024-741-32-3404-LUP-2023-459 SUBMIT COMPLETED APPLICATION AND
FEero: APPLICATION FOR LAND USE PER��M�*IT �
Sawyer County SAVI�YER COUNIY;�N115CONSIfV�'� w
Zoning&Conservation Depart. ;--� am�, �' e � a8 �-� �
10610 Matn St Suite 49 r fP1° "--- �, y���� T
Hayward,WI 54843
�ZOZ 8 Z d�S L�,k# ►a3 3 s
(715)634-8288 . �
. � Q u =;,,, 3!�l. _..__. ---._ �
INSTRUCTIONS: No permits will be issued until all fees are paid. � �•�� ����-� �� ��
Checks are made payahle to:Sawyer Lounty Zoning Oepartment.
DO N0T START CONSTRUC710N UNTIL ALL PERMITS Hl1VE BEEN ISSUED TO APPLICnN7. Original Appflcati�n MUST be 5ubmitted PiLL OUT IN INK (NO PENCR)
Submittal of this applicatlon or recelpt of fees does not constitute permit issuance.
Owner(s)Name: Contrector�s)Name ��Y e'i-Z�� 1
Darr l a�n d Su.sak S�.n�.S �'Y e,��� i�,�;���� s ��,�a �
Mailing Address: � � Mailing Address:
1 l l�4 . . Q d �i --�-- w�=r�
Phone: ��O - ��� . 1�0� Phone:
Emaii: ��' � G�� Email:
Site address: „� .�� • �Q� �____ Or Date ap lied for:
Legacy.PlNif o a y�y �3� 3 V Tow�of; �O�lVla (,
Permit delivery Method all Owner o Mail Owner o Call Contractor a Mail Contractor
`-Is Property/Land within 300 feet of River,Stream (�nci. Distance Structure is from Shoreline: Is vour P.operty
�ntermittent) —► feet in FIoAd0lain Are WeNar+is
Creek or Landward side of Floodplain? If yes---continue PreSiPnt?
:_I Shoreland z�ne?
Yes YeS
- Is Property/Land within 1000 feet of Lake,Pond or Flowage Distance Structure is from Shoreline: �� No
If yes---continue --► feet ;rvo )
`r
Non-Shoreland ���
Describe Project
Value at Time of Total#of
Project type Foundatlon What Type&Capacity is the
Completion Number bedrooms
`include donated (House,garage,shed,deck, (Basement, Sewer/Sanitary System(s)
Addit(on,etc...) of Stories Crawispace, Post
time&material ��st separately 518b �onstruction
)
y03�. ,� 1 G ro�� nb��
$ or�a.
owetling
$
accessory sldg
$
ii-� ci(; ���v�y ::��.�t,.�.; ...._
Additian/Alterallon
Height:
TotalSquare Lowest
Proposed Use ✓ Proposed Structure Dimensions footage Grade to
(multiply per Highest
story) Peak
Residence ( x �
Ft.
with 2^d story or loft I X )
Ft.
with 8asement ( X , Ft.
�Residentfal Use
Attached Qarage � M � Ft.
Aetesspry Strutture(ex��P�n) � p• x ,�• � � � ''
� A�r�CUltUrB� (d�techedgeraQee,shedx,l�oa�houtos,ata.) � Q Ft.
U��° Temporary G+�Q�t Quarters or���nkhouse(C�r�ic tyncl � X )
Ft.
❑ Commercial/ Deck/Porch/Patio � t X �
Ft.
Industrial Use � x � -
(2"d)Deck/Porch/Patio Ft,
❑ Munfcipal Use .m"
OthEr(explain) � x '
Ft.
❑ Other ( X )
PYI�CIPaI Stl'UGtUf2(Agricultural,Commercial,Munidpal,Etc,) Ft.
Addition/Alteretion(expla�n� �� ( x � Ft.
Total habitable square feet: Total Non-habitable square feet: I� � i
(decks,patios,garages,sheds,storage area&other structures)
��
Origin.,i �rNiieation h1U5T Le su�mittea
Attach a Pian pr Sketch your Property on 8.5"x 11"or S.S"x lA"paper:*Must'include location and setback of proposed and existing structures,roads,
driveway,sanitary components,well,lake,river,stream,and wetlands.
Description 5etback Setback
Measurements Oescription
Measurements
Setback from the Centerline of Platted Road and/or � Feet Setback from the Lake(ordinary high-water mark� � Feet
Setback from the Established Right-of-Way J`' Feet Setback from the River,Stream,Creek Feet
Setback from the eluff if applicable � Feet
Setback from the North Lot Line Feet �
Setback from the South Lot Line 7 Feet Setback from Wetland � Feet
Setback from the West Lot Line �e Feet Slope within area of construction/disturbance � /Slope
Setback from the East Lot Line � Feee tlevation of Floodplain � Feet
Setback to Septic Tank or Holding Tank Q Feet Setback to Weil feet
Setback to Drain Field Feet
Setback to Privy(Portable,Composting) � Feet
Prior to the placement or<onstructlon of a structure within five(5)feet of the minimum required setback,the 6oundary line from which the se[back must be measured must be visible from one
previously surveyed corner to the other previously surveyed�omer or marked by a licensed surveyor at tbe owner's expense.
Prior to the placement or construction of a struaure more than five(5)feet but less than ten(SO)feet from the minimum required setback,the boundary line from which the setba�k murt be
measured must be visible from one previously surveyed comer to the other prevlously surveyed mmer,or verifiable by the Department by use of a corrected compass from a known comer
within 500 feet of the proposed site of the structure,or must 6e marked hy a licensed surveyor at the owner's expense.
. • � . •�• r � � •- • • �- .
Calculate impervlous surfaces.(Roofed,concrete,paved,and other surfaces that water cannot penetrate.The Zoning Office can help you determine if a
surface is considered impervious}
Calculate lot area:
Indicate lot size from SfV r NOVUS(circle one}: �. _,__Acres;Multiply by 43,560=Lot area: ! � .�5quare Footage
Galculate impervious surface area:
Determine the total size,in square feet,of your projects listed above(include eaves): � /C �_sq ft.
Determine the total size,in square feet,of all existing roofed structures(include eaves):___._�.�9 y sq ft.
Determine the total size,in square feet,of all existing paved/bricked/blocked s�rfaces: ��_��_sq ft.
Add these measurements to determine total impervious surfaces: ���__9�sq{t.
Calculate impervious lot percentage
Total impervious surface�a�.�-,,,«L-Lot area3G///�.Sq ft.X:L00=impervious surface .0 05�Y%
�Mitigation is requirzd if total exceeds 15%)
"'Notice a separate grading permit needs to be obtained if disturbed area is within the Shoreland district as indicated on previous page and meets criteria below"•
Grading on a slope greater than 20% Grading of more than Z,0�0 Sq.Ft.on 12/0-20%slopes
� �raqing ot more than 2 000 Sq Ft on Slopes less than 12°/ � . Grading is in excess of 10 000 Sq Ft
Fa1LUkE TO UBTaW c�FLRMI f,��51:lKTING CONSTIlUCTION WITHOUT A PERMIT WILL RE�ULI IN PENnLIlFS
I(we)declare that this application(including any accompanying informatlon)has been examined by me(us)and to the best of my(ourJ knowledge and belief it is true,correc[and
complete. I(we)acknowledge that I(we)am(are)responsible for the detail and accuracy of all information I(we)am(are)providing and that it will be relied upon by Sawyer
County in determining whether to issue a permit. I(we)further accept liability which may be a result of Sawyer County relying on this information I(we)am(are)providing in or
wi[h this application.I(we)consent to county officials tharged with administering county ordinances to have access to the above described property at any reasonable time for the
purpose of inspectlon.Additionally,the undersigned person(s)hereby give perrnission for access to the properry for onsite inspection by Municlpal Officials.
Owner � =�s Owner
5ignature y/y�� Printed name D a r v�'t SQ�S Q 9 �j
Date
(Signature and Printed Name required)
N0710E; Ali Land Use Perrnits Expire One(1)YCar from tht�Date of Issuance.
For the Construction Of New One&Twn Family Dwelling: ALL MunicipaliUes Are RE:quired To Enforr.e The Uniform�welling Code.
The local Town,State or federal agencles may also requlre permiis.
You are responsible for complying with the requirements of the Sawyer Counting Zoning Ordinances and law and regulations of the State of Wisconsin.You are also responsible for
complying with State and Federal laws concerning consVuction near or on wetlands,lakes,and strearns.Failure to comply may result in removal or modification of construction
that violates the law or other penalties or costs. For more information,visit the department of natural resources wetlands identification web page or contact a department of
natural resources service center(608�267-3125
Issuance Information(County Use Only) Sanitary Number: It of bedrooms:
Permit Denied(Date): Reason for Denial:
Permit#t: Issuing agent:
r� �
�3 — �-1 � � �te:
_.
; ri���.�_.,,,,,--- y,`��, �3
Is Parcel a Sub-Standard Lot I.i Yes (oeed of Record) '!�t No ' T�
Is Parcel In Common Ownership 49 Yes (Fused/Contiguous lot(s)) `I No Mitigation Required f i Yes o
Is Structure Non-Conforming LI Yes �No Mitigation Attached !_i Yes �No
Granted by Variance(B.O.A.) � Granted by Conditional Use
U Yes�(No Case q;
)Yes �,CNo Case il:
Was Parcel Legaily Created �y'Yes �No Were Property Lines Represented by Owner �Yes
Was Proposed Building Site Delineated '`rYes Ci No No
Was Property Surveyed Yes No
Office Commentr.
Zone District: Fee:
12�- i � S�
Hold ForSanitary: [; Hold ForTeA: ;J Hold ForAffidavit ❑ Hold Forfees:i � ;]
�Fe62021
9/26/23, 1:00 PM Novus-Wisconsin Access rev. 13.1108
Real Estate Sawyer County Property Listing Property Status:Current
Today's Date: 9/26/2023 Created On:2/6/2007 7:55:44 AM
�Description Updated: 1/8/2005 '� Ownership Updated: 6/3/2019
_ —--- _ _ _
Tax ID: 26133 DARRYL A&SUSAN E SAMS HAYN/ARD WI
PIN: 57-024-2-41-07-32-3 04-000-000040
Legacy PIN: 024741323404 Billing Address: Mailing Address:
Map ID: .12.4 DARRYL A&SUSAN E SAMS DARRYI A&SUSAN E SAMS
Municipality: (024)TOWN OF ROUND LAKE 11645W COUNTY HWY B 11645W COUNTY HWY B
STR: 532 T41N R07W HAYWARD WI 54843 HAYWARD WI 54843
Description: PRT SESW LOT 1 CSM 26/131#6883
Recorded Acres: 8.290 � Site Address *indicates Private Road
__ _.__ ____
ottery C aims: 1 11645W COUNTY HWY B HAYWARD 54843
First Dollar: Yes
Zoning: (RRl)Residential/Recreational One
ESN: q43 --) Property Assessment Updated: 7/16/2019
2023 Assessment Detail
Code Acres Land Imp.
Tax Districts Updated: 2/6/2007 G1-RESIDENTIAL 8.290 25,400 208,000
1 State of Wisconsin
57 Sawyer Counry Z_Year Comparison 2022 2023 Change
024 Town of Round Lake Land: 25,400 25,400 0.0%
572478 Hayward Community School District Improved: 208,000 208,000 0.0%
001700 Technical College Total: 233,400 233,400 0.0%
.� Rewrded Documents Updated: 8/19/2014
_ _ __ _ _...__ _ __
� WARRANTY DEED ' Property History
Date Recorded: 5/23/2019 417881 - - - __. _.__ _.___
N/A
0 WARRANTY DEED
Date Recorded: il/15/2004 326675
� CERTIFIED SURVEY MAP
Date Recorded: 10/12/2004 325739
https://tas.sawyercountygov.org/IAccesslmaster.asp 1/1
PAULA CHISSER
SAWYER COUNTY, WI
�\ REGISTER OE DEEDS ��
325739
10/12/2009 8:30 AM
RECORDING FEE 11.00
Pages 1
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