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024-641-24-4304-LUP-2004-033
Application for Land Use Permit(*Shoreland*) v�{����� o ;!, County of Sawyer �,� �j:�;=:�� � PO Box 676 -Haywazd WI 54843 S''` 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. CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. � � PRINT-USE BLACK INK OR PENCIL � O ThO�na�s� 1/�C;`N�� y _ Kw��- il�iaiU� l��ioSko C�w ry t�. � � Owner Builder Y� (��c��A-I -z4�� Si-k2�-q-�. �. � Mailing Address � n Mailing Address � �I�.�T I�K�� I�N yJh z�� ~° City,State,Zip City,State,Zip -� 5 �-bmE ,-h 1- �-�-�Z.—Z��D � Daytime Phone Daytime Phone � -fom's c� (pIZ- �j�o- c�35�i ��' Additional Information: Zone District: � - I� - � � LotDimensions: 10�k ����P � �i���'�- � h S��yE4L-D 2 JUu G Date lot was created:(�N KNGW N I Zcw3 Acres � 1 4C Is there wetland near the proposed structure?If yes,how far NO � �j Building Land Use Floodplain:( )Yes �<)No G � ( )New ( )Filling Chippewa Flowage:( )Yes �lj No ;� � �Addition O Dredging Driveway access off of a(Check one): � � ( )Alteration ( )Grading ( )Private Rd �Town Rd. � •- State H O Moving On O O County Hwy O wY o 0 � )—--- � �— n.> S ��, r� Primary Structure Accessory Building Addition o ° Gara e attached/detached ( )Deck '`' ( )Dweiling � ) g - `O ( )Year round ( )#of caz stalls ( )Porch � ( )Seasonal ( )Storage Building ( )Enclosed �., Frame built on site O Screenhouse {jQ Living room � ��� ( )Modulaz/manufactured ( )Greenhouse ( )Kitchen � �, ( )Mobile/manufactured ( )Other ( )Bedroom � - ( )Other primary structure ( ) ( )Relocate/enlazge L `� _ � � ( )#ofnew � �� � � ) � L AdditionalInformation: - ' c �`� � � �= � � Type of Construction: �� � � OC).Frame ( )Log ( )Pole/metal ( )Block OQ Concrete�.r�3 F�-v6R. � + c� ( )Other � � Construction Cost:Pcimary Structure$_ ° Accessory Building:$ Addition:$�I.3F33.°= � � � �13 � �y c�'�>y wr Pav��crrnow ,� — Deed:V ol Yg � Certilied So�l�1'est# Cl����t a. �, z N � r CSM:Vol 7�-� Pg Z`i�� Lot# � Sanitary Permit# <-I Z��'2(p C3��'(� : � L Plat Envelope i� G�� � �r� °� � c Condo Vol Pg Yeaz Installed: 2-�'<�� N L � � "Loads and Flows": Vol Pg Owner When Installed: � SI�-v+�� P�a l�xs- b�{-a33 -fina�nA� J-- Wen,D�-I �Nc�-'o � Previous office approvals/actions: C Variance:# LUP:# SP:# CUP:# � Inspection Report:# Change of Zone District: � �1���1 lT, � . ay53$ ,� , . - 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. � . #l . C� �� � #2. � a� �-r] 6N #3. #4. Size ` y ft. wide !.� ft. wide ft. wide ft. wide 3C ft. long Z� ft. long ft. long ft. long Floor area ��V sq. ft. � I� sq. ft. sq. ft. sq. ft. Hgk from grade �3` Z'� to peak � ft. hgt.����rzc,yC ft. hgt. ft. hgt. Stories f _� stories stories stories # of bedrooms Z Lake/Pond/Flowa e/River/Stream Name M�'GSc= L-A Kr= �.,:;l�c �'���-�'�� SE�: ,,���Hc:-A �i;��iE� Fire Number and Name of Road f �5 �e Z ,b� FC'�r L� 2i_[.E �R-� �(; 1 . Enter lot dimensions and indicate north by arrow. s S�gnature of Owrer or Authorized Agent: 2. Indicate the location and size of the requested construction � � •�� E� � Si nature activities. ����p��� Print Name:Tl'10 f�'�A�' . 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. a��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: $ Total land area within 300' of the waterbody: (A) � � �CO Total impervious surface area [including this proj ect] (B) i `1�' �' (B) / (A) x 100 = % Used .�.`-���o (Shall not exceed 15%[or 25% with a conditional use permit].) Shoreline Vegetation Protection Area: Mitigation Required? (� Yes ( ) No March 1 , 2004 �� ' � Issue Date Signature of Issuing Agent Mar ch 1 , 2 0 0 5 50% Rule: Average Road Setback: Expiration Date `'rla9/oy � 0�-m���d� << ' � ' qc� �.,p�� -;- ty o h a�Z �o�.l�e C�s- '► nc�- ,c Office Comments: s�f"(�ac,� a I' S6 -fd bc �to�o�^� i h �0 `� b�c5 cA� o-�t. 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LOT EVIDENCE OF OWNERSHIP OR BOUNDARY LOCATIONS SHORELAND PRESERVATION AGREEMENT Qntact Shoreline Veeetation Protection Area) Land Use Permit No. D / 'O J � (To be entered by the Zoning Office) Indea No. G'�� - �3�� WHEREAS, (list all owners)�hOYnaS }-� . � �,U�i c.� �l, Z��-I`1 b� !!-0 -f 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) heceby certifies that, as a condition of issue of said Land Use Permit, that the SHORELINE VEGETATION PROTECTION AREA on said real estate is intact to a minimum depth of 35' landward from the ordinazy high-water mazk of the waterbody. 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 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 �vith the Sawyer County Zoning Office. Legal Description of Proper[y: ��� . �`'� T� � � � 1P � �N-�� � ��� �� Dated t ' � �� day of �L� I�1�12e�1 , ZO6� ��, � �� �� _ (Owner) (Owner) - (Owner) (Owner) (Owner) (Owner) This instrmnent was drafted b� Sawycr Cou�ty Zoning Office C� —n,mnAs d- l,l:�'T��y ZA+•.cG�i�-�i _ �_- (o �f-bt�o ��rrlo�s___ ' ' — `� �m I-1-r��� wr�� rn�� ��r�j� -- l.fS� CA�R-��vlz ;� ` I� �112i-� h'IxY21J� : wI\/r1LbWTl�e CSI�[rJQ�i7as�� / I� w� �In�K ��-AC� Ol4 �o�Si� �, ;; 7 ii. ��� l___[�-��� j; I I �� �d��r-�,N��I��- ������ Z.c�.c� � _._ ;� s��1....r,�c 11��i �-r�roti-G � �}c� niE� �uT�+ �a.( -- ' ��k'7N- .5'r t�G' lj� �i��� /-1 M� � ' �� ��- z��E 'r- - - �N�E ��ec7,�-nd� ,�r-�,�r-,�Si- _ ; F-�yy, ��,.r7-�-�iDc � � C�.i�i�°. I I i ��D' �+v?1-�paS r CB�IC� O�l ��d� *. _~, -��� "��, ,i�p���,' ;�: _ R �� ;. ♦ ����� ^�. -� 'J�R�.� f 4: �/. ... f��� � i!4 �C�• � •'�� l'• - .i.:;. .. . 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