HomeMy WebLinkAbout010-941-15-1101-LUP-2023-385 SUBMIT COMPLETED APPLICATION AND
FEEro: APPIICATION FOR LAND USE PERMIT '
SavryerCounty SAWYER COUNTY,WISCONSIN 0 1
Zoning&Conservatbn Depart. oa�e se+mv la�cewea) ��� �— r`J
10610 Main St Suite 49 `.;3r,^�,�C._,..�,._���.,.�,.��.e.,�,r,•m._,:,.-. (f.�
Hayward,W154843 : f
(715)634-8288 3 �;hk� �Ns 3 ��► .._ �
�/a9��l.
wSTRurnoNS:nopermitswillbelssueduntilsl�ieessrepaid. �?L't�'ad �.g�� _ �
Checks arc made payable to:Sawyer Cowny Zoning Department. � � ...._....._a.._.._.»..
DO NOr S7AR7 CONSrRUCnOry UrvT�i At�cFaMITS HAVE BEEN�SSUED 10 avvuCANT Original Application MUST be submitted FILL OUT IN INK (NO PENCIL) " �
SUbm�ittai of this applicatlon or rcrcipt of feet does nat constitutC pErmit'issuan<e.
o�,MS�name: Hayward Area Memorial Hospital and Contnctor�s�Name
Water's Edge,Medical Services, Inc.
rna�i��gnaaress: ��040 N State Road 77 MailingAddress:
Hayward,WI 54843
rno��: 7�5-934-4497 Phone:
Eman: di,wegener@hamhwe.com Email:
Skeaddress: Same OrDateapplkdior.
le acyPINN ��V- ��y�— I S— � �01 rowoor: Hayward
Property has floodplain,but
Permit delWery Method u Call Owner n Mail Owner r Call Contractor ❑Mail Contpctor email and call improvements are not
_ impacting
� Is Property/land within 300 fcet of River,Stream nnd. Distance Structure is from Shoreline: Is your Property
ime.mixme) _� Are wetlands
Creek or Landward sWe of Floodplain? it yes--continue feet in Floodplarn presant?
�Shoreland zone'
)(Is Property/Land within 1000 feet of Lake,Pond or Flowage � DisWnce Structure is fram Shorelioe: Yes xYes i
• Ifyes--continue --i Addition is more than 600�teet XNo No
.,�+ , . .. . �
''Non-Shoreland
Value at time of Describe Proj� Total p of
Projed type Foundation What Type&Capacity is the
Completlon (House,garage,shed,deck, Number bedrooms ry Y ��
��nco,nF donaced of Stories (Basement, P�st Sewer/Saoita S stem s
Addition,etc...) Crawlspace,
ume&materfal ��st sepantely Slab) construction
5 Clinic Addition 2 Slab with Private on site collection system
Frost Walls that discharges to City of Hayward
Dwelilne
system
S
Ac<essory&d6
5 8,386,742
ndaiHon/atwtbn
Height:
. Total Square Lowest
Footage Grede to
Proposed Use � Proposed Structure Dime�sions (mukiply per Highest
story) Veak
Residence ( x 1
Ft.
with 2nd story or loft � X �
Ft.
with Basement , ( x �
Ft.
Attached Garage ( x �
� Residential Use Ft.
ACcessory Structure le�plain� ( X �
❑ Agrieulturol (e«.�n<e`.�se�s.eneee,boaano�..�,.:�� Ft.
Use � X �
Temporary Guest Quarters or eunkhouse(a.de cwe) Ft.
�Commercial/ Deck/Porch/Patio ' X 1 Ft.
Industrial Use � x �
(2nd)Deck/Porch/Patio Ft.
C Municipal Use ( X �
Othef(expialn� Ft.
Vestibule=107 SF
J Other ` , ( Main Level=15,804 SF 30 Ft
XPf10CIPBl StfUCtU�C�Agriwltural,Commerciat,Municipal,EIc.J Second Level=14,396 SF Ft.
( TOTAL=30,370 SF
Addition/Alteration{exoia�r,� F�,
30,370 SF Total Non-habitable square feet:
Total habit0ble Square feet: (decks,patios,garages,sheds,storage area&other st�uctures)
�"
Original Application MUST be submitted
Attach a Plan or Skeuh your Property on 8.5"x il"or 8.5"x 14"paper.'MusN Include IocaUon and setback of proposed and existing structures,roads,
drfveway,saniwry components,well,lake,river,stream,and wetlands.
Description Setback Descrlption Setback
Measurements Measurements
Setback from the Centerline of Platted Road and/or 350 Feet Setback from the Lake(om���a�y n��en-wace�mark) 600+ Feet
Setback from the Established Right-of-Way 275 Feet Setback from the River,Stream,Creek feet
Setback from the Bluff��aooiicanie Feet
Setback from the North Lot Line 2400 Feet
Setback from the South Lot Line 1250 Feet Setback from Wetland 450 Feet
Setback from the West Lot Line 275 Feet Slope within area of construction/dlsturbance up to 4°k %Siope
Setback from the East Lot Line 2100 Feet Elevation of Floodplain FeM
Setback to Septic Tank or Holding Tank �/a Feet Setbatk to Well 910 Feet `
Setback to Drain Field ��a Feet �
Setback to Privy(Portable,Composting) �1a Feet
.-.�t��rr �.la �,,. � . .r o�,�I . ,.,...�,�n f�v�(,I`ee.�. .. � � .i ��,� ,o�:e[back,t�e 6ounaary line f�orm�vnich the 5etback must be measurPd must be v�is�hle f�o n one
.,�.,,i� ,_. . �� �,r,r�:�� � , ..i i _a-.�ncro� - .��r.,�i .�.I�,�i�:ryora;ihcown.�r'sexpense
. [;.rn�_:�_.�e:�t n ,,„t,���c,�<,1�. ,i����_ni� .,I,or f����.,t �:.t h.R Ir�.,� e.,t�r _, -et`.n.ii h�:i � ..m. ., ieA se;OecK.chi bo��nda,y i ne froin.vn ch ine sribnck n.,.st ne
� � �
_ �ifr. . .�t_Ir., „zpre� >ly�i�ci�d.>� �r..i.l•__t, �rt.evo.�l� i v<�. ,_ ni , i� L �G�t.-Ce.:,it��iz^:b�.zr��f�c.irict�Oc��ipe�sirpr�ar .v�nC��rri�•�
-t'� n_iU f�!� ...hi Pt:..i_. .�.i U,'hv . .. ..� I.,�..iii�4. J.r�li�"PnSt'�-i�i y[ at I .. 2 .,�c•,�..�
Calculate imperviaus surfaces.(Roofed,concrete,paved,and other wrfaces that waur cannot penetrete.The Zaning Offlce can hetp you determine H a
wrface is considered impervious)
Calculate lot area: 393.73 17,150,879
Indicate lot size from CSM o NOVUS ircle one�: Acres;Multiply by 43,560=Lot area: Square Foo[age
Glculate impervious wrface area:
25,490 �`�`/A ►�A��
Determine the total size,in square feet,of your projects listed above f include eaves�: sq ft. J���
� z56,3�0 � Ala� M
Determine the total size,in square feet,of all existing roofed structures(include eaves�: sq h. � h'f`�
Determine the total size,in square feet,of all existing paved/bricked/blocked surfaces: 483.4�4 sq ft.
Add these measuremenu to de[ermine total impervious surfaces: �65,334 sq k.
The work for the clinic addition
and another project will be
Calculate impervious lot percentage submitted to the WDNR for
765,334 17,150,879 4.46 grading related permitting for
Total Impervious surfate: >Lot area: Sq ft.X 100=impervious surface % land disturbance over 1 acre.
(M�itigacion is required if total e�ceeds 15%�
""Notice a separate grading permit needs[o be obtained if disturbed area is within[he Shoreland district as indicated on previous page and m ets crkeria bebw••'
Grading on a slope greater than 20% Grading of more than 1,000 Sq.Ft,on o-20%slo s
Grading of more than 2,000 Sq.Ft.on Slopes less than 12Y Grading is in excess of 10,000 Sq.Ft.
�.���i �.� ..,i.�l-F�.91'� �•{,i.�ut.^NSII�L�I.�:�1N� ��..���f'I ;.;IL��r�'F �'�f.l"._.._„_
I(we)dedare that thi:application(including any accompanying information)has been examined by me(us)and to�the best of my�our�knowledge and belief it is true,mrrect and
wmplete.I(we�acknowledge that I(we)am(are)responsible for the detaii and accurecy of all information I(we)am�are)providing and that It will be relied upon by Sawyer
County in determining whether to issue a permit.I(we)further accept liability which may be a resuk of Sawyer County relying on this��ntormation I(we�am(are)providing in or
with this application.I(we)consent to county officials charged with administering county ordinances to have access to the above described property at any reazonable time for the
purpose of inspection.Additionally,the undersigned personls)hereby we permission for access to the property for onsite inspedion by Municipal Officiais.
oW�� 5; �,tlnfc. �� ��-^'"'/� S�1"
Signature 1 Printed name , Date
a,� .-�d w���.ed'i;�,,, ��.u��,rP�.!�
NOTICE =:1:I . ,�Pern��5 Enpir�C)�e`1�Yv�f�ro tht U�le�„' � ,..i__
f .Y_.C�,�i,tr , .n�f'��_., _.�.:�F , :Uwall'. ¢.A��Mu^c,;ali.esA�eReV��'P�Te t � �-. ri, ,,,,,. ...
�be Io-ca:7,;,���,5,a-e c�Pederai ager.ci s�^aY�Iso requue pe;�„ts.
You are responsible for complying with the requirements of the Sawyer Counting Zoning Ordinances amllaw and reguiations of the State of Wisconsin.Vou are also responsible for
complying with State and Federal laws conceming construction near or on wetlands,lakes,and streams.Failure to comply may result in removal or modifcation of construction
that violates the law or other penalties or cosu.For more intormation,visit the department of naNral rezources wetlands identification web page or contact a departmenc of
natural resources service center(608)2673125
Issuance Information(County Use Only) Sanitary Number: p of bedrooms:
Permit Denied(Date): Reason for Denial:
Permit#: Issuing agent: Date:
Is Parcel a Su6-Standard Lo[ '�.Yes �oeea ot rsecord� NO Mitigation Required ��.:Yes �-No
Is Varcel in Common Ownership :Yes (Fused/Contiguous Lot�ip .No Mitigation AttacAed i:Yes ,No
Is StruRure Non-Conforming �Yes :.qa
Granted by Variance(B.O.A.) Granted by Conditional Use
�'Yes �'�.No Case M: �.Yes "�No Case il:
Was Parcei Legally Gea[ed Yes No Were Property Lines Represented by Owner ����.Yei � .��.No
Was Proposed Building Site Delineated Ves No Was Property Surveyed �:Yes :i No
O�ce Comments: Zone Distric[: Fee:
Hold For Sanitary: Hotd For TBA: � Hold For Afiidavit Nold For Fees:
m7an2o2o
Original Application MUST be submitted
Attach a Plan or Skerch your Property on 8.5"x il"or 8.5"x 14°paper,'MusN Indude Iocation and setback af proposed and existfng structurcs,roads,
driveway,sanitary componeMs,well,lake,firer;stream,and wetlands.
Dexrfptio� Setback Description Setback
Measureme�ts Meawrements
I
Setback from the Centerline of P!a[ted Road and/or Feet Sethack from the Lake(o�d���ary n-�gn-wa��,ma�k) Feet
Setback from the Estabiished Right-of-Way Feet Setback from the River,Stream,Creek Feet
Setback from the Bluff��f aovi���abie Feet
Setback from the North Lo[Line Feet
Setback from the South Lot Line Feet Setback from Wetla�d Feet
Se[back from the West Lot Line Feet Slope within area of construction/disturbance %Siope
Se[back from the East Lot Line Feet Elevation of Floodplain Feet
Setback to Septic Tank or Holding Tank Feet Setback to Well Feet
Setbackto Drain Field Feet
Setback to Privy(Portable,Composting) Fee[
- -�� -. �. � � � ��� �i ��� � . �f��e(��,`ee:o�.h�.n�n���� i �.r.���. tb ck,t'�-hr - , �-��_(ierr,vhich tne s,�.oac�r}us�be measu�ed must 6e v�s��6ie frem��re
. . , . . .. . . . . � _ _..r ne o r�a�4.ed 7y.�I .r�.,. -,_ a'�he o.v�e s-r.per�,r.
t ,��o-r��i � ...� ,� , -i ,,,�,.-t.� . .�,r.�v-Fan f„�5, _c+h.i�I<<t i „ .._, ret .o.n�he m .. �m < u red�e_ba�k.�he bour.dT�y��r_frcm.vht:n�he zet�ack m�st be
�.
, r:Jn,.� „blefr.: . .n�e,�.r ly .n.,���rl � . r,�th=,� r���.,�:�lv. <<ei0�m r�_ �at r�.C�et �.n..��L� ��.fa.e,r��,.[Ed.� �a�ct.p�na�rrwncnrne�
t�i>>fr_t t�_=. i.ihr�i�..Gc. c �n!IF�- 'r ,.i ._�r .ho-naf4�.� .i,i _. ,_ vi�Ynr i.�1 .nr.�e.�per s . .
ICalculate impervious surfaces.(Roofed,concrete,paved,and other wrfaces that water cannot penetrate.The Zoning Oifice wn help you determine If a
surface is tonsidered impervious)
Calculate lot area:
Indicate lot size from CSM or NOVUS(tircle one): Acres;Mukiply by 43,560=Lot area: Square Pootage
, Calculate impervious surface area:
��: Determine the total size,In square feet,of your projects listed above(include eaves): sq ft.
� Determine the total size,in square feet,of all existing roofed structures(include eaves): sq ft.
i
Determine the total size,in square feet,of all existing paved/bricked/blocked surfaces: sq k.
Add these measurements to determine total impervious surfaces: sq ft.
Caltulate impervious lat percentage
TOTaI impervious surface: +Lot area: Sq ft.x 100=impervious surface %
(Mitigation�is required if rotal erceeds 15?c�
"`Notice a separate grading permit needs ro be obtained if disturbed area is within the Shoreland district as indicated on previous page and meets criteria below••'
Gradin on a slope reater than 20% Grading of more than 1,000 Sq.Ft.on 12%-20%slopes
Gradin of more than 2,000 Sq.Ft.on Slopes less than 12% Grading is in excess of 10,000 Sq.Ft.
c� :. _ �.:i�a a�*riannn o�s�nr i�����Cori�ir .,. � � , , :�iu�=i�,� c�in�-����_
I(we�dedare that this application(including any aaompanying Information)has been examined by me(us)and ro the best of my(our)knowledge and belief it is true,rorrect and
tomplete.I�wel acknowledge that I(we�am(are)responsible for the detail and accuraty of all information t(we)am(are)providing and that it will be relied upon by S�wyer
' Counry in determining whether to issue a permit.I(we)further accept liability which may be a result of Sawyer County relying on this�information I(we�am(are)providing in or
with this application.I(we)consent to county officlals tharged with administering counry ordinances to have access to the above described property at any reasonabie time for the
pur e inspection.Additionally,tfie undersigned person�s�hereby give permission for access to the property for onsite inspection by Municipal Officials.
Owner� ! Owner � ` /��^��,�� ^ �
Signatu��� Printed name�� //��� Date ��
(ye� � .,,i. .,;1 Vamr-r�ou�redl
NOTICE�. �III� ]l,•r.F�.�.i�� � �� ]I���a"fro� t.�l�.t,,�:�..�i�__
f-i,t, .-.,,��,ir�-tor.')(�'�„wOn�.: �t�( n vU-"I ._'_Mti^cC�It:�p�A�oRr�,,..�1"r. rr ��. .... �...
.h�Iocal7ow�,St,],�� �tl_�ai aP,e _,s ma4'als.: c . rr,p,•rT.l,. � � �
You are responsible for tomplying with the reqWrementr ofthe Sawyer Counting Zoning Ordinances and law and regulations of the State of Wisconsin.Vou are also responsible for
complying with State and Federal laws concerning construction near or on wetlands,lakes,and streams.Failure to comply may resutt in removal or moditication of mnstruction
that violates the law or other penalties or wsis.For more informatioq visit the department of natural resomces wetlands identitication web page or contact a department of
natural resources service center(608)2fi7-3125
Issuance Information(County Use Only) Sanitary Number: p of bedrooms:
Permit Oenied tDate�: Reason for Denial:
Permit It: Issuing agent: Date:
�3 -- 3 � 5 • ;
Is Parcel a Sub-Standard Lot '�Yes (Deed of Record� � �
Is Varcel in Common Ownership ',Yes (Fused/Contiguous Loqsp if tion Required .��.Yes ���No
Is Structure Non-Contorming �Yes o tigation Attached ��;Yes .No
Granted by Variance(B.O.A.) Granted by Conditional Use
�'.Yes '�No Use it: �_Yes ��.No Case p:
Was Parcel Legally Created Yes No Were Property Lines Represented by Owner �.Ves �No
Was Proposed 6uilding Site Delineated Ves No Was Property Surveyed ��.Yes �:No
Office Comments: Zone District: Fee:
,�-� 16 �?1, 6�
Hold For Sanitary: Hold for TBa: Hold For AffldaviC Hold For Fees:
�San2020
Real Estate Sawyer County Property Listing Property Status: Current
Today's Date: 9/6/2023 Created On: 2/6/2007 7:55:21 AM
=7
�' Description Updated: 5/6/2020 � Ownership Updated: 2/6/2007
Tax ID: 12099 MEDICAL SERVICES INC ASHLAND WI
PIN: 57-010-2-41-09-15-1 01-000-000010
Legacy PIN: 010941151101 Billing Address: Mailing Address:
Map ID: .1.1-10.1 MEDICAL SERVICES INC MEDICAL SERVICES INC
Municipality: (010) TOWN OF HAYWARD 1615 MAPLE LN 1615 MAPLE LN
STR: 515 T41N R09W ASHLAND WI 54806 ASHLAND WI 54806
Description: N1/2 SW & N1/2 SEC 15 ti
Recorded Acres: 393.730 �� Site Address * indicates Private Road
Calculated Acres: 344.946 11040N STATE HWY 27/77 HAYWARD 54843
Lottery Claims: 0 11036N STATE HWY 27/77 HAYWARD 54843
First Dollar: No 11134N STATE HWY 27/77 HAYWARD 54843
Waterbody: Indian School Lake 11128N STATE HWY 27/77 HAYWARD 54843
Smith Lake Creek
Zoning: (A-1) Agricultural One ..� property Assessment Updated: 2/6/2007
(F-1) Forestry One __ _ _
ESN: 444 2023 Assessment Detail
Code Acres Land Imp.
� Tax Districts Updated: 2/6/2007 X4-EXEMPT OTHER 393.730 0 0
1 State of Wisconsin z_year Comparison 2022 2023 Change
57 Sawyer County Land: 0 0 0.0%
O10 Town of Hayward Improved: 0 0 0.0%
572478 Hayward Community School District Total: 0 0 0.0%
001700 Technical College
.
� Recorded Documents Updated: 8/11/2017 � property History
WARRANTY DEED _ _-.--.--------
N/A
Date Recorded: 12/2/1986 202882 397/460
MAINT AGREEMENT
Date Recorded: 8/7/2017 408032
ROADWAY DISCONTINUANCE ORDER
Date Recorded: 11/9/2009 36367Z
QUIT CLAIM DEED
Date Recorded: 11/9/2009 363672
❑M� Market&
Johnson
�lddir)(/rJ�m tn Ei�rr�thir�We Do
Markel 8 Johnson,Inc. 2350 Galloway Street PO Bov 630 Eau qalre,WI 54702-0630 Ph_��5.834_1213 Fex.]15.834.2331
��� � � � �
PROJECT:HAMHCIinicAddition DATE:6,�30/23
Hayward,WI
� �.
� �
Budgeted
�Description Costs CosUSF Comments
�Work Scope Cate o Breakdown
' WC 03 10 00 Concrete 490,000�: 16.13
WC 04 10 00 Masonr 609,000' 20.05
WC 05 10 00 Steel Material 607.400� 20.00
WC 05 10 01 Steel Install 242.960���. 8.00
WC 06 10 00 Buildin Works 50,000'� 1.65
WC 06 20 00 Finish Car entr Fumish � 0.00
WC 07 20 00 S ra Foam 15.000 0.49
WC 07 30 00 Air Barriers 41,104 1.35
WC 07 40 00 Metal Wall Panels 260,620 8.58
WC 07 50 00 Roofin 334,540" 11.02
WC 07 90 00 Joint Sealants 20,000��� 0.66
WC 08 10 00 Drs,Frames,Hdwr Furnish � 0.00
WC 08 80 00 Aluminum Framin &Glazin 403,700 1329
WC 09 21 16 G Board Assemblies 250,000 8.23
WC 09 30 00 Tilin 0 0.00
WC 09 50 00 Acoustical Ceilin s 0 0.00
WC 09 60 00 Floorin 0 0.00
WC 09 90 00 Ta in &Paintin 0 0.00
WC 10 26 01 Wall Protection Furnish 0 0.00
WC 14 20 00 Elevators 0 0.00
WC 21 00 00 Fire Su ression 0 0.00
WC 22 00 00 Plumbin 0 0.00
W C 23 00 00 H VAC 0.00 i ��
WC 26 00 00 Electrical 0! 0.001 ! '
Construction Budget Total 3,324,324 109.46 ��
�� �"''a
�Q ��,�����fi��
Page 1 of t
Confidential Pnnted 8I22I2023 @ 2:37 PM
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