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LWCD Application Form 04/2017 DOUGLAS COUNTY LAND AND WATER CONSERVATION DEPARTMENT 1313 BELKNAP STREET, ROOM 206, SUPERIOR, WI 54880 [PHONE REDACTED] / FAX [PHONE REDACTED] / www.DouglasCountyWI.org APPLICATION FORM Shoreland Mitigation, Stormwater Management, Non-Metallic Mining Reclamation, Erosion Control and Plan Reviews Date of application: Property Daytime Phone: Mailing E-Mail Agent Daytime Phone: Mailing E-Mail SITE INFORMATION: Property Address: of Legal Description: Tax Parcel No. Section_________ Waterbody:. TYPE OF ASSISTANCE REQUESTED: $ Cost Design, Inspection & Review of Residential Shoreland Mitigation and/or Stormwater Mgmt. Plan 450 Design, Inspection & Review of New Shoreland Mitigation and/or Stormwater Management Plan Required for Compliance (Failure on Previous Plan) 450 Inspection and Review of Residential Shoreland Mitigation and/or Stormwater Management Plan (plan designed by property owner or third party) 250 Inspection and Review of Non-Metallic Mine Reclamation Plan 1,250 Design, Inspection & Review of Shoreline Erosion Control Plan (Rip Rap Design) 500 Recording Fee – Shoreland Mitigation / Preservation Affidavit 30 TOTAL Services provided may include: site visits, compilation of supporting documentation, development of a certifiable plan or written review, and final report provided to the landowner and the Zoning Department. The Douglas County Land & Water Conservation Department will try to complete plans and reviews within ten working days of receiving the completed application, fee, and/or site plan. Notice will be given to the landowner and the Zoning Department if this timeline cannot be met. Permit Number Amount Date Paid Receipt # $ Vendor #