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SUBMITCOMPLETED APPLICATION AND `
Feero: ,_.AP�LI_CATION FOR LAND USE PERMIT
Sawyer County �SA�l�Y�'(�11�� (' �� 2�i'? i 'J
5 �ia�te._.� � ,
Zoning&Conservation Depart. ` oare3famvDt�xerved�-', �� ((( ` ,
10630 Main St Suite 49 j )) h \ j�
HaYward.WI 54843 `— �+�� O � ajdn� t.� j l.hk� 1 v � �./
(715)634-8288 � � � '✓ �L �Q
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INSTRUC710NS: No permits will be issued until all fees are paid. (���(�f(�'A�� �
Checks are made payable to:Sawyer Lounty Zoning Department.
DO NOT START CONSTRUCTION UNTiI ALL PERMITS HAVE BEEN ISSUED TO APPLICANT Original Application MUST be submitted FILL OUT IN INK (NO PENCIL}
_ _ ___
Su6mittal of this applicatlon or receipt of fees does not constitute permit issuance.
Owner(s)Name: �� � � Contnctor{s)Name
1�� `"�Q/l�s�'d� �l �� 5 ��D'� �! �I/ !Y (�O h S����
Mailing Address:� ,�/�L� Mailing Address: � �y�i�JV�
7�7g �'���rT i
l��sT �1-ve�vu.� cv��c k 767'8'�✓ / os7 f�r/�-nu� � s
Phone: Phone:
7!9 -8$g- D�a--B '7/�T- 8$8 O�fa-�l
Email: �� � C�7'Y) • Email:
Site addrcss: L- L Or Date applied for. n P P L��� U `
Le6acy PIN� Q����Y7/� ����-�i/� Town of: [j��� �, L C\,�,. v � 4 UL'
4iG
Permit delivery Method II Owner u Mail Owner ❑Call Contractor �-Mail Contractor
=� ' �1 Z
�(Is Property/Land within 300 feet of River,Stream (�nci. Distance Structure is from Shoreline: Is your Property
IMermittent) ��S � Are Wetlands
feet in Floodplain �
Creek or Landwa Side of Floodplafn? If yes--continue Present.
7 Shoreland - zone?
Yes es
7CIs Property/Land within 1000 feet of Lake,Pond or Flowage Distance Strudure is from Shoreline: No
, J ls If yes--continue —► �a feet �1��
��C;
'J Non-Shoreland
Describe / �,.� Project Total#of
Value at Time of trP/I
Project type Foundation What Type&Capacity is the
Completion Number bedrooms
(House,garage,shed,deck, (Basement, Sewer/Sanitary System(s)
` `� " '��` Addition,etc...) of Stories �rawlspace, Nost
'��•�_�- �"-'�����'� construction
list separately Slab)
$ 350,aod �3 ��f8 �w(�� �se `� �'D
Dwelling
�v�c.� C9�ro.�c- ! S*�°rY S�.r3 _ a _
$ �7, oov 2g x Z.8
s l�D � 5�o�y o,� ��sTs _ o _
Accessary Bldg �f f Z, (o X��o
s
Addition/Alteration
Height:
TotalSquare Lowest
✓ Pro osed Structure Dimensions Footage Grade to
Proposed Use P (multfply per Highest
story) Peak
� � 3� X �-f0 � � 7 Z8
Residence Ft.
`/ with 2^d story or loft ( �Y X � } �" �� Ft. �~�
X � \_?�.8
with Basement ( 3� �g Ft.
� ReSidential Use Attached Garage j�ET/J�C�i� Giq'�� ( �-� x �� , �8 � Ft. �5�
ACCe55oryStruCtu�C(explain) �'jtfBO � /t( X 2y � �j?j(� Ft. ?5
❑ Agrieu Itural (detached garages,sheds,boat houses,etc)
Use � X �
Temporary Guest Quarters or Bunkhouse(cr�de cyve) Ft.
�,�� � ,y X �g � �7� ,5J
� Commercial/ Deck/Porch/Pa� Y$ Ft.
Industrial Use ( x )
(2^d)Deck/Porch/Patio ft.
J Municipal Use ( x )
Other(explain� Ft.
❑ Other ( x }
P�I�Cipal St�uttuff(Agricultural,Commercial,Municipal,Etc.) Ft.
( X )
Addition/Alteretion�exPia�n� Ft.
�Q�j�- Total Non-habitable square feet: ' ��Q� C�
Total habitable square feet: �� (decks,patios,gareges,sheds,storage area&other structures �
� Original Application MUST be submitted
Attach a Plan or Sketch your Property on 8.5"z 11"o�8.5"x 14"paper.�MusN Indud!loodon and fetback of proposed a�ezirting structures,twds,
driv¢Way.sanitary components,well,lake,rlver,stream,and wetlands.
SMWck Setback
Descrlption Measuremenu DesctipNon Meawrements
Set6ack from the Centerline of Platted Road and/or :� Feet Setback from the Lake(o�a��„�rogn.w,ie,m„k) Feet
Setback lrom the Esta6lished Right-af-Way Feet Set6ack from the Rivei,Stream,Creek Feet�
' Setbackfromtheeluff�rappr�,bi� Feet
i Setback from the North Lot Line (� Feet
Setback from the Soutb Lot Line Feet Setback from Wetland Feet
Setback from the West lot Line 0 Feet Slope within area of conztruction/disturbance %Slope
,Se[back from the East Lot Line Feet Elevation o(Floodplain Feet
Setback to Septic Tank or Holding Tank � Feet Setbatk to Well O Feet�
I Set6ack to Drein Field Feet
'�SetbacktoPrivy(Portahle,Composting) Feet
�—
� -. ..s.���.-.� �as.��a�� ��r�e�c
i _:.� _ . - w. �,�,� . ��,�.,,,� , .. � .�����,�-1� "omwn��c5ir , ' _
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.� . .,. . _,.. ,_�
.. ._. .., c �wi,�, iv.i�..�. . ,�k,ia,. � ... ..,. . .���� �.p:�,.>_.
� ,, ...-���- . ., �., . ,e,n.r_ ���i.-- .�>>n�n��c�.m... �� zma���.P.�.�nani� ,��wnmmeseieack�,.s_ ..
c.ir_. �, p. . ��e�... �r�o .�.,�ie �,�d.or r , ,�i.b����..�n,eo.e� . a.o���ir.�o i ssnor,e..ow�m��
,c,.te�or F _,..,,n �e�t�.w�r. . ,he�,ar-etivaice�sea �a.m�:, .�r.���a..
Calculate impervious surfaces.(Roofed,conaete,paved,and other surfaces that water cannot penetrote.The Zoning Office wn help you determine if a
wrface ls considered impervious)
i
'i Galculatelo[area: c
Indicatelottizefr�NOVUS�cirdeone�: 1•�� Atres;MWtiplyby43,560=Lotarea: �� ��J SquareFoo[age
�
; Calculateimpervioussurfacearea:
'; Determine the total size,in spuare feet,of your projects listed above(indude eaves�: �\�� sq ft.
�' Determine the[otal size,in square feet,of all existing roofed structures(induae eavesl:_�sq k.
Determine the total size,in square feet,of all existing paved/bricked/blocked surfaces:_�_sq ft.
Add these measuremenu to determine total impervious surfaces: ��`J 1 sq ft.
Calculate impervious lot percentage
''�, Total impervious surface:��I +Lot area:��S Sq k.x 100=impervious surface �� %
�Mit�igat�ion iz required�if to�al eviceeds 15%�
'•Notice a separate grading permit needs to be obtained if disturbed area is wiMin the Shoreland dis[ric[as indicated on previous page and meets crrteria bebw"•
Grading on a slope greater than 20% Grading of more than 1 000 Sq Ft on 12%-20%slapes
Gradmg of more than 2,000 Sq.Ft,on Slopes less than 12% G adi R�s i exces of 10 000 Sa Ft
�,. ., .�,i:�in�a .. , srv.uc u�. �r,n��:i�.a -i^�,�_c��
I(we)detlare that IhiS application(including any ac ompanying Information��has been eram ned by me�us)and to the best of my(our�knowledge and helief it i5 true,corrett and
omplete.I(we)acknowleEge that I(we)am(are)responsible for the de[ail an0 accurary of all information I(we)am(are�providing and[ha[i[w�ll be relied upon by Sawyer
Counry in determining wM1ethe�to issue a permit.I(we)further acrept liability which may be a result of Sawyer[ounry relying on thls info�mation I(we)am(are)providing in or
with Ihis application.I�we)Consent m munty officials charged wlth adminlstering counry ordinances to have access to Ihe ahove described property at any reasonable tlme for Ihe
Ipurpose o�ditionallY,[he undersigne0 Personls)herebY Hive Permission for access to the proPertl'for onsite insVection bY Municipal O�tlals.
IOwnef Owner 1.
���. Signature PrinteC name ��1 n �����'/LS�D� �'S— z�
Date
I . .. '.�)'� .,. , , ' .. .. ,;..:,
' vouareresponsbleforcomplyng tht q�'rementsoftheS y Co tngZ -gOE' n dl d g It nzoftheStare fW� Y� alsorespons-Dlefor
omplying wtth Stare and Fede I laws concermng constr�cYon near or on wetla ds,akes,and streams Fa lure to comply may suk n removal r mod f'cation of construct on
cchat v�olares the law or other penalties or costs.For more informatior�,vrsit[he depanmen[of natural�esources wetlanOs identifica[ton web page or contact a devartment of
,, natural rezources service center�608)26�-3125
Issuance Information(County Use Only) Sanitary Number: �1 _�� x of bearooms:y
I
Permit Denied(Date�: Reason foi Denial:
Permit k: Issuing agent Date:
2 �- �a � � �' �'� a�a�
is Parcel a Su6-Standartl Lot I��,Yn �oeeE of Recortl� YNo
I5 Parcel in Cammon Ownership '(��Yes (FuseE/Contiguous Lorys�� � No Mitigation RequireA '��Yes No
Is Structure Non-Conforming �'Yes �� Mitigatian Attached !_'�Yes �No
/
Granted by Variance(B.o.A.) Granted by Conditional Use
-:Yes '����No Gse p: ��:Yes -�.No Gse M:
Was Parcel Legally Created �,.,Yes f_�'No Were Property Lines Aepresented by Owner ���':Yes No
Was Proposed Building Site Delineated '�.�Va '��:No Was Property Surveyed �Yes No
Offi<e Comments: Zone DisMtt: Fee: /
.�(�SQ,d�3,��S
Hoid for5ani[ary: Mold For isn: Mold For Affidavit�. Mold Fcr Fees:
OFeE2021