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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 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 may result in a double permit fee and/or citation. Please stake site prior to submitting this application. PLEASE CONTACT TOWN CLERK REGARDING CONDITIONAL-USE PERMIT APPLICATIONS REQUIRED TO BE REVIEWED BY THE TOWN BOARD PRIOR TO SCHEDULED ZONING COMMITTEE HEARING. Property Owner's Name Mailing Address City, State, Zip Telephone No. PROPERTY DESCRIPTION: Information must be complete and accurate. If applicable to your property description, state lot number, block number, subdivision name, government lot number, quarter sections, etc. (Note: This may be copied from your tax notice or deed.) Legal Description Lot Block Subdivision Name Section T N-R W Tax Parcel No. (i.e. ZO-123-45678-90) Town of Property Address Lake Classification Zone District If parcel is less than ten acres, when was it created? Lot Size: Length Width Sq. Ft./Acres Mobile Home Date of Manufacture Type of Construction Estimated Cost $ Building Size: Length Width Area Sq. Ft. Accessory Building Size: Length Width Area Sq. Ft. Building Height (ft.) No. of Stories No. of Bedrooms Occupants Has any portion of the project been started? Signature of Owner or Agent: Date: Agent Address & Phone: 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. Proposed Use year-round/seasonal dwelling, accessory building, commercial building, change use of structure.) Print Form ---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 EXAMPLE A EXAMPLE B ---PAGE BREAK--- LOT LAYOUT DIAGRAM NORTH SOUTH SCALE: 1 Block = feet If drawing is not to scale, show all dimensions. ---PAGE BREAK--- NEW RESIDENCE FLOOR PLANS ATTACHED LAND-USE PERMIT LAND-USE PERMIT CONDITIONAL-USE PERMIT LAND-USE PERMIT DOUBLE PERMIT FEE DATE PAID RECEIPT NUMBER VENDOR NUMBER PERMIT NO. DATE ISSUED: ZONE CHANGE NO. VARIANCE NO. FOR COUNTY USE ONLY