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002-840-29-5315-LUP-2010-354Application for Land Use Permit (*Shoreland*) County of Sawyer PO Box 676 - Hayward WL 54843 715/634.8288 *Property that has frontage on a creek, river or stream, a flowage, lake or pond or has any of the above water bodies located widen the property's boundaries.* CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. SHORELAND PROTECTION AGREEMENT MUST ALSO BE SIGNED BY PROPERTY OWNER d / SIGNATURE OF PROPERTY OWNER IS REQUIRED. USE BLACK INK OR PENCIL /LJi/(iltZF 4gelAj 046 IF_� 0-hr1er Builder ga 89 x1 60 44 ;Ed • � Mailing Address Mailing Address City, State, Zip Daytime Phone City, State, Zip Daytime Phone Site address: MW i ll (Fire number. & name of road) Proposed construction (check one): building Number of bedrooms: ( )New or replacement dwelling/primary ( )New or replacement accessory building ( )Addition or alteration to dwelling/primary building. Total number of bedrooms: ( )Addition or alteration to accessory building ( )New business or use of existing building (�Otise of land (such as mining, grading, filling) lP,4d1 Foe C tS !}? Additional information: Construction Cost: Primary Structure Accessory Building: $ Addition: $ Describe what you ara building. List each project (from what you have checked above). C Project#1.Size of footptint: ( b Height from E5 `E3grade to peek: D sq ft. Total sq ft: (This total includes additional stories or lofts.) ft = sq ft. Project#2• Size of Total sq f ftt. RHeight from grade to peak: Project#3. Size of footprint: fLx ft= sq ft. Total sq ft: Height from grade to peak: Additional information:iExamplrt e: A dwelling is #1, an attached or detached garage is #2. Calculate impervious'surface. (Roofed/paved or other surfaces water cannot penetrate. The Zoning Office can, help you determine if a surface is considered impervious.) This calculation may be; omitted if there is no increase in amount of impervious surface. Calculate lot area: ft Determine lot width in';feet (measure from side lot line to side lot line): Multiply by lot depth in'! feet (measure from shoreline to the landward) sq ft or multiply by 300 feet if lot is more than 300 feet deep: A maximum of I S% impervious surface is allowed by this permit. Multiply square foot calculation by .15: 5�(a /v 7(o sq ftx .15 - sq ft Calculate impervious surface area: Determine the total size in square feet of your projects listed above (include eaves): n sauare feet of all existing roofed structures (include eaves): sq ft Dete'pa the total size in square feet of all existing paved/bricked/blocked surfaces: ,pd I.,,, sq ft Add these square foot measurements to determine total impervious surface: sq ft If the total square feet of impervious surface does not exceed the 15% limit that you have calculated above, proceed to page 2 of this application. The drawing on page 2 must, indicate the location and dimensions of all these measurements. V, Setback measurements are from any point of a structure closest to waterbody, road, or lot line. This may be an overhang, deck, porch, etc. - W7 T,44V&C 4 Fire Number and Name of Road Jl�f "d Show lot dimensions and indicate north. Draw the location, size, and dimensions of each structure on the property. Indicate new structure. Show driveway access. Draw the location of the septic system and distance to structure. Show the distance to the-shoreland of the waterbody. Show location of any wetland. Show the distance from the structure to mad centerline, lot lines, wetland, septic system (drainfield and/or tank). Shoreland vegetative buffer: The shoreline area is to. be fully vegetated to a depth of 35 feet from the shore of any waterbody. The exception is an access corridor of 30 feet within any -100 feet of shoreline. Indicate on the above drawing the location of the access corridor. Owner's signature is required on the appropriate attached Shoreland Protection Agreement. This permit cannot be issued without a signed Shoreland Protection Agreement. If the 35 foot buffer is fully vegetative, sign the Shoreline Protection Agreement #1. If* any part of the 35 foot buffer is not in compliance with vegetative requirements, sign the Shoreline Protection Agreement #2 - Non -Intact. Please submit a shoreline photo to verify buffer status. Notice: Land Use Permits expire one year from issue date. The undersigned certifies that the listed information and intentions are true and correct, that all work shall be performed In compliance with the requirements of the Sawyer County Zoning Ordinance and the laws and regulations of the State of Wisconsin. The undersigned person(s) hereby give permission far access to the property for onsite inspection. Signature of property. owner (or agent with Power of Attorney). Permit Fee�5�� Page 2 -716- - &3V -d ya3 peri ✓cwcuJ. DRAIM FIE SEA 1� - T (,0,/) e- ml /S�LurL:na� .a 4aal !0 ! 8' 7p IC.k& ias / �n BL= to � I 13 0 rl 1.4 r Lac (ourfe drerY/es 06 simya (exrsfiSny� 00 4p-r Page i.of i Property Status: Current Real Estate Sawyer County Properly Listing Today's Date: 12/7/2010 ' D o Updated: 10 1 2007 Tax ID: 39492 PIN: 57-002-2-40-08-29-5 05-003-0001SO Leciacy PIN: 002840295315 Map ID: :3.15 Mun[dDallty: =21 TnWN nF FIASS 1 AICF STR: S29 T40N R08W Description: PRT GOUT LOT 3, LOTS 4 & 5 CSM 17/9 #5192, LC=CO & AP HORMAN Recorded Ames: 1.240 Calculated Acres: 0.000 Lottery Claims: 0 First Dollar: Yes Zoning: (RR1) Residential/Recreational One I Tax Districts Updated: 10/1/2007 1 State of Wisconsin 57 Sawyer County 002 Town of Bass Lake 2478 Hayward Community School Dish a 17 Technical College 4 Recorded Documents Updated: 1/5/2009 ® QUITCLAIM DEED Date Recorded: 12/12/2008 357282 ® LAND CONTRACT EXTENSION Date Recorded: 7/17/2007 347721 ® WARRANTY DEED Date Recorded:2/7/2007 107/227 Created On: 10/1/200711:45:41 AM 42 OwnershlD Updated:1/5/2009 MICHELE R HORMAN HAYWARD WI Billing Address: Mailing Address: MICHELE R HORMAN MICHELE R HORMAN 808ON CTY HWY K 808ON CTY HWY K HAYWARD WI 54843 HAYWARD WI 54843 9 Site Address N/A ® Pronerly Assessment Updated: 5/20/2010 2010 Assessment Detail Code Acres Land Imp. GI -RESIDENTIAL 1.240 204,300 130,500 2-Year Comparison 2009 2010 Change Land: 204,300 204,300 0.0% Improved: 82,100 130,500 59.0% Total: 286,400 334,800 16.9% a Property History Parent Properties Tax ID 57-002-2-40.08-29-5 05-003-000010 2381 12/7/2010 iK IGHTS LITTLE GRINDSTONE LAKE —NW 9M:tl1 C r@ipAy19 SECTIOI ° -- TOV - ---; Say � sm«wam] LAKE GRINDSTONE iao 66 pp1Y6]Bilf] TAIN M, IAO 9 G.L. 2 T.3 9r] IpWAS'IDI rm�. ] �a aN ➢ G.L. 3 ® T.9Tl a g11i0 R9V. RBV. RN. 0.9 a. 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