HomeMy WebLinkAbout010-285-00-0100-LUP-2004-348 Application for Land Use Permit(*Shareland*) �' -
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County of Sawyer � � -
PO Box 676 -Hayward WI 54843
715/634-8288
*Property that is located witlun 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. ''
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. '
PRINT-USE BLACK INK OR PENCIL
1 � 1�'ir�- C,•L��Si�L�/'��1_ ���-T� � �
Owner uilder A:
l D6�r%S",�' � ��'��rhs�il� I� �
ailing Address ,� ,(`� Mailing Address � O
�( � G Gl.� ( 12S � > � �
City State,Zip �e(( City,State,Zip � �� �
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Daytime Phone Daytime Phone f �r 'F`
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Additional Information: Zone District: �,�' � �0 3 �_n
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Lot Dimensions: �
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Date lot was created: Acres: � 1� ( � � ti.1,
Is there wetland near the proposed structure?If yes,how far o �
Building Land Use Floodplain:O Yes O No �
�New ( )Filling Chippewa Flowage:( )Yes ( ) No �o
��
O Addition O Dredging Driveway access off of a(Check one): �
( )Alteration ( )Grading ( )Private Rd ( )Town Rd. ?
( )Moving On ( ) ( )County Hwy ( )State Hwy °Q
� ) � ) � S
Primazy Structure Accessory Building Addition o ,��.
( )Dwelling ( )Garage-attached/detached ( )Deck �
O Yeaz round �#of caz stalls O Porch �;,
( )Seasonal Storage Building ( )Enclosed �
O Frame built on site O Screenhouse O Living room co
( )Modulaz/manufactured ( )Greenhouse ( )Kitchen �
( )Mobile/manufactured ( )Other ( )Bedroom \
( )Other primazy structure ( ) ( )Relocate/enlazge �
( ) ( ) ( )#of new �,' ,�
tV r
Additiona(Information: � p
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(� �
Type of Construction: 7 Q �
�'rame ( )Log ( )Pole/metal ( )Block ( )Concrete 0 O W
( )Other p w
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Construction Cost:Primary Structure$ � �
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Accessory Building:$ � , ��� � Addition:$ �
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Deed:Vol az� Pg�/p� Certified Soil Test# � �
CSM:Vol Pg Lot# Sanitary Permit# 70- I 0373 DO-CY•/(p bQ 7y
Plat Envelope Or: o, �,p
Condo Vol "joC� Pg y3 Year Installed: N
"Loads and Flows": Vol Pg Owner When Installed: o �
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Previous office approvals/actions: �
Variance:# LUP:# SP:# CUP:# '4'
V
Inspection Report:# Change of Zone District: �
�.�P g4-035 t�oo�-�A.u..�.�u- �1111�-
to3aN
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 z 8�5 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
IN
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Odd 2� O
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Z ry
Z �
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Fire Number and Name of Road
1. Enter lot dimensions and indicate north by arrow.
2. Indicate the location and size of the requested construction
activities.
3. Also, indicate the location and distance to the well,
septic tank and drainfield, wetland areas, lot lines,
centerline of the road and waterbodies.
I
Signature
Agent:
Print Name:
The above 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, and if
acting as owner'(s) agent, 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
onsite inspection.
Permit fee: $ 174
Total land area within 300' of the waterbody: (A) yov
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S ECTI O N �3, T
TC�WN OF H�
Sawyer County, 1
T. 42N. LEN OOT S IDER L KE
7. 41N. R UNO LA E
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T. 40N. HU ER
BASS KE
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LEGEND
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— Right of way(Approximated
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SHORELAND PRrSERVATION AGRTEMENT
(Non-Intact Shoreline Ve2etation Protection Areal
Land Use PermitNo. �4..���J (To be entered by the Zoning Office) Index No. ��- 3y�
WIIEREAS, (list ali owners) /n(�� (y��,p�y-��,y� (,� �Q �� �,
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 PROT�CTION t1REA 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 Pernut 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
authorize, in addition to other penalties 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.
T
� Part of Sec 23 T41N R 8W Condo PLat vol 700
i L,egal Description of Property: � . .
T
� �age 439 , hP;ng ;n Rnnnd Take Park Subdivision Town of Hayward
WI 010-171-00-2700 / O10 - 285-00-0100
Dated this_�_ day of �^��� � ,
������ (Owner)
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(Owner) (Owner)
(Owner) (Owner)
This instnunent was draRed by:
Sawyer County Zoning Office
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