HomeMy WebLinkAboutZP2026-1111ZONING PERMIT APPLICATION
Grunt County Conservation, SanitationanIREZ�� yFAR FROM THE DATE ISSUE ter WI 53813 608-723-6080
THIS PERNII
n�° /7lldS, Phone Number: lB� Property Owner! /1 /` /^ 1 �17y/�S lids �. CdY4
` f/�Email:
Mailing Address: 77 i
Property Address if different: /--
_ (� � Township:
Parcel ID:
Acres: Legal Description: Sec
T _N R�—W s� —
DESCRIBE YOUR BUILDING PROJECT J S
/ �L Intended Use(s):
Type of Structure(s): eQ r
Area Sq. Ft: �Diurnber of Floors Above Grade:
Living Quarters: Yes o Number of Bedrooms: —
Length: Width: -0
Structure Height: � Permit number
Will any of the structure(s) have internal plumbing
e No If yes, enter sanitary p
Plumbing: '�
Will you be creating a new driveway? YES olf yes, contact town chairperson to obtain a driveway permit
If yes, identify the name and phone numbers of the utilities serving this property
Will you need a Fire Ntun e? YES
Phone Number:
Electric Company: ,p ', S l __Phone Number:
Private Sewer/Well YES(O ewer & Water Utility: v phoneNumber:
umber:
Private Security Company:
c�r' Contractor Info:
/'�,�
+�
Phone Number:
Builder Name: 6 '
Proposed Setbacks: Side Yard 2:
Center Line of Road: Front Property Line:
Rear Yard Property Line: Side Yard 1:
FEE SCHEDULE: is based upon the estimated value of the proposed construction/improvement to the property with a cost of $1.00 per $11000.00 0
ase to inimum of
estimated value. For projects $300,000 or greater, mmefee is $204 00I f construction cos0 estimated cost' ts $304,000 fermi 0fee is $60 .00)
000 the p p � � 5
(Example: If the construction cost $204, r
FEE ENCLOSED: $
ESTIMATED VALUE OF WORK/IMPROVEMENT: $ PROPERTY,
AND ARE APPLYING FOR A ZONING
,[WE,THE UNDERSIGNED, ACKNOWLEDGE I/WE ARE THE OWNER(S) OF THE PROP G THIS
SED
RK
EPT. FOR THE
PO
PERMIT TO THE GRANT COUNTY CONSERVATION, SANITATI UNDERSIGNED,
ZONING
S NED ACKNOWLEDGETHATY OMAKIN SCRIBED AND
LOCATED ON THE PROPERTY DESCRIBED HEREIN• I/WE, TROVEMEN I S (DESCRIBED IN THIS APPLICATION &PLOT PLAN T
APPLICATION WE ARE RESPONSIBLE FOR ALL WMOENRK/IMP TS OF THE GRANT COUNTY COMPREHENSIVE ZONING UNDERSIGNED,
BE DONE IN ACCORDANCE WITH THE REQUIRE
MEN
FOR CONTACTING THE GRANT COUNTY CONSERVATION, SANITATION &ZONING AN T.
APPLICABLE TOWNSHIP AND COUNTY ORDINANCES AND THE LAWS OF THE STATE R OR ZONING TECHNICIAN'
ACKNOWLEDGE TO BE RES
FOR EACH REQUIRED INSPECTION AS DIRECTED BY THE ZONING ADMINISTRATOR
PROPERTY OWNER( SIGNATURE GRANTS CONSENT FOR CSZCSTAFF ANUPON
POF ABOVE INFORMAT ON. T
PROPS
TO THE GRANT COUNTY COMPREHENSIVE ZONING ORDINANCE
ING TO 2009 WISCONSIN ACT 373, NO PERMIT MAY BE ISSUED RECEIVED FOLLOWINHE PROPERTY G NOTICE: ER SIGNS THE STATEMENT
ACCORD
BELOW ACKNOWLEDGING THAT THEY HA
R ON
NOT ASSOCIATED WITH OPEN WATER CAN BE DIFFICULT TO
YOU ARE RESPONSIBLE FOR COMPLYING WITH STATE AND FEDERAL LAWS CONCERNING CONSTRUCTION NEAR
TEO THE LAW
WETLANDS, LAKES, AND STREAMS. WETLANDS THAT RESOURCES WETLANDS
OF NATURAL
IDENTIFY. FAILURE TO COMPLY MAY RESULTOFORMATION,
FO�MA�O O�SIOD, IF�ICDAEp� OF CONSTRUCTION STRUCTION THA
OR OTHER PENALTIES OR COSTS. FOR M
IDENTIFICATION WEB PAGE at ht ://dnr.wi. ov/to ic/Wetlands/identification.html ORCON'I'ACT THE DEPARTMENT NATURAL
�G
RESOURCES SERVICE CENTER. TS IS A VIOLATION OF THE GRANT COUNTY COMPRE
FAILURE TO COMPLY WITH THESE REQUIRE G RECEIVED THIS NOTICE. —� r
ORDINANCE. BY SIG Date: _ ----(p
Owners) Signature: ED JUL 13 2
dame:
OFFICE USE ONLY
Zoning District:
Minimum Setback Requirements: Side Yard Ft., Rear Yard Ft., Front Yard Ft., Center of Street/Road Ft.
Shore-land/Wetland Protection Ordinance Zoning District: F"Flood Study:
Reviewed by: ❑ Approved Denied Date
X — Coordinates Y — Coordinates Assigned Fire Number Town Notified
ZONING PERMIT CERTIFICATE OF COMPLIANCE
AND INSPECTION RECORD
Contact our department when the footprint is marked and when the project is complete at 608-723-6080
DATE INSPECTION TYPE NOTES APPROVED INSPECTOR
DENIED
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