HomeMy WebLinkAbout008-130-00-2502-LUP-2004-031/ \
Application for Land Use Permit(*Shoreland*) ��
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County of Sawyer S��.�,;_; :.__ .,_;'�+::r���� �
PO Box 676 -Haywazd WI 54843
715/634-8288 }.` O
*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. z �
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 Mailing Address � O
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City,State,Zip City,State,Zip \�' `
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Daytime Phone r� (���7� j9���v���/ Daytime Phone C
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Additional Information: Zone District: R ►`��/
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Lot Dimensions: �
7
Date lot was created: Acres: �' �`�
Is there wetland near the proposed structure?If yes,how faz /�✓� o �
Building Land Use Floodplain:( )Yes ()(jNo � �
Q�New O Filling Chippewa Flowage:O Yes (l�j No c�
O Addition O Dredging Driveway access off of a(Check one): � 3
( )Alteration ( )Grading ( )Private Rd ( )Town Rd. � r
( )Moving On ( ) ( )County Hwy ( )State Hwy °Q
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Primazy Structure Accessory Building Addition o 0
( )Dwelling ( )Garage-attached/detached ( )Deck �
O Yeaz round O#of caz stalls O Porch W
�Seasonal ( )Storage Building ( )Enclosed �,
O Frame built on site O Screenhouse O Living room �o
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen �
( )Mobile/manufactured ( )Other ( )Bedroom � � �
( )Other primazy shvcture (�1') �>'�t /�e���''= ( )Relocate/enlazge � c,
� � ( ) ( )#of new
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AdditionalInformation: v � >
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Type of Construction: � � �
�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete �� Sa
( )Other y
Construction Cost:Primary Structure$ � ,.� �
Accessory Building:$ .f ��� ' Addition:$ �` �'''
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Deed:Vol Pg Certified Soil Test# � a- 3�ti �, z
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CSM:Vol Pg Lot# Sanitary Permit#_��.� � y�4 �
Plat Envelope Or: � �
Condo Vol Pg Year Installed: c:�
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"Loads and Flows": Vol Pg Owner VJhen Installed: �
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Previous office approvals/actions: �, �3
Variance:# LUP:# �o1-p(�� SP:# CUP:# ��
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Inspection Report:# Change of Zone District: � \pa
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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. - , `
#1 . #2. #3. #4. -
Size >' �- ft. wide ft. wide ft. wide ft. wide
,�- � ft. long ft. long ft. long ft. long
Floor area � `/� sq. ft. sq. ft. sq. ft. sq. ft.
Hgk from grade 9��� '� to peak ft. hgt. ft. hgt. ft. hgt.
Stories � stories stories stories
# of bedrooms � '
Lake/Pond/Flowa e/River/Stream ame �'y G�'r� �Gti
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Fire Number and Name of Road %�1�i�� f�'� �'=� �^^ �
1 . Enter lot dimensions and indicate north by arrow. Si natu wner or Authorized Agent:
2. Indicate the location and size of the requested construction �`'
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Signature
aCt1V1t1eS. Print Name: �J �` / `�'"
3. Also, indicate the location and distance to the well, The above certifies that the listed information and intentions are
true and correct., that all work shall be performed in compliance
septic tank and drainfield, wetland areas, lot lines, with the requirements of the Sawyer County Zoning Ordinance
and the laws and regulations of the State of Wisconsin, and if
centerline of the road and waterbodies. act��9 as ow�er�s� a9e�c, has the permission of the owner(s) to
perfortn the work requested on this application. The above
personsls hereby give permission for access to the property for
L �,_,. onsite inspection.
Permit fee: $ l `�
Total land area within 300' of the waterbody: (A) �' ��� �`
Total impervious surface area [including this project] (B) �?�� ��
(B) / (A) x 100 = % Used � � (Shall not exceed 15%[or 25% with a conditional use permit].)
Shoreline Vegetation Protection Area: Mitigation Required? O Yes O No
February 24 , 2004 � �
Issue Date Signature of Iss 'ng nt ,
February 24 , 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments: ��l.V.� �j�,Z C�ti� �� (� n�,,.�� � � ������
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SHORELAND PRESERVATION AGREEMENT �
(Intact Shoreline Veeetation Protection Area)
Land Use Permit No. � �� ( 5/ (To be entered by the Zoning Office) Index No. �- ( �
WHEREAS, (listallowners) ,/ cmr1 ��fr,� �;���, L��lor-
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 ceRifies that, as a condition of issue of said Land Use Permit, that
the SHORELINE VEGETATION PROTECTION AREA on said real estate is intact to a minimum depth of
35' landwazd from the ordinazy high-water mazk of the waterbody.
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
inspect the structure(s) or uses authorized by said Land Use Peanit and to determine if the SHORELINE
VEGETATION PROTECTION AREA exists and that it is being preserved. Violation of this Agreement will
authorize, in addition to other penal6es 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.
Legal Description of Property: �`'� ��-'�`�` `� ��'r`�a
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Dated this �" day of ��'-'S , .��y
(Own��_, (Owner)
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(Owner) (Owner)
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(Owner) (Owner)
This instrument was drafted by:
Sawyer County Zoning Office
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SCALE : I INCH = 400 FEET F�R ASSESSMENT USE ONLY NO�
" DRAWN BY :/�.L�-✓ ���- DATE �7- 3 - g4 INTENDED TO SHOW CONCLUSIVE
COLON � : ) INDIGATES GOVT. LOT gO��JNDARY�LOCATIONS 'P �R
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