HomeMy WebLinkAbout008-937-17-5427-LUP-2004-612 � � - � �
' Application for Land Use Permit (*Shoreland*) o 0
County of Sawyer � �
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PO Box 676 - Hayward WI 548�+3 ��
715/634-8288 �
*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 boundaries. `��
C O N S T R U C T I O N S H A L L N O T B E G IN U N T I L A L L R E Q U I R E D P E R M I T S H A V E B E E N I S S U E D. �
PRINT—USE BLACK INK OR PENCIL � �
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Owner Builder �
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Mailing Acidress i�:aiii:�g Ac'�dre;,,s � p ��
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City, State, Zip City, State, Zip �,
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Daytime Phone Daytime Phone ��✓� �
Additional Information: Zone District: ����d�G��'q�� �1
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Lot Dimensions: ���1. � Z� • � �
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Date lot was created: 5-/z -� ? Acres: .S �
is there wetland near the proposed structure? If yes, how far /��L= 01 �
Buil 'ng Land Use Floodplain: O Yes (�o � �.
(��iew ( ) Filling Chippewa Flowage: ( ) Yes (i�'No � C�
O Addition O Dredging Drive ay access off of a(Check one): � �
( ) Alteration ( ) Grading ( rivate Rd ( ) Town Rd. �
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( ) Moving On ( ) ( ) County Hwy ( ) State Hwy � �
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Primary Structure Access y Building � Addition o �
( ) D elling ( arage-attach /detached �� ( ) Deck �
(v�Year round ( of car stalls O Porch W ..0
(�'Seasonal ( Storage Building ( ) Enclosed �
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O Frame built on site O Screenhouse O Living room c�
( ) Modular/manufactured ( ) Greenhouse ( ) Kitchen �
( ) Mobile/manufactured ( ) Other ( ) Bedroom
( ) Other primary structure ( ) ( ) Relocate/enlarge A
� � O O # ofnew t
Additional Information: ;
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Type of Construction: �
( ) Frame ( ) Log ( Pole/metal ( ) Block ( ) Concrete �
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( ) Other ., r ,�� <<� � �
Construction Cost: Primary Structure $ � %� '�����' ��� �'���-' �'������ �h���
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Accessory Building: $ �' � Additinn: � �'�/� �
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- �:,eu�: Y'��_ 'y�j ng�_ r`P.-r;f�,��! c��� TPcr#_ � �
CSM: Vol�_Pg��Lot#�_ Sanitary Permit# "� �
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Plat Envelope Or: � �
Condo Vol Pg Year Installed: N
"Loads and Flows": Vol Pg Owner When Installed: � �
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Previous office approvals/actions: , �
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Variance: # LUP:# SP: # CUP: # �i
Inspection Report: # Change of Zone District: v �I
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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
Floar area �� sq. ft. sq. ft. sq. ft. sq. ft.
Hgt.from grade��to peak ft. hgt. ft. hgt. ft. hgt.
Stories / stories stories stories
# of bedrooms
Lake ond/Flowa e/River/Stream Name
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Fire Number and Name of Road /�.��C' /���»� ,��"�1������f�TC� llo�3�5GJ /�vm�t�nc��fo•`��
l. Enter lot dimensions and indicate north by arrow. Sign of Owner or _ horized Agent:
2. Indicate the location and size of the requested construction � ZL�
activities. � Signature
Print Name: ��/���� ��� Ci�����
3. Also, indicate the location and distance to the well, The above certifies that the listed information and intentions are
true and correct.,that ali work shall be performed in compliance
septic tank and drainfield, wetland areas, lot 11nes, 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. a�t��s as ow�er�s�a9e�t, has the permission of the owner(s)to
perform the work requested on this application. The above
` personsls hereby give permission for access to the property for
c�C� I onsite inspection.
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Permit fee: $ � ���� ���� �
Totai iand area within 30u' of tn�waterboay: (A} �� rJgC� - l
'r'�r��. ;,-,�nPn>;n�i� ���rface area fincluding this proiectl (B)____�__�1,���, , � -
(B) /(A) x 100 =%Used /d�p (Shall not exceed 15% or 25% with a conditional use permit].)
Shoreline Vegetation Protection Area: Mitigation Required? ( Yes O No
ncte�p� �,T�nni, —
Issue Date Signature of I uin gent
October 27, 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments: ��� � � ��� ���j 1(�� ��� ���y�G ���
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( xx,.) INFO FR6M CSM H`/ F. NFaVEL
Certified Survey Map for Harold Johnson
A part of Government Lot k, Section 17, Township 37 North, Range 9 West� Town of Edgewater,
County of Sawyer, State of Wisconsin.
Sheet 1 of 2 ,�,;f�.. , � , � y s,�
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T�WN OF EDC�E�
SEC. 17 TWP 37N.
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SHORELAND PRESERVATION AGR�EMENT
(Non-Intact Shoreline VeEetation Protection Area)
Land Use Permit No. �- (p/z (To be entered by the Zoning Office) Index No. �- �O�Z
�E�as, �i�sc��o�ers) /�O�C`�T— /�. C'����t/� �`T/l1G�T f�- GC��/
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 Sawyer 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
inspect the structure(s) or uses authorized by said Land Use Permit and to determine if the SHORELINE
�' VEGETATION PROTECTION AREA exists and that it is being preserved. Violation of this Agreement will
c�/p authorize, in addition to other penalties and relief required under the Sawyer County Zoning Ordinance,
O mjunctive 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.
.J'„ Legal Descripti n of Property: � � / fiv"'vi/ 3 7 ���� lit/
O � �� � 3 � 7�z2z
Dated this Q day of ��
,
(� r) (Owner) G�-�/Y �
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(Owner) (Owner) � �
S/-��'�� �- �GSG�.f
(Owner) (Owner)
This instrument was drafted by:
Sawyer County Zoning Office
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