HomeMy WebLinkAbout014-941-08-4403-LUP-2004-524 ��rt/ . �� �
Application for Land Use Permit (*Shoreland*) o 0
County of Sawyer " �/� �
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PO Box 676 - Hayward WI 54843
715/634-8288
*Property that is located within 300' of a creek, rzvPr or stre�m or within l 000' of a � _
flowage, lake or pond or has any of the above waterbodies located within �' �d
the property's boundaries.
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PGIZMITS HAVE BGEN ISSUED.
PRINT-USE BLACK INK OR PENCIL �-�
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Owner T�I i(, �" N (:, �'-- Builder a:
1 �:�b(�til �v.,,vs� � C,' ��«� �An��.� o:
Mailing Address Mailing Address � �
I�I ��l�� t,�r �� �� � �
City, State, Zip City, State, Zip �
`-1 � � - c� 3y- �� yl % � �
Daytime Phone Daytime Phone �
Additional Information: Zone District: '`�C ' � '�
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Lot Dimensions:
as� ' Xa �� � �
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Date lot was created: x -�1- 1 I ��� Acres: �� `� � C
Is there wetland near the proposed structure? If yes, how far 't' a D r� � o R�
Building Land Use Floodplain: ( ) Yes (�No G
�New ( ) Filling Chippewa Flowage: ( ) Yes (n} No �
O Addition O Dredging Driveway access off of a(Check one): �
( ) Alteration ( ) Grading ( ) Private Rd (� Town Rd. �
( j Moving On ( ) ( ) County Hwy ( ) State Hwy � �
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Primary Structure Accessory Building Addition o 0
( ) Dwelling ( ) Garage-attached/detached ( ) Deck �
( ) Year round ( ) # of car stalls ( ) Porch �
( ) Seasonal �Storage Building ( ) Enclosed �
O Frame built on site O Screenhouse O Living room ? '�
O Modular/manufactured O Greenhouse O Kitchen � R�\
( ) Mobile/manufactured ( ) Other ( ) Bedroom � --
( ) Other primary structure ( ) ( ) Relocate/enlarge � '
� � ( � ( ) # of new `� �
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AdditionalInformation: � r
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Type of Construction: �
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�j Frame ( ) Log ( ) Pole/metal ( ) Block ( ) Concrete ;�.;
( ) Other y
Construction Cost: Primary�Structu��$ ..d �
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A�cessory Building: $ �vC�U" 7� Addition: $ � -�
# ��R`"¢�� 3�y'7� �
Deed: Vol Pg Certified Soil Test# C�/ - / �'�- � z
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CSM: Vol �� Pg oZ�W Lot# �v Sanitary Permit# ��%- ��-i'� �
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Plat Envelope !_c- �; J`�� Or: �
Condo Vol Pg Year Installed: N
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"Loads and Flows": Vol Pg Owner When Installed: �
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Previous office approvals/actions: �� -��:��j� �
Variance: # LUP:# `��i - 3 3c') SP: # CUP: # ,'
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Inspection Report: # Change ef Z�r.� Listrict: ___ _ q/����y
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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.
Hgt from grade to peak ft. hgt. ft. hgt. ft. hgt.
Stories stories stories stories
# of bedrooms � �
4
Lake/Pond/Flowa e/River/Stream Name
�.���% �-�,� L�C L� �!�
Fire Number and Name of Road
l . Enter lot dimensions and indicate north by arrow. Signat � of Owner Authorized Agent:
2. Indicate the location and size of the requested construction 1--�c.. t, - {�-,�
Signature
activities. / `
Print Name: L.t�l� �� ' �:-[ . n � �t�i /
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. 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.
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Permit fee: $ �� '
Total land area within 300' the waterbody: (A '
Total impervious surface area [i luding ' project] (B)
(B) / (A) x 100 = % Used (Shall not exceed 15 o r 25% with a conditional use permit].)
Shoreline Vegetation Protecti Area: Mi ' ation Required ) Yes No
Se�tember 21 ,. 2004 ` � �—
Issue Date Signature of Iss g ent
September 21 , 2005 50% Rule: Average Road Setback:
Expiration Date
Office Comments:
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� M/NK CAP/TAL SURVEYING, INC. S�R���N�SEa���Es • �
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Medlord,W isconsin c..r,rw s�.�..v
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I,Charles Orferman, °a =��oi zs�.00 — zo's
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lan3 aurvey-�r of Lhe State I r, t: �+�, r�s
of Wisc�nei¢, d: �ereby —� ' 6 _`—; S �d o ��•�w�, �
certify that by the order ,M,�,oa ��ua 'oo�'¢ �ear�c a� � � �'�
of �rSmh'a Aooee, I have u o a u �szc�c Y`— u�
ma3e the followi ng aurvey o° � o� �' 1° �u*�
Sn the SE}of Lte SE4 oY �• `'�� "'=
Section 8, T. 4] h., R. 9 M,� Ic zr.or H� ��.ol' ezn•w1Y �$� ;
N89 5618 74602 I q
Snwyer County,w�isconsln, ���.� ��y
�ore particularly deecrlhad 3 n�3'�'•
ea follows: $m �z�� �,
Co^mer,cing=.t Lhe SE c�rhe of eaid Section 8; Lhence � o a
ti 1 00'�5" T, a:.on2 the 5. line of said S2� of the SE}, 593•Ol' ,E��-.`+v 4r ��
to the coint of real be.-inning; Lhence contlnuin;N 1�00'35" E� 9 �235.00' o
`N89'S618 E �
163'. ��re or lesa, to the existlne=F.ore line of e lake;
thence &ort?�erl;�and Westerly, along=ald s�.ore line, $90',
more or less; t!�=�ce S 89°SE�18" M�SBz'.more or leea; LhPnce �� W
S 1°00'35" M� 261.00�; t?�ence-S 89°56�18" E, y46.02'; t.*.ence ���
S 1°00'35" W� 2t�g.02'; th�nce N 89°56'18" °, 235•00� to the i � R� 'S
point of rexl Lu-ln�ln�
I further certSfy thnt I hnve complied vith the crovisiona
of Chaoter 236 af the revise"_ stn!utee of the Stste of Visconsln � °
Sn surveyln�an:l :naopin� Lhe eame. . !
'Phia lnet.^unent 3ra.fted by Charles 0`fernan. �e
A'PROPs9 ^,?.Ig,,�DAY OF PL/AIGb� . 197�'. _
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