HomeMy WebLinkAbout010-263-00-0300-LUP-2004-483 Application for Land Use Permit(*Shoreland*) o 0
County of Sawyer � '�
PO Box 676 -Hayward WI 54843 �
�715/634-8288 s'
*Property that is located within 300'of a creek,river or stream or within 1000'of a p
flowage,lake or pond or has any of the above waterbodies located within �
the property's boundazies. �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. �
PRINT—USE BLACK INK OR PENCIL �''+ �
f��� q,�� W �4-lYl�ri�c E Rocli�er �R�.1'� �o�trorn� �
Owner Builder ¢: �
5�55 ��th flV'� 50Ut}'1 ��02..� 1V �ArSCvU �1C� o.
Mailing Address Mailing Address � O �
�rl�tUNe�D��S . `1"T1N 55`-111 HH WR�� WIS 5't843 � �
City,State,Zip City, tate,Zip i° �o
t�t2.-823- yI99 115-f�3y - `i`iZZ o T
Daytime Phone Daytime Phone � �
Additional Information: U N It 3 0� Zone District: R�� � �
ShOreS Lorv�O �
Pi N� C.utK bu 'J �� �A� Lot Dimensions: � �
�
Date lot was created: 1 1`�� Acres: �n-� �
o f
Is the:e wetland near the proposed structure?If yes,how far_ o�.�
� orn
.Building Land Use Floodplain:O Yes (Xj No s,5p5�/ o/ob!j � �
Q�New O Filling Chippewa Flowage:O Yes O No c� c �
O Addition O Dredging Driveway access off of a(Check one): x� ��
O Alteration O Grading Q�Private Rd O Town Rd. �w S
( )Moving On ( ) ( )County Hwy ( )State Hwy °Q
� ) � ) ���
� J �Primary Structure Accessory Building Addition o —.
Q�Dwelling (Xl Gazage attache etached O Deck � -zF�
Q�j Yeaz round (2)#of caz stalls O Porch W Z
( )Seasonal ( )Storage Building ( )Enclosed
QC}Frame built on site O Screenhouse O Living room � � �
( )Modular/manufactured ( )Greenhouse ( )Kitchen
( )Mobile/manufactured ( )Other ( )Bedroom V � —
( )Other primazy structure ( ) ( )Relocate/enlarge �"
( � ( ) ( )#of new � S
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Additional Information: � .,�
—H c�
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r �
T e of Construction: r Ic
�Frame ( )Log ( )Pole/metal ( )Block ( )Concrete
�.,
( )Other ,�
Construction Cost:Primary Structure$ 30��npo•[SO ,.d �
Accessory Building:$ Addition:$ ^ s
s�scZ79�/ `�
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Deed:Vol Pg Certified Soii Test# q�'-��3 Z ry z
CSM:Vo! Pg Lut,"r__ Sanitary Permit# R�' `z-��U � ��
Plat Envelope �r� �` �
Condo Vol �o Y 3 Pg z�cq Co n3`�3O year Installed: N
"Loads and Flows": Vol Pg Owner When Installed: � �
ci
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Previous office approvals/actions: � %
Vaziance:# LUP:# SP:# CUP:# � ��
Inspection Report:# Change of Zone District: � ��`I�
w �
tioaa3 �
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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. l�we��r��v�� tY2. �\'i/•Ci.r� ��:+r:rvFtiC�€ �3. ..Jt.:�,, ' \ �4. _, \�
Size 32 ft. wide 2�{� ft. wide ft. wide ft. wide
_�_ft. long 22� ft. long ft. long ft. long ' .
Floor area (3'- sq. ft. 528 sq. ft. `�F�� sq. ft. sq. ft.
Hgt.from grade 2.,�' to peak �� ft. hgt. l 0, ft. hgt. � ft. hgt.
Stories I ' stories I stories stories
# of bedrooms �
�r;t�t����,;`�, ��.hl`�E�
Lake/Pond/Flowa e/River/Stream Name � °
��2�� -E �,_�A�!'r- ��Y�Arr1s INS�rII� ��g`�� , ;1;t Q �-.��} ���r��,p.i � � ,�
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L�F�' S��i�iu,J. 5<P}�� '�ANKS C.ol.J,xc,�ionl Li►lie� � I
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Fire Number and Name of Road �c u�� �h o�-� EK��=�.�
1. Enter lot dimensions and indicate north by arrow. Sign ure of 0 er o�Authorized Agent:
2. Indicate the location and size of the requested construction � li� ,t��zi-
Signature
activities. ` l � �� �I
Print Name: �l_.\�}�,t:..Ct ��. C 1�.��
3. Also, indicate the location and distance to the well, The above certifies that the listed information and intentions are
true and correct.,that aIl 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. a�c��s as ow�er�s�a9e�t,has the permission of the owner(s)to
perform the work requested on this application. The above
persons/s hereby give permission for access to the property for
onsite inspection.
Permit fee: $ 2�.�x� �' .5a Z 50°�'
Total land area within 300' of the waterbody: (A) a�'�r, `/y�
Total impervious surface area [including this project] (B) `/�, ��''�'`
(Bl i(a� X 100 =°��1TS�� � _ _(sr�ail nat exceed 1�%[or��°io with a conditional use permit].)
� � �����
Shoreline Vegetation Protect�n Area: lVlitigafion Required? ( ) Yes ( )No
September 7, 2004 ����-����J�I�c�.���
Issue Date Signature of Issuing Agent
September 7, 2005 50%Rule: Average Road Setback:
Expiration Date
Office Comments: Fred ��+lo�v .,�;c�;, �Y _� ;a .;,;� � � i. ;�: �, ,�.cc �r, . �r . � .
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POWER OP ATTORNEY
, {1��
Know all Men by these presents,that I, t��,11�l.C� �,'. E�L�C��r I`
property owner,Town of��'� Sawyer Cou�ty,Part of Government Lot
�_,��1/4,�,1_�1/4,S_�(�,T � ( ,R�\;t',State of Wisconsin,have
made,constituted and appointed���[.��;��—{����� o �� ' �-� �,�L
in the County of, >� �. ,State of isc�sin,my true ]awful agent for
me and in my name,place and stead to do any and all things necessazy for the application
for,negotiation of,or obtaining of state,county and local permits with the County of
Sawyer,Wisconsin,giving and granting hereby unto said agent full power and authorize
to do so and perform all and every act and things whatsoever required and necessary to be
done in about said premises,as fully to all intents and purposes as I might and could do if
personally present,reserving full power of substitution and revocation,hereby ratifying
all that my said agent of his substitute shall lawfully do or cause to be done by virtue
thereof,
In witness whereof,I have hereunto set my hand and seal this �3 � Day
of ��,���-t ,2004.
�/�tC� .v /L�Z �(
owner
Notary: �/�m��� � �fa{'IE��Y�
State of: �j y�ylP S O� �WWT P•JOHNSON
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�ra.�rrEv..a.„.�oos
County of: u�n V1 e f�;v�
Personally came before me this a' `"� day of �-���"'t ,2004,
The above named �r�l�a-� � �_✓ to me to be the person who
executed the foregoing instrument and acknowledged the same.
`�-�'�/�/— r!>iy' —77cN/;��i// /,'/qrlasc��
Notary Publie� County State
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