HomeMy WebLinkAbout026-939-14-5217-LUP-2004-117_�..,—_ _�
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��� Application for Land Use Permit (*Shoreland*) o o - .
County of Sawyer N � � 4
PO Box 676 - Hayward WI 54843 �(� -�J
715/634-8288 �
*Property that is located within 300' of a creek,river or stream or within 1000' of�
flowage, lake or pond or has any of the above waterbodies located within
the property's boundaries.
CONSTRUCTION SHALL N PRINT I USE BLACK IN OR P NCIL MITS HAVE BEEN ISSUED. I � ��'�
C' '"'-�"'� I ta
���1� �� Cs, �14, � �
Owner Builder �
- � �J � o� �
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Mailing Address � �
Mailing Address ! �
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City, State, Zip
�� City, State, ip
��"7 ��� ��9 `-�
Daytime Phone Daytime Phone
Additional Information:
Zone District: ����
Lot Dimensions: ,�
Date lot was created: Acres: 6 �7
Is there wetland near the proposed structure? If yes,how far �
Land Use Floodplain: ( ) Yes ( )No '�
Building �
e�,�, O Filling Chippewa Flowage: O Yes (�No �;
� � Drivewa access off of a(Check one): *�
( ) Addition ( ) Dredging y Town Rd. CD
( ) Alteration ( ) Grading ( ) Private Rd ( ) �
( )Moving On ( ) ( ) County Hwy ( ) State Hwy o 0
O_— O � r
�rimary Structure Accessory Building _ � Addition o °
Gara e attached/detached , ( ) Deck �`' �
� Dwellin ��� g - �°
�'� g # of car stalls ( Porch W
�( ) Year ro d ��--'� nclosed '�
� ) Seasc��al ( ) Storage Building � ) � �
Screenhouse ( ) L�uing room r?
O Fra�ie built on site O � �
( )lv�4dular/manufactured ( ) Greenhouse ( )Kitehen � �
Ivlobile/manufactured O Other O Bedroom p A
� �� ( ) Relocate/enlarge �
( ��ther primary structure ( ) ( ) # of new '
����( � � � w
.� �
AdditionalInformation: ' �,
1 �
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I
Type of Construction: N -�C
(}Fraxne ( ) Log � ( ) Pole/metal ( ) Block � ) Concrete �
�
( ) Other �
Construction Cost: Primary Structure $
b �
� ' ` Addition: $ � �
` C l,
Accessory Building: $ �� j�? �° �
�
�� p� y�( Certified Soil Test# 78�6 3� � z
lleed: Voi_� c►� �,
CSM: Vol Pg Lot# Sanitary Permit# ��,-64(0 ".
Or: O1 �
Plat Envelope ;._..
Year Installed: �' �
Condo Vol Pg `"
Owner When Installed: �
"Loads and Flows": Vol Pg �
..
Q�
Previous office approvals/actions: �
G l� LUP:# SP: # CUP: # �1 ��,.�
V ariance: # �a' a`r;`.,
Inspection Report: # Change of Zone District: `
a�y`-1�l
_ \
. ,
� �
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. � •
#? , ; y � #2. #3. #4. •
Size 1� ft. wide�� " ft. wide ft. wide ft. wide - .
2 �=i`�ft. long �%,� � ft. long ft. long _ ft. long
�~��� Floor area ' � SZ sq. ft. sq. ft. sq. ft. sq. ft.
;
�"- � Hg� from grade ��' to peak ft. hgt. ft. hgt. ft. hgt. �
Stories � stories stories stories
# of bedrooms ��
Lake/Pond/Flowa e/River/Stream ame
t
1� �'
� c�— �d •; r �,-_ �;�.
_. ->x
Fire Number and Name of Road � 2 � �'`" N � ``"� `' ` �� ;�' �� ` 'a`� C ��
1. Enter lot dimensions and indicate north by arrow. Signatur�e of,Owne,�' orAuthorized Agent:
2. Indicate the location and size of the requested construction \�� LY . .�` E-�..
' Signature
activities. �� � � J�
Print Name: �G� " _
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. ac��s a5 ow�er�s� a9e�t, 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: $ � 0 � a o
Total land area within 300' of the waterbody: (A) � �' ' "
Total impervious surface area [including this project] (B)
(B) / (A) x 100 = % Used /� % `% (Shall not exceed 15%[or 25% with a conditional use perr.lit].)
Shoreline Vegetation Protection Area: Mitigation Required? O Yes (�) No
May 4 , 2004 — —
Issue Date Signature of Iss ng A ent
Ma.y 4 , 2005 50% Rule: Average Road Setback:
Expiration Date
��'���'�r�, ���' �`��� 6�- %�- ` = ��e�� d����
Office Comments: ��'
��;2.�� C��-
SU�VEY �oR:
D48CR1 T�ON: taAM[ Ae DEGD VOL. 344. �PAl9E 362) . �
� A PApT 0p �,L. 2 S�C. 14. T30N..R9W.
C tiM�i1CINp .t 7H� u_�unre pn.T oN W�
N RTH BHORpE�OF '�ITfiFItH LAKE AND THE WEEt .
FD. I' IRON YIN J 3E75FfEETD THENCE4N4JHSOC4JN�2B.SQ FEET
WI/4 coR. SEC. I� �• 7 p pEROD BEINO THE POINT OF BEOINNING:
' T ENC�E DIB 44'3'E A03?26FFEE7T OAAN1RRONP,PE�
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� ' �Q�.y�' 'x P�:pE ON THE lHORE OF WHITEFI�H LpKE:
v o � �• 7 ENCE 95D•52'22'M ON A MEANDER LINH oF
, � 8'ID LAKE D0.96 FEET To AN IRON PIPE:
� �'��*�' � g*� T ENCE N�3'SB'38'W 391.+0 FEET TO THE
,r , .� P INT oF BEOINNINO.
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DATEc 9EP?d18ER 20. IR06
i HEREBY CHRTIFY THAT TMIe BUHVEY �.
� IS CORRECT 70 THE BEST OF MY
KNQYtLED/iE AND BEl I EF� ��N :1 A,w.
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R,A. RECORDED AS �'�, �' ,
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SHORELAND PRESERVATION AGREEMENT
(Intact Shoreline Veeetation Protection Areal
Land Use Permit No. �- // 7 (To be entered by the Zoning Office) Index No. �- // �7 •
WHEREAS, (list all owners) `` � � -. G— /'�� � ;� + v� �I,- y � S . �L ��
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 PROTECTION AREA on said real estate is intact to a minimum depth of
35' landwazd from the ordinary high-water mark 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 detemune 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.
LegalDescriptionofProperty: Part of Gl 2 , Sec 14 , T 39N, R 9W, Town of Sand Lake
Sawyer County , WI • 026-939-14-5217
Dated this �� day of �n � L �a 4�
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(o� > (o.,�e�>
,
(Owner) (Owner)
(Owner) (Owner)
This inshument was drafted by:
Sawyer Cou�ty Zoiiing Office
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