) 7�o m�s p � ��� �o,�er>
(Owner) (Owner)
(Owner) (Owner)
This inswment was drafted by:
Sawyer County Zoning O�ce