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012-740-06-5202-LUP-2004-067
Sent By: HP LaserJet 3100; 7156383277; Apr-8-04 � 1 :33AM; Paqe � i2 . ��� �h'�_ ° '�'�'�� ;y'. . , _ � - * > :', ,�,. Application for Land Use Permit (*Shoreland�`) ` o o ' . . County of Sawyer c� � � PO Box 676 - Hayward WI 548�3 �' � 715/634-8288 � � *property that is locaied within 3U0' of a c�eek,river oz stream or within 1000' of a � , flowage, Iake or pond or has any of the above waterbodies located within � C the property's boundaries. CONSTRUCTIOiV�HAZ.L IYOT�EGIN UNTIL ALL REQUIRED�ERMITS HAVE BEEN xSSU�SD, � 1 Y PRINT—US�BLt�CK INK OR P�NCIL � y• 8-° �`� -� L, C'i a,U »��,v� � ry� ;oY1 � � Builde� � , 2 sfi �.i q�q ��, Rd. � o� 'ling Adciress Mailing Address � � � ,� ('.,� sse � W ►. �{601 _ ' -5 -� � City, State, Zip � ity, S e,Zip � p - � � �D�b '7/�- 7 66 - q ,— �. Daytime Phone Daytime Phone Le��q2� 8��Y Addirional Information: Zone District: �Or'��!"'N , Lot Dimensions: .S ee. .�l g- �'�P � - � Acres: ���/ � Date lot was created: � Is there wetland near the proposed structure? If yes, how far a Building Land I3se Floodplain: ( ) Yes (�Q No � ( ) New ( ) Filling Chippewa Flowage: ( ) Yes �Q No ,� ( ) Addition ( ) Dredging Driveway access off of a(Check one): ' ^ ( )Alteration (1,�'�rading 6(1 Private Rd ( ) Town Rd. � � ( ) Moving Qn ( } ( ) County Hwy ( ) State Hwy o � l � lJ N � Primary Struccure A.ccessory�uilding Addition o � ( )Dwelling ( ) Garage-attached/detached ( )Deck �`' ( ) Year round ( )#4f car stalls ( )porch w ( ) Seagonal ( ) Storage Building ( )Enclosed �, ( ) Frame built on 9ite ( ) Scieenhouse ( )Living room fi ( ) Modular/m�nufactured ( )Greenhouse ( )Kitchen :� ( ) Mobile/manufactured ( ) Other ( )Bedroom � ( } Other primary structure ( ) ( )R:elocate/enlarge � A � � � � ( )#ofnew � � - Additionallnformation: A i � � � n t Type of Construction: V� ( } Frame ( ) Log ( ) Pole/metal ( )Block ( ) Concrete ( ) (hher ..� 1 Construction Cost: Primary Struchae$ ,b � � Accessory Building: $ Addition: $ � F�,�i�!�(�� � Deed: Vol P� Certified Soil Test# ro z CSM: Vol�_P�,S�i Lot#___��___ Sarutary Penmit# "� %n Plat Envelope � Or: � Condo Vol Pg Year Installed: N "Loads and Flows": Vol Pg Owner When Installed: � � � � Previous office approvals/actions; , Variance: # LUP:# SP: # CUP: # N Inspection REport: # Change of Zone District: �..� , - ._ , . , _� � .. ,. .. <,._ . . �,� �iE� OF�IC� ����.���-r�4T� �uqai sent �y: HP Laser�et 3�U0; 7156383277; Apr-B-04 11 :34AM; Page 2!2 Deacribe the conatruction uaing theae columns.List the dimensions of each structure in a separate : column.Liat each atory,each addition,each alteratfon in a separat0 column. - ' #1. #2. #3. #�• Size R, wide ft. wide ft. wide ft. wide ft. long ft. long R. long ft. long Flooc azea sq. ft. sq. R. sq. ft. sq. ft. Hgt,fi�gade m peak ft. hgt. ft. hgt ft. hgt. s�eg stories stories stories # of bedrooms L on owa iverlS m a Fire Numb�r and Name of Aoad 1. Enter lot dimensions and indicate north by arrow. gj p�tur o( er or uth �ized A ent: 2. Indicate the Iocauon and size of the requesced constructian ' "0�ur���- � Sgoedre n activities. �� 6�„ U r, Prin7 Nanre: i G 3. Also, indicate the location and distance to the well� 1Ta aDmO oeMPse lhat tl�a FBSBd hAom�etion and Mlantbna aie bue md mr�BU.,Eat all wR slMll be OBrfarmad In Wrtlptler� septic tank and drainfield,wetland areas, lot lincs, � �+e ream�eme�+e a nb s�,�ye.co�h z�,u� om�nanm era 9+e b•a sna regubuoro a 9�e Smm a wtemnaF�, ero rc centcrline of the road and waterbodies. °��'��Q)°�"��'��"`"�81°"°�'"�°�8�m perram ne wonc rea�aroe on mb aaa��uon. me eDove � perymyfn he�eDy pke�enn br a¢ess m+�a ProDaM�a p p �onake Inepactlan. Permit fee: S �S. Total land area within 300' of the waterbody: (A) Total impervious sucface area [inctuding this project] (B) (B)/(A)x 100=% Used (Shall not exceed 15%[or 25% with a conditional use pemut].) Shoreline Vcgetation Protection Area: Mitigation Re�uired? ( ) Yes ( )No Anri 1 1 („� 9()p!+ _ �����%7' - ����/�/P�/'�"��� Issue Da et Signature ofIssuing Agent April 16, 2005 50% Rule: �, Average Road Setback: Expiralion Date Office Comments: ��� �-C�C�Lc��l'v �-�:�GlJZ;I Sep 02 03 ll : �la Todd Gooltl % 156399tiG2 N � o . PAUI.F� CHISSEA ' � � SAHYER COUNYY, WT . �. ' A£GISTf;0. OF DEEDS • . 319710 08/28/2003 1:45 pM RECORDING FEF. �17.00 Page.r 4 SAWYERCOUNTYCERTlFIEDSURVEYMAP , LOCA 7'EO/N COVf/MI,VEM LOT Z,SECY/QN Q, TlpN.R7L7; 70WN CF HCW7ER,ANDlNCLlJdNG AN EASEME/J7 LOCATED lN 7NC SW f/a OF SECnpY J7, T01N. R7W, TOwN OF ROUND LIKE SA LWER COUMY, WISCOKSrN. 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