SUBMIT: COMPLETED APPLICATION, TAXSTATEMENT AND FEE TO:

Bayfield CountyPlanning and Zoning Depart.

PO Box 58Washburn,WI 54891

(715) 373-6138

APPLICATION FOR PERMITBAYFIELD COUNTY, WISCONSIN

INSTRUCTIONS: No permits will be issued until all fees are paid.Checks are made payable to: Bayfield County Zoning Department.

DO NOT START CONSTRUCTION UNTIL ALL PERMITS HAVE BEEN ISSUED TO APPLICANT.

Permit S:

'v| Date:

'r^Refund:

r?l-A^/c^C^'Qr^fr6^£r?s~<3-'5?sl \i-l-75

Original Application MUST be submitted FILL OUT IN INK (NO PENCIL)

TYPE OF PERMIT REQUESTED-^- ^sJ-ANDUSE D SANITARY D PRIVY D CONDITIONAL USE D SPECIAL USE D B.O.A. D OTHER.

ner.s Tjaffie:

^Sterne^i/Address o.f Propertvi

W^WhiS/7^ Kd

ress: / | | Lity/State/flp:

^'f'^WP^^ I IT®%w l\f/^W/City/State/Zip:

CitYi/State/Zip:

hJSWM^ ^ SLiWf^57-^2-02^

Telephone:

Cell Phone:

Cont/actor:

// \e>(^ /%^77/^ ^-tr^ i&Contractor Phone:

•llS-H/^o^j Jr^ ^^b^̂Ay/s

Plumber Phone:

7/^-^y-^/Authorized Agent: (Person Signing Application on behalf of Owner(s))

A/^Agent Phone:

A///4

Agent Mailing Address (include <jty/State/Zip)

A//A

WrittenAuthorization

Attacheda Yes ^QjNo

PROJECTLOCATION

Legal Description: (Use Tax Statement) 3, ,9^Recorded Document: (Showing Ownership

c^Dl'S ft, 5'7S"^?/

Gov't Lot Lot(s) CSM Vol & Page CSM Doc # Lot(s) <f Block tt Subdivision:

Section , Township N,Range <^5 w Town of:

lA/ashhi/^'i^Lot ?i

Qo_ '3SL

D Shoreland

5( Non-Shoreland

Is Propertv/Land within 300 feet ot Kiver, Stream (incl. intermittent)

Creek or Landward side of Floodplain? If yes—continue —^.

L_: Is Property/Land within 1000 feet of Lake, Pond or Flowage

If yes—continue —^-

Oistance Structure is from Shoreline :

feet

Distance Structure is from Shoreline :

.feet

is your Propertyin Floodplain

Zone?

U Yes

^10

LAre Wetlands

Present?

r I Yes

& No

Value at Time

of Completion

* include

donated time

& material

$LIDO^T

Project

>^ New Construction

; Addition/Alteration

D Conversion

Relocate (existing bldg)

Run a Business on

Property

D

Projectft of Stories

1-Story

1-Story +

Loft

X^Z-Story

Project

Foundation

^^Basement

Foundation

i_j Slab

r,

Use

Year Round

0

(

Total# of

bedroomson

property

n i

X3)

None

What Type of

Sewer/Sanitary System(s)

Is on the property or

Will be on the property?

ij Municipal/City

)sL(New) Sanitary Specify Type.y.ohv&a^^f

3 Sanitary (Exists) Specify Type:

Li Privy (Pit) or U Vaulted (min 200 gallon)

Li Portable (w/service contract)

i Compost Toilet

None

Type ofWater

on

property

i City

>fyle\\

[_i

Existing Structure: (if addition, alteration or business is being applied for)

Proposed Construction: (overall dimensions)

Length: /(//A-Length: ^^'

Width:Width: "7C!

Height:Height: -Z^>'

Proposed Use

residential Use

D Commercial Use

D Municipal Use

•/

^_A

DDaDa

aa

.X-

Proposed Structure

Principal Structure (first structure on property) ZBX^'2- -h (8x1^Residence (i.e. cabin, hunting shack, etc.) +~^- 1 -(-ic^Ol^-ff^/S-p

with Loft

with a Porch

with (2nd) Porch

with a Deck

with (2nd) Deck

with Attached Garage

Bunkhouse w/(Li sanitary, or L1 sleeping quarters, or Fi cooking & food prep facilities)

Mobile Home (manufactured date)

Addition/Alteration (explain)

Accessory Building (explain)

Accessory Building Addition/Alteration (explain)

Special Use: (explain)

Conditional Use: (explain)

Other: (explain) AAUi'bS^DM. 6fN 'N 'l'=^.Tt€?(\T

(.

Dimensions

{=>0

^D{•

11!_

1((((({

(((

~̂3-4^-~7

'2^

w

xZ6X^5

:̂x£x

x

T2^x

x

x

x

x

x

x

J3_

)1_L

))

J_

_L))))))

)))

Square

Footage

l^H- w

^^19^/

~78LT

79^"

?

FAILURE TO OBTAIN A PERMIT or STARTING CONSTRUCTION WITHOUT A PERMIT WILL RESULT IN PENALTIESI (we) declare that this application (including any accom(are) responsible for the detail and accuracy of all inforresult of Bayfield County relying on this informati<property at any reasonable time fo^he purposej

Owner(s);(If there are Multiple Owners}

Authorized Agent:

information) has been examined by me (us) and to the best of my (our) knowledge and belief it is true, correct and complete. I (we) acknowledge that I (we) am/e) am (are) providing and that it will be relied upon by Bayfield County in determining whetherto issue a permit. I (we) further accept liability which may be a

iijje) provi^BgTFT&rsyith this application. I (we) consent to county officials charged with administering county ordinances to have access to the above described

}/{ I i I /h^h^ Date Dl-^r-2>ljSTsign or letter(s) of authorization must accompany this application)

Address to send permit

(If you are signing b<i behalf of the owner(s) a letter of authorization must accompany this application)

S?^5 Z^Az^ \AJ IV^h^K \A}] ^/^/

Date

Attach

Copy of Tax StatementIf you recently purchased the property send your Recorded Deed

Original Application MUST be submitted

APPLICANT - PLEASE COMPLETE PLOT PLAN ON REVERSE SIDE

R DraworSketchyour Property (r.egar.dless of what you are applying for)

5how Location of:

'2j Show /Indicate:'(3) Show Location of (*):(4) Show:

(5) Show:(6) Show any (*):(7) Show any(*):

Fill Out in Ink - NO PENCILProposed Construction

North (N) on Plot Plan(*) Driveway and (*) Frontage Road (Name Frontage Road)All Existing Structures on your Property(*) Well (W); (*) Septic Tank (ST); (*) Drain Field (DF); (*) Holding Tank (HT) and/or((*) Lake; (*) River; (*) Stream/Creek; or (*) Pond(*) Wetlands; or (*) Slopes over 20%

) Privy (P)

ST>F^

]'^C?^tC7^A/

4-

5^? CL^aa^~©v' w\ev^ ofe-feuf

ftm/<s^^

Please complete (1) - (7) above (prior to continuing)

(8) Setbacks: (measured to the closest point)Changes in plans must be approved by the Planning & Zoning Dept.

Description

Setback from the Centerline of Platted Road

Setback from the Established Right-of-Way

Setback from the North Lot Line

Setback from the South Lot Line

Setback from the West Lot Line

Setback from the East Lot Line

Setback to Septic Tank or Holding Tank

Setback to Drain Field

Setback to Privy (Portable, Composting)

SetbackMeasurements

^ <^<£?0> Feet

/V S'7cy Feet

/v (^7 5x?7 Feet~ Cc'C^ Feet

-~- ty ^^? Feet^Cf0 Feet

-^ SC? Feet

/^ Lf('} Feet

Feet

Description

Setback from the Lake (ordinary high-water mark)

Setback from the River, Stream, Creek

Setback from the Bank or Bluff

Setback from Wetland

20% Slope Area on the property

Elevation of Floodplain

Setback to We!!

SetbackMeasurements

.U/^ FeelhJ'ffit Fee-

FeeT

,4- Fee

i Yes J><tjoFee

^0 Fee

Prior to the placement or construction of a structure within ten (10) feet of the minimtim required setback, the boundary line from which the setback must be measured must be visible from one previously surveyed comer to thother previously surveyed corner or marked by a licensed surveyor at the owner's expense.

Prior to the placement or construction of a structure more than ten (10) feet but less than thirty (30) feet from the minimum required setback, the boundary line from which the setback must be measured must be visible from

one previously surveyed comer to the other previously sun/eyed comer, or verifiable by the Department by use of a corrected compass from a known comer within 500 feet of the proposed site of the structure, or must bemsj^ed^y^Jicensed^uryey^

(9) Stake or Mark Proposed Location(s) of New Construction, Septic Tank (ST), Drain field (DF), Holding Tank (HT), Privy (P), and WelL(W).

NOTICE: All Land Use Permits Expire One (1) Year from the Date of Issuance if Construction or Use has not begun.

For the Construction Of New One & Two Family Dwelling: ALL Municipalities Are Required To Enforce The Uniform Dwelling Code.

The local Town, Village, City, State or Federal agencies may also require permits.You are responsible for complying with state and federal laws concerning construction near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult

to identify. Failure to comply may result in removal or modification of construction that violates the law or other penalties or costs. For more information, visit the department of naturalresources wetlands identification web page or contact a department of natural resources service center (715) 685-2900.

Issuance Information (County Use Only) Sanitary Number:Sl - / g-5

# of bedrooms:

{^Sanitary Date:

5-Si^- 3-1Permit Denied (Date): Reason for Denial:

Permit #:'^ -GCQQ Permit Date ^-^-fflIs Parcel a Sub-Standard Lot

Is Parcel in Common Ownership

Is Structure Non-Conforming

a Yes (Deed of Record)

a Yes (Fused/Contiguous Lot(s))

a Yes

Mitigation Required

Mitigation AttachedD Yes

a Yes

No

No

Affidavit RequiredAffidavit Attached

a Yes

D Yes

No

No

Granted byj/ariance (B.O.A.)

LJ Yes S^fis Case #:

Was Parcel Legally Created

Was Proposed Building Site Delineated

\e.s 0 No

i'es D No

Previously Granted by Variance (B.O.A.)

D Yes OJW Case #:

Were Property Lines Fiepreserrted by Owner

Was Property Surveyed

.B-Y6S

J^fwDN.a !'•'-

Inspection Record: 5, ^ ^|] , ^r^ ^^ ,^ ^^ ^ ^l d U fff ^ QQ ^C

f^^\. f^-fp^.^ c'c^t-c^f^^^-.Zoning District ( ^.^j

Lakes Classification ( —

Date of Inspection: 5- ^ ' ^l inspectedby: .^^ |J,,^J Date of Re-lnspection:

Condition(s): Town, Committee or Board Conditions Attached? D Yes D No-(If No they need to be attached.)

/7f<^ ah-k^ CL Ofl'^^ D^-/lt^ C^ (u^^-) pe/^ <'-<r--A^ •^ (e^fl-/

UI>C. ii-^^chir^ ^^Mfy pr^ ^ A-^ o( €s>-^^^ . ^o^ ^^/ ^^ fl^'iJei^'S-^-i"^-c» -

Signature o^spectorl .-^J ^^ ^^jP Date of Approval:?.^..

Hold For Sanitary: D Hold For TBA: D Hold For Affidavit: D Hold For Fees: D D

®®August 2017 3c+ 2019)

^ge, State or Federal[iso Be Required

x21-18S

j, - Class A

nONAL-

BAYFIELD COUNTY

PERMITWEATHERIZE AND POST THIS PERMIT

ON THE PREMISES DURING CONSTUCTION

21-0034

SE V4 of

Issued

NW 1/4

Lot

To: Michael

Section 34

Block

Sterner

Township 49

Subdivision

N. Range 5 w. Town of

CSM#

Washburn

lential Use: [ 2- Story; Residence (50' x 28') = 1.400 sa. ft: Porch #1 (4' x 14') = 56 sq. ft;Porch #2 (14' x 14') = 196 sq. ft; Mudroom (14' x14') = 196 sq. ft.Attached Garage (28' x 28') = 784 sq. ft. ] Total Overall = 2,632 sq. ft.

Any future expansions or development would require additional permitting.

(s): Must obtain a uniform dwelling code permit from the locally contracted UDC inspectionagency prior to start of construction. Must meet and maintain setbacks.

iplying with state and federal laws concerning construction near or on wetlands, lakes, and streams. Wetlands that are not associated with open water can be difficult to identify. Failure to comply may result in removal orthat violates the law or other penalties or costs. For more information, visit the department of natural resources wetlands identification web page or contact a department of natural resources service center(715)685-2900.

Todd Norwoodlit expires one year from date of issuance if the authorized construction work or

[land use has not begun.

; in plans or specifications shall not be made without obtaining approval. Thisbe void or revoked if any of the application information is found to have been

tnted, erroneous, or incomplete.

^may be void or revoked if any performance conditions are not completed

ibitory conditions are violated.

Authorized Issuing Official

March 23, 2021

Date