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HomeMy WebLinkAbout25-0268Return to: 117 E 5th Street, PO Box 58 Washburn, WI 54891 permits@bayfpermits eldcountV.wi.goy Bayfield County Planning and Zoning De ailment LAND USE PERtT APg1c4 1 ')l APP 1 0 2025 i County Use Only: 9 Submission U: t_1)-003 Permit U:__________ Date: UJ tu' SECTION A: General Information Property Owner Name: Authorized Agent Name (if applical le): G:Usn ls�sn Fan.) "ir..sfi Telephone umber: Telephone Number: Iola 436 boon E -Mail Address: E -Mail Address: tic G:11 s.n n41'Lc0s 1 Mailing Address: Mailing Address: 232 Crai j Cli a i)r City, State, Zip: City, State, Zip: H..d WT o1L Contractor: Telephone Number: E -Mail Address: Cedar a $ tone S+asr. t 6110 322 '4003 cedar, ,I S+,r a s= ., c..'n SECTION B: Property Information Project Address (if ditlerent from mailing address): 43545 c1l 'CI. C.y1 a Wr S4 21 Legal Descri lion (if additional s ace is needed attach a separate sheet): .6t3 GSA1 Ilo »t V.$ P *S Loc.;EL in GovT Le+s 1 Z e3 i. DoC- 202'4R 6055S2 Section, Township, Range: S2,1 —r41.g g4s1 Town of Crr .. av;ew Tax ID #: IL Sl9 Lot Size (Acres/Square Feet): 3, 43 Acres SECTION C: Project Information (check all that apply) Project Use is: RO Residential ❑ Commercial ❑ Municipal Project Type is: 1l New Construction ❑ Addition/Alteration (existing structure) ❑ Change Use (existing structure) ❑ Relocate (existing structure) ❑ RV Placement 21+ days ❑ Sign ❑ Establishing a Business ❑ Temporary (12 or less months) ❑ Shoreland Grading, Class A ❑ RV Placement 4+ months, Class A ❑ Other (describe): required (Total sq ft): required SECTION D: Structure Information (Does not apply to RVs and Signs, go to Section Structure 'Type is: ❑ Residence ❑ Principal Structure (describe): ❑ Accessory Structure (describe): ❑ Shoreland Exempt Structure (describe): ❑ Mobile Home (provide manufactured date): ❑ Shipping Container ® Other (describe): S a�Na Foundation Type: ❑ Basement ❑ Walkout Basement ❑ Slab ❑ Crawlspace ❑ Ground ❑ Skids LB Other (explain).t44es Jroe!H s Erist,ng Structure: Length: 8 Width: 1SHeight: 9' Proposed Structure (Provide Sq Ft based on outside dimensions, including unfinished areas, attached garages/above grade decks/porches): Basement Sq Ft: I ' Floor Sq Ft: Loft Sq Ft: 2o° Floor Sq Ft: 3`a Floor Sq Ft: 3'MS= 120 .fo-. — —' — Garage Sq Ft: Porch Sq Ft: Deck Sq Ft: Other Sq Ft (describe): Other Sq Ft (describe): Total Sq Ft: 12 o r (a. Overall Height (finished grade to peak): I # of Stories: 1 Existing # oM3edrooms on property: 3 Proposed # of Bedrooms in project: — SECTION E: RV and Sign Information (check all that apply) Sign is: N p RV is: N/A ❑ New ❑ Replacement ❑ New ❑ Replacement ❑ On -premise ❑ Off -premise ❑ 1 -sided ❑ 2 -sided Year: Vin #: ❑ On -building ❑ Multi -Tenant Length: Width: Height: Make: Model: SECTION F: Site Plan — attach a site plan or draw site plan in box below (See pages 1 & 2 of Land Use Permit Application Information for information that is required to be provided on site plan) Show location of: ❑ Driveways ❑ Frontage Roads (include name) ❑ Existing Structures ❑ Well (W) ❑ Septic Tank (ST) ❑ Drain Field (DF) ❑ Holding Tank (HT) ❑ Privy (P) ❑ Lake ❑ River ❑Stream/Creek ❑Pond ❑Floodplain ❑Wetlands ❑Slopes over 20% WeU s8' lunlf APR 1 0 2025 GA6 M1 eFC/ et Bayfield Co. Zoning De •h, S�pt� 35 T tS' •l Setback or distance from furthest extent of structure County Use Only including eaves and overhangs to (include on site plan): Verified setbacks Road Centerline — ft. ft. Notes/Comments: Front Lot Line/Right-of-Way — ft. ft. Side Lot Line 1 (NoflhDEastISouthDWestD,check one) ft. 140 % A) ft. Side Lot I,,ine 2 �& ft. 1 /1) ft. (NorthThstDSouthiD,check one) t9 — Rear Lot Line Si )1P. 1 Septic/Holding Tank 35 ft. ?7f ft. Drainfield 30 ft. J b ft. Privy .— ft. ft. Well 65j ft. ft. Existing Structure/Building SI ft. Q ft. Wetland — ft. ft. Elevation of Floodplain ft. ft. Ordinary High -Water Mark (OHWM) ft. ft. Other (describe) ft. ft. A. Lit Lrutb IKO" SECTION G: Additional Questions J ",wa_ ❑ Yes 9No Has the location of the proposed project including caves and overhangs and the sanitary system and well been staked? If no, what date will this be completed: 51,1 po25 0. Zoning De ❑ Yes 0 No Did a licensed surveyor mark lot line(s) if project is 'thin 10 feet of required setback? See page 2 of Land Use Application Information for required setbacks. N ElYes ❑ No Did property owner or applicant mark lot line(s) if project is within 30 feet of required setback? See page 2 of Land Use Application Information for required setbacks. N A Yes 0 No Is there an existing sanitary system on the property? If yes, what kind? RfDrainfield ❑ Holding Tank ❑ Municipal/Public ❑ Other (describe): ElYes [ 'No Will pressurized water be installed in the structure? If yes, what kind of sanitary system will be installed or used to manage wastewater? ❑ Drainfield ❑ Holding Tank El Municipal/Public El Other (describe): ❑ Yes C'No Will sleeping occur in the structure? If yes, contact local Uniform Dwelling Code (UDC) for approval and inspection requirements. Is the project associated with any of the following: II h 0 Rezone 0 Class A Special Use ❑ Class B Special Use ❑ Conditional Use 0 Variance Fee payment will be made via: [tCheck (attached) ❑ Cash (attached) El debit/credit/echeck (department to call once payment is ready to be taken) How would you like to receive your permit card? ToD D & 11 i ntt M n 1 ❑Mailto:OR❑Email to: T4 G; It, 96a 9tk+.•Cevh 0 Property Owner Address ❑ Agent Address 0 Contractor Address C3�Other (provide Name and Email or Address): Section H: Acknowledgement ement and Signature All Land Use Permits expire Two (2) Years from the date of issuance if construction or use has not begun. Sanitary Permit issuance, if required, needs to occur prior to Land Use Permit issuance. Failure to obtain a permit or starting construction without a permit will result in penalties. The local Town, Village, City, State or Federal agencies may also require permits. The new construction of one- & two-family dwellings requires review and approval by the local Uniform Dwelling Code (UDC) authority. Additions and alterations to one - and two-family dwellings may require review and approval by the UDC authority. All municipalities are required to enforce the UDC. If subject property is part of a Condominium Plat, applicant hereby certifies and represents that applicant has all necessary approvals and recorded documents required to complete the project for which this permit is sought including requirements set forth in Wisconsin statutes pertaining to condominium associations, the Declaration of the Condominium Association in which the property is located, and all other rules, regulations and requirements pertaining to that Condominium Association. 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 ofNatural Resources wetlands identification web page, dnr.wi.gov/tonic/wetlands, or contact a Department of Natural Resources service center (715)685-2900. I (we) declare that this application, including any accompanying 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 (are) responsible for the detail and accuracy of all information that I (we) are providing and that will be relied upon by Bayfield County in determining whether to issue a permit. I (we) further accept liability which may be a result of Bayfield County relying on this information I (we) are providing in or with this application. I (we) consent to county officials charged with administering county ordinances to have access to the above -described property at any reasonable time for the purpose of inspection. Owner(s) or Authorized Agent Printed Name: Ott r K121 &E KI e t L[ .J tl P-.} Owner(s) or Authorized Agent Signature: (.0 Date: 14 -2-02S NOTES: 1. If you are signing on behalf of the owner(s) a letter of authorization st accompany this application. 2. Specific conditions/instructions may be stated on the face of the issued Land Use Permits. Owners, agents, & contractors must all be aware of permit details & conditions and permit card must be posted on property prior to start of project. Gillingham Sauna -2 147850 North Diamond Lake Road, Cable, WI I v2 Updated: 2/11/2025 To Completed by Build Director/Project Manager: Start Date:_ Completion Date' Install Date:_ Install Method: Mule ;It t4earest Model or Full Custom Build Tier.Model c, Build Team: Lead:. Skilledpunioc . - ID Dimensions Model: Standard Model 5+( MS+LHE) Electrical Service: 60 amp (Rake Wall, Hardwired) Footprint: 8' x 1410" Hot Room: 5'2" x 5'8" Cold Room: 210" x 5'8" Entry Porch: 7'2" x 2'6" Orientation: Left Stove Model: HUUM Hive Mini 10.5 kW Controller. Uku Glass Controller Safety Pail: Yes Reflector Panels Yes Exterior Cladding Siding: Arborwood Ash I Raw Wing wall: Cedar Slats I Raw Deck Cedar Deck Boards Soffit Cedar Slats I Raw Fascia: Arborwood Ash I Paw Lighting: Standard (Cube Sconce, qty 1) Box Steps: Yes (2) Bad Type: Standard (Vented Standing Seam Metal) Benches Straight top bench I Cedar Straight bottom bench I Cedar Hot Room Finishes Partition Wall: Cedar T&G I Paw High Wall: Cedar T&G I Raw Low Wall: Cedar Slats I Paw Rake Wall: Cedar Slats I -Paw Ceiling: Cedar Slats I Raw Lighting: Standard (Under bench LED) Ventilation: Standard (through wall vents) Cold Poem Finishes Partition Wall: Cedar T&G I Paw High Wall: Cedar T&G I Raw Low Wall: Cedar Slats I Paw Rake Wall: CedarT&G I Paw Ceiling: Cedar Slats I Paw Bench: Yes l Cedar Lighting: Standard (Cube Sconce) Towel Hooks: Standard (6) Shelf: Yes Ventilation: Standard (Bath Fan) Outlets: Standard (2) Project Manager Signature: Windows: Quantity (2) Window 1: Hot Room - H Window flflft:j) APR 10 2025 zoning Dept. Glass Size: Window Wall (PO: 81" H x 72" W) Frame Finish: Black Ext. Casing: Arborwood Ash Int. Casing Finish: Cedar I Raw Glass type: Clear, "`---- Ld Window 2: Cold Room - H Window Glass Size: Tall (PO: 81" H x 30-1/2" W) Frame Finish: Black Ext Casing: Arborwood Ash Int Casing Finish: Cedar I Raw Glass type: Clear, P lirrorcd, Cmchod,- Doors Exterior Door - H Nordic Door Swing: Left hand outswing Finish: Black Ext. Casing: Arborwood Ash Int Casing: Cedar I Raw Frame: Black Glass Standard Glass type: Clear, , Hardware: Dallas Handleset Hot Room Door - White Oak Swing: Left hand outswing Finish: Black Ext. Casing: Cedar I Raw Int Casing: Cedar) Raw Frame: Black Glass: Standard (16"x60") Glass type: Clear, P'lirrorod, Emoltod,- - Hardware: Standard (Bar Pull Exterior, Oak Knob Interior, Spring Hinges) All Cedar interior in Changing Room Client Signature: AFFIDAVIT OF AUTHORITY (Trust) PURPOSE. This Affidavit of Authority is used to certify the individual submitting an application is authorized when the property is owned by a Trust. STATE OF WISCONSIN ss. BAYFIELD COUNTY The undersigned affirms and states as follows: 1. Address of Subject Property: t 75Y5 4a4 , w•tna R. (mob IC? WZ S4 1 2. The Subject Property is owned by: ( p , t NCs1AQM 6 -P, ¼ cY I IC y5T (Name of Trust) 3. The name(s) of the current Trustee(s):' _f'•• S. Ai LLIN(r{-4AM CCtS4CN GI LLINGt4-AM 4. I certify that the Trust named in paragraph 2 is valid and in effect on the date signed below. I am the duly appointed agent of the Trust named above in paragraph 2, and I have the authority under the terms of said authorization to submit an application to the Bayfield County Zoning Department concerning the Property described in paragraph 1. I further certify that the information and statements made within this affidavit are true, accurate, and complete to the best of my knowledge. 5. I am authorized by the above -named Trust to apply for and bind the Trust to the terms and conditions of any decision or permit that may be issued by the Bayfield County Zoning Department. 6. By signing this affidavit, I attest that I am unaware of any known or unknown person(s) who would contest this application. I agree to indemnify Bayfield County or such person or legal entity suffering a damage resulting from any illegalities of the application. Dated: 9-zc-zo1r )O,1O S l7lL {(Y "AM Print Name Subscribed and sworn to before me this day of Prp,4\ KIMBERLY C MASANZ Notary Public State of Wisconsin —Notarya y PIc, ir - C rn ,I County, Wisconsin My commission: 10 0(4 - Z c- �^ PROCESSING INFORMATION INITIAL PROCESSING. Once the department receives your affidavit, the department will review it for completeness. If the information is not complete, the department may reject your affidavit and the application. REQUEST FOR MORE INFORMATION. The department may request that you provide more information or evidence to support your affidavit. DECISION. The department will review all documents submitted as part of the application for registration and title, this form included, and may approve, deny or request more information. Bayfield County C L` 0 V E n Impervious Surface Calculations APR 28 2025 0 These calculations are REQUIRED per WI Admin Code NR 115.05(1)(e) and Section 13-1-32(g) and 13-1- 40(h) of the Bayfield County Code of Ordinances. The undersigned hereby makes application for construction, reconstruction, expansion, replacement or relocation of any impervious surface within 300 feet of the ordinary high water mark and agrees that all activities shall be in accordance with the requirements of the Bayfield County Code of Ordinances and all other applicable ordinances and the laws of the State of Wisconsin. Pursuant to Chapter 1, Title 13, Section 13-1-106(d) of the Bayfield County Zoning Ordinance(s), Planning and Zoning Department employees assigned to inspect properties shall have access to said properties to make inspections. Property Owner(s): GILLIN6NAp "-ce keST Qu �TE6S I aop lTl��(;J64}AM a ST 1LL- ti ' LtA� Mailing Address: Property Address 212 Cro O. psocVI 6'fb1W c jumu t.t CAS LC VJZ ≤42( Legal Description: Section, Township. Range 114, 1/4, // Sec C2 ? Township6t$) N, Range (6) W Authorized Agent/Contractor Gov't Lot (r)i2�C3� Lot # 3 CSM# 1106 L s- qj Vol & Pag - �s Lot(s) # Block(s) # Subdivision Town of: r/,, G,'AV&1r W Parcel ID # (PIN #) Tax ID # Date: 04-021-2-tiy- 2q-1OS-602-243000 160'1 yl_Slzoz.S Impervious Surface: An area that releases as runoff all or a majority of the precipitation that falls on it. "Impervious surface" excludes frozen soil but includes rooftops, sidewalks, driveways, parking lots and streets unless specifically designed, constructed and maintained to be pervious. Calculation of Impervious Surface: Percentage of impervious surface shall be calculated by dividing the surface area of existing and proposed impervious surfaces on the portion of a lot or parcel that is within 300 feet of the ordinary high water mark by the total surface area of the lot or parcel, multiplied by 100. Impervious Surface Standard: Allow up to 15% impervious surface but not more than 30% impervious surface on the portion of a lot or parcel that is within 300 feet of the ordinary high water mark. A permit can be issued for development that exceeds 15% impervious surface but not more than 30% impervious surfaces with a mitigation plan that meets the requirements of the Bayfield County Ordinance(s). Existing Impervious Surfaces: For existing impervious surfaces that were lawfully placed when constructed but that do not comply with the standards in Section(s) 13-1-32(g) and Section 13-1-40(h), the property owner may do any of the following: a. Maintenance and repair of all impervious surfaces: b. Replacement of existing impervious surfaces with similar surfaces within the existing building footprint; c. Relocation or modification of existing impervious surfaces with similar or different impervious surfaces, provided that the relocation or modification does not result in an increase in the percentage that existed on the effective date of the county shoreland ordinance, and meets the applicable setback requirements in Section 13-1-32. Impervious Surface Item Dimension Area (Square Footage) Existing House 2 x 2R o 4 Existing Apessory Buildin arage Existing Sidewalk(s), Patio(s) & Deck(s) D r� 4 �d Existing Covered Porch(es), Driveway & Other Structures 1O X go 3 goo Proposed A ' lon/House Proposed Aetessory Building! arage Sidewalk(s) s) Patio(s) Proposed d� 2O,,3 x 3 (,o Propos overed Porch(es) & Dec ProposedXveway Proposed Other Structuress,d uN� x i 5 Total: a. Total square footage of lot: I Lj b. Total impervious surface area: ' ; 641 c. Percentage of impervious surface area: 100 x (b)/a = L4 Z % If the proposed impervious surface area is greater than 15% mitigation is required. Total square footage of additional impervious surface allowed: @ 15% fS 3 60 @ 30% Issuance Information (County Use Only) Dateof Inspectbn: Inspection Record: Zoning District { Lakes Classification { ) Condition(s): Stormwater Management Plan Required: OYes ONo Signature of Inspector: Date of Approval: u/formslimpervioussurface Created: May 2012 (# pr 2016; Sept 2020) Proofed by: Land Use Permit Application Review Checklist Submission #: What zoning district is the project located in? R-1 ❑ R-2 ❑ R-3 ❑ R-4 ❑ R-RB ❑ C ❑ 1 ❑ M ❑ A-1 ❑ A-2 ❑ F-1 ❑ F-2 ❑ W ❑ M -M ❑ Yes ❑ No Is lot substandard (does not meet current zoning dimensional requirements)? Deed of record: ,Idlles ❑ No Is the project located in the Shorelands (Shorelands are lands within 300 feet of a river/stream OR landward side of floodplain OR 1000 feet of a lake/pond/flowage, whichever is greater)? es ❑ No Is impervious surface required? (Required if riparian lot OR lot is entirely within 300 feet of OHWM of navigable waterway) ❑ Yes No Is the project located in the Floodplain? Zone: ❑ Yes lo Are there wetlands on the property? ❑ Yes No Is project associated with a nonconforming use or structure? ❑ Yes 1 No Is project associated with a variance? Case #: ❑ Yes 7No Is project associated with a Special B or Conditional Use Permit? Permit #: ❑ Yes o Is the project associated with a Special A Use Permit? ❑ Yes o Does the project require sanitary? ❑ Existing ❑ New ❑ Intercept 0 Reconnect 0 Non -Plumbing ❑ Public Sanitary Permit #: ❑ Yes ❑ No Does the project require mitigation? Implementation Deadline: Date of Compliance: ❑ Yes ❑ No Does the project require an affidavit? Affidavit #: ❑ Yes ❑ No Did licensed surveyor mark lot line(s), if project is within 10 feet of required setback? ❑ Yes ❑ No Did applicant/property owner mark lot line(s), if project is within 30 feet of required setback? Project use is?Residential ❑ Commercial 0 Municipal Project type is?'New Construction ❑ Addition/Alteration ❑ Change Use ❑ Relocate ❑ RV Placement ❑ Sign ❑ Establishing a Business ❑ Temporary ❑ Shoreland Grading 0 Other, describe: Structure Type is: O Residence ❑ Principal Structure Accessory Structure O Boathouse (one story only) ❑ Open-sided/Screened Structure (gazebo, etc.) ❑ Stairway to navigable waters ❑ Mobile Home ❑ Shipping Container ❑ Other, describe 54.MVIg Total Sq. Ft. of Project: Number of Stories: Overall Height: Calculated Fee Category: ❑ Residential Principal Structures - $0.75/square foot (minimum $125) ❑ Habitable Residential Accessory Structures - $0.50/square foot (minimum $75) ,ion -Habitable Residential Principal and Accessory Structures - $0.20/square foot (minimum $75) ❑ Commercial/Municipal Principal Structures - $0.75/square foot (minimum $125) ❑ Commercial/Municipal Accessory Structures - $0.20/square foot (minimum $75) Calculated Fee Amount: Additional Fees: O Return Inspection O Land Use Revisions O Special Use Permit - Class A ❑ After -the -Fact (ATF) ❑ Floodplain ❑ Shoreland - Impervious Surface ❑ Shoreland - Non -Conforming, etc. O Tower Siting/Collocation 1 ❑ Tower Collocation 2 ❑ Metallic Mine ATF Fee Amount: Inspected by: % 4 S Date of Inspection:_ ! 2J Re -Inspected by: Date of Re -Inspection: Denied by: Reason for Denial: Date Denial Letter Mailed: Approved by: Date of Approval: Condition(s): / / llust meet and maintain setbacks from furthest extension of structure including eaves and /overhangs. ❑ For personal storage only. ❑ For personal residence only. -L7 Not for human habitation or sleeping purposes. /❑Town/State/DNR/Federal may require permitting ❑ A Uniform Dwelling Code (UDC) Permit from the locally contracted UDC Inspection Agency must be obtained prior to the start of construction. ❑ A Uniform Dwelling Code (UDC) Permit from the locally contracted UDC Inspection Agency must be obtained prior to the start of construction (if applicable). ""a Use best management practices to limit and prevent erosion during construction. ❑ This permit cannot be transferred if property is sold. ❑ A Bayfield County Health Dept permit is required. ❑ Check with Town regarding room tax. ❑ Short -Term Rental is for a maximum occupancy of persons. 0 Sign must meet the requirements of Article E of the Bayfield County Zoning Ordinance. To be constructed per plan. 0 Adhere to privy agreement. ❑ Temporary permit allowing existing structure for a period of less than 1 year. ❑ RV may not be used for permanent residence or storage. ❑ RV allowed for ❑ RV must be removed by 2TNo sewer and pressurized water allowed in the structure. JcNo plumbing or plumbing fixtures allowed. ❑ No additional sleeping areas allowed without obtaining necessary sanitary permit(s). ❑ Land use permits shall be required for any new residence, any building or structure erected, relocated, rebuilt, or structurally altered ❑ Land use permits shall be obtained prior to the initiation of construction or a change in land use ❑ Requirements (e.g., permits/licensing/tax) of Local Town, Village, City, State or Federal agencies are required ❑ Sanitation requirements must be met (if applicable) ❑ Additional conditions may be placed and need to be adhered to at the time of permit issuance Other Conditions: B-YFIELD Bayfield County Planning & Zoning Department 117 E 5w Street P.O. Box 58 Washburn, WI 54891 Phone: 715-373-6138 Fax: 715-373-0114 Property Owner: Submission Number: GILLINGHAM FAMILY TRUST LU-01588 282 CROIX RIDGE DRIVE HUDSON, WI 54016 Transaction Number: LU-01588-2B3FA Description Amount Shoreland - Impervious Surface $25.00 Verified Fee Amount $0.00 Habitable Residential Accessory Structures - $75.00 $0.50/ square foot (minimum $75) Total: $100.00 Payment Amount: $200.00 Reference: 179 Paid by: TODD S & KRISTEN J GILLINGHAM Payment Type: Check Transaction Date: undefined Receipt of payment does not guarantee eligibility of permit and is not proof of issuance of a permit. Town, City, Village, State or Federal Permits May Also Be Required Substandard — / Nonconforming — No Shoreland - Yes / Impervious Surface - Yes Floodplain - No / Wetlands - No Mitigation - / Affidavit #: LAND USE - X SANITARY — SPECIAL A — SPECIAL B/CONDITIONAL — BOA — No. 25-0268 Tax ID: 16819 Issued To: GILLINGHAM FAMILY TRUST WEATHERIZE AND POST THIS PERMIT ON THE PREMISES DURING CONSTRUCTION Location: S29 - T44N - R06W Town of Grand View Legal Description: LOT 3 CSM #1106 IN V.7 P.75 (LOCATED IN GOVT LOTS 1, 2 & 3) IN DOC 2024R-605552 Residential Structure in R-1 zoning district For: New Construction, Accessory Structure on Tubes, Footings [120 Total sq. ft.] Height of 9' (Disclaimer): You are responsible for complying with state and federal laws concerning construction near or on wetlands, lakes, and streams. Any future expansions or development would require additional permitting. Condition(s): See back of card NOTE: This permit expires two years from date of issuance if the authorized construction work or land use has not begun. Changes in plans or specifications shall not be made without obtaining approval. This permit may be void or revoked if any of the application information is found to have been misrepresented, erroneous, or incomplete. This permit may be void or revoked if any performance conditions are not completed or if any prohibitory conditions are violated. Scott Roush Authorized Issuing Official May 16, 2025 Date Condition(s): Must meet and maintain setbacks from furthest extension of structure including eaves and overhangs. Not for human habitation or sleeping purposes. Use best management practices to limit and prevent erosion during construction. To be constructed per plan. No sewer and pressurized water allowed in the structure. No plumbing or plumbing fixtures allowed.