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Revised 11/2011 DOUGLAS COUNTY PLANNING, ZONING & LAND INFORMATION OFFICE 1313 BELKNAP STREET, ROOM 206 SUPERIOR, WI 54880 715 – 395-1380 / FAX 715 – 395-7643 APPLICATION FOR LAND-USE & CONDITIONAL-USE PERMITS APPLICATION WILL NOT BE PROCESSED WITHOUT SIGNATURE & DATE ON FRONT AND BACK OF THIS PAGE. TO WHOM IT MAY CONCERN: The undersigned hereby applies for a permit to do work herein described in this application. The undersigned agrees that all work will be done in accordance with the Douglas County Zoning, Shoreland Zoning, Subdivision Control, Floodplain Ordinances and with all laws of the State of Wisconsin applicable to said premises. Do not start any construction until this office has issued a permit. Failure to obtain the necessary permits will result in a double permit fee and/or citation. CONDITIONAL-USE PERMIT APPLICATIONS: PLEASE CONTACT TOWN CLERK - APPLICATIONS REQUIRE REVIEW BY YOUR TOWN BOARD PRIOR TO SCHEDULED ZONING COMMITTEE PUBLIC HEARING Property Owner’s Name: Mailing Address: City, State, Zip Telephone: E-mail Address: PROPERTY DESCRIPTION: Information must be complete and accurate. If applicable state lot number, block number, subdivision name, government lot number, quarter sections, etc. (Note: This may be copied from your tax notice or deed.) Tax Parcel Section________Town_______N_Range_______W_ Town of: Parcel Acreage or Size: Property Address: Legal Description: Name of Adjacent Lake or Stream: Lake Class____________Zone District__________ Type of construction: (new building, manufactured home, addition to seasonal dwelling, alteration to accessory building, relocate structure) Proposed Use: (year-round or seasonal dwelling, accessory building, commercial building, change use of structure) Length Width Area (sq ft) Height Stories # Bedrooms # Occupants Est Cost - $ Dwelling Accessory Bldg Accessory Bldg Please stake building site prior to submitting this application. Has any portion of the project been started? Yes No Sanitary Permit Signature of owner or agent: Agent address & phone number: By signing this application, I give my/our permission to allow a site inspection to be made of the site by Zoning staff and allow photographs to be taken if necessary. PERMIT NO: DATE ISSUED: ZONE CHANGE NO: VARIANCE NO: Type Amount Date Paid Receipt # Land Use $ Land Use $ Cond. Use $ A-T-F Double $ Vendor # ---PAGE BREAK--- LOT LAYOUT DIAGRAM SCALE: 1 Block = feet If drawing is not to scale show all dimensions N 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 Natural Resources wetlands identification page or contact a Department of Natural Resources Service Center. Additional responsibilities for owners of projects disturbing one or more acre(s) of soil I understand that this project is subject to regulations regarding erosion control and storm water management and I will comply with those standards. For more information, visit the Department of Natural Resources or contact a Department of Natural Resources Service Center. Applicant’s Signature: ---PAGE BREAK--- LOT LAYOUT DIAGRAM TO BE COMPLETED ON THE NEXT PAGE Show location and size of the existing and proposed structure(s). Show location of proposed/existing sanitary system/privy, drainfield and well. Show the distance in feet to the following on the diagram: New structure to all lotlines including ordinary high water mark of a lake, river or stream. New structure to centerline of road. Indicate road name. Sanitary system/privy to closest lotline, new structure, existing or proposed well. Sanitary system/privy to the ordinary highwater mark of a lake, river or stream. LOT LAYOUT DIAGRAM EXAMPLES LOT LAYOUT DIAGRAM N EXAMPLE A EXAMPLE B NEW RESIDENCE FLOOR PLANS ATTACHED ---PAGE BREAK--- NEW RESIDENCE FLOOR PLANS MUST BE ATTACHED TO APPLICATION__