HomeMy WebLinkAbout032-539-01-5317-LUP-2004-251 . �
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Application for Land Use Permit (*Shoreland*) r y � ���
County of Sawyer ° �
PO Box 676 - Hayward WI 54843 `�
715/634-8288
*Property that is located within 300' of a creek, river or stream or within 1000' of a -
flowage, lake ar pond or has any of the above waterbodies located within b� `
the property's boundarie;s. �
CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN ISSUED. ,
PRINT-USE BLACK INK OR PENCIL
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Owner Builder �
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Mailing Address Mailing Address � � _
(�rr�-I e S il,�I(P /�����,1�D F �c'�� ��-✓ C�e� ei"' lv1���� �
City, State, Zip City, State, Zip
�� - �!�t�-���� ��f�d �✓ � � 7�� c�
Daytime Phone Daytime Phone �
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Additional Information: Zone District: �� �
Lot Dimensions: �,t1 f0 U d� ���; �. l��',�y3 7 �
Date lot was created: � �� � Acres: Q� /�, ':��,; :%� �� "� a �<o �
Is there wetland near the proposed structure? If yes, how far o
A
Building Land Use Floodplain: ( ) Yes ( )No � �`
(�New ( ) Filling Chippewa Flowage: ( ) Yes ( ) No �
O Addition O Dredging Driveway access off of a(Check one): �
( ) Alteration ( ) Grading ( ) Priv��te Rd (� Town Rd. �
( ) Moving On ( ) ( ) County Hwy ( ) State Hwy `m
� ) � ) � �
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Primaxy Structure Accessory Building Addition o 0
� Dwelling (� Garage-attached c etache O Deck �
( ) Year round (�) # of car stalls (� Porch W
(j�f Seasonal ( ) Storage Building ( ) Enclosed �
O Frame built on site O Screenhouse O Living room �
(� Modular/manufactured ( ) Greenhouse ( ) Kitchen �
( ) Mobile/manufactured ( ) Other ( ) Bedroom �-� �
( ) Other primary structure ( ) ( ) Relocate/enlarge � "
� � O O # ofnew �..9
�
Additional Information: `°� A
_�;
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Type of Construction: �
( ) Frame (�Log ( ) Pole/metal ( ) Block ( ) Concrete
( ) Other y � ,�
Construction Cost: Pri yary Structure $�, 0� C� ,.ti �
Accessory Building: $��, �C7 � _ Addition: $ �
� 3a a r�y �
Deed: Vol���l�l Pg_���'� Certified Soil Test#_ � 7
CSM: Vol_�_Pg z� ���� Lot#�_ Sanitary Permit# � �/- (i � � 1 � � �
Plat Envelope 1$' ���� Or: �"�```'t� a� �
Condo Vol Pg Year Installed: N �
"Loads and Flows": Vol Pg Owner When Installed: �?
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Previous office approvals/actions: W
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Variance: # LUP:# SP: # CUP: # ,�
oa
Inspection Report: # Change of Zone District:
�\�`�
3�st� i
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. P 5; of e"h c- e- 42. e aq l'Xi #3. �c v & '.
9
#4.
Size ft. wide, ft. wide
ft. wide
ft. wide
_ ft. long — ft. long
'30 ft. long
ft. long'
Floor area 7 0 sq. ft. 3 6 0 sq. ft.
1,70 sq. ft.
sq. ft.
Hgt from grade ,") 2 a to peak 0 � n ft. hgt.
ft. hgt.
ft. hgt.
Stories 2, stories
stories
stories
# of bedrooms _ ,Z'
,r- (—�xN)rr U:> KYtr I(OXIS SCALE
V'-50'
( 75avf Lot 3, Sec
T 3 3N R51/v
50
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e�
SY
LOT 7
JY
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ogtr
15
584-o3-t'pF
Fire Number and Name of Road
1. Enter lot dimensions and indicate north by arrow.
2. Indicate the location and size of the requested construction
activities.
3. Also, indicate the location and distance to the well,
septic tank and drainfield, wetland areas, lot lines,
centerline of the road and waterbodies.
pa
Permit fee: $ 1 Z"
Total land area within 300' of the waterbody: (A) 9
14?w
Signature of Owner or utho fixed Agent:
Signature
rinf Name:
The above certifies that the listed information and intentions are
true and correct., that all work shall be performed in compliance
with the requirements of the Sawyer County Zoning Ordinance
and the laws and regulations of the State of Wisconsin, and if
acting as owner(s) agent, 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.
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➢AGE / oF Z
SHORELAND PRESERVATION AGREEMENT
(Shoreline Vegetation Protection Arca)
Land Use Permit No. (�y—�J�'/ (To be entered by the Zoning Office) Index No. �-�c5�
WHEREAS,(list all owners) James M. Siefkas
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 mazk of the waterbody.
The owner(s)hereby agrees to comply with the shoreland vegetative protection azea requirements of Section
4.410 SHORELAND VEGETATION PROTECTION AREA,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
� between the hours of 8:00 A.M.and 6:00 P.M.[Section 9.13(1)POWERS,Sawyer County Zoning Ordinance]
��r to inspect the structure(s)or uses authorized by said Land Use Permit and to determine if the SHORELIN�
` V VEGETATION PROTECTION AREA exists and that it is being preserved.This authorization shall terminate
� on the date of expiration of the land use permit. However,the owner's obligation to maintain the SHORELINE
� VEGETATION PROTECTION AREA in accordance with Section 4.410 SHORELAND VEGETATION
PROTECTION AREA,Sawyer County Zoning Ordinance remains in effect.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: Lot 6 of CSM vol 8 pa�e 228 part of Gov't lot 3
Section 1, T 39 N, R5 W, Town of Wlnter, Sawyer CountyWl
Dated this 28 day of �y 2004
(Owner) (Owner)
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(Owner) (Owner)
(Owner) (Owner)
This instrument was drafted by:
Sawyer County Zoning Office
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