HomeMy WebLinkAbout26-0068Return to: County Use Only:
117 E 5'h Street, PO Box 58 Bayfield County Planning and Zoning Department Submission #: LU- Ob123
Washburn, WI 54891 LAIYA_II,SF,PEI3�IIT APPLICATION Permit #: L' 8
permits@bayfieldcounty.wi.gov R��CC:: �IVVtGUv Date: b&oa(o
3 f
SECTION A: General Information
Pro y Owyer Name: L L Bayfield Co. Autho d Agent me (if applicable):
Ibb I . " Yl L" n and i tic C C
Telephone Number: Telephone Number:
aka
3
E- ail Address: E -Mail Address:
V oD 1cc-it f r et i/e-2o12
Mp',lin Address' Mailin A dress:
City State, Zip: City, tale, Zip:
r file z , S '!$
Contractor: Telephone Number. E -Mail Address:
SECTION B: Property Information
Projeci Address (if differenl from mailing ad ):
cr(rrgr 84a.CN ox swit/
Legal escri io (if additional s ace' needed attach a sep• to sheep:
n Lob < f CSAAl Ifl1t ek PIl /2cr
Section, Township, Range: • 3— Town of
Tax ID #: Lot Sire (Acres quart Feet):
SECTION C: Project Information (check all that apply)
Project Use is: lRcsidentia1 ❑ Commercial ❑ Municipal If Commercial, estimated cost of construction: $
Project Type is: O New Construction ❑ Addition/Alteration (existing structure)
Of Change Use (existing structure) ❑ Relocate (existing structure) O RV Placement 21+ days
❑ Sign O Establishing a Business O 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 B)
Structure Type is: 'Residence ❑ Principal Structure (describe):
❑ Accessory Structure (describe): O Shoreland Exempt Structure (describe): O Mobile Home (provide manufactured
date):
❑ Shipping Container O Other (describe):
Foundation Type:
[Basement O Walkout Basement O Slab ❑ Crawlspace ❑ Ground ❑ Skids O Other (explain):
Existing Structure: Length: Width: Height:
Proposed Structure (Provide Sq Ft based on outside dimensions, including unfinished areas, attached garages/above grade
decks/porches):
Basement Sq Ft: 1 ° F o q Ft: Loft Sq Ft: 2"" Floor Sq Ft: 3"t Floor Sq Ft:
Garage Sq Ft: Pore Sq Ft: Deck Sq Ft: Other Sq Ft (describe): Other Sq Ft (describe):
Total Sq Ft: Overall Height (finished grade to peak):
# of Stories: Existing # of Bedrooms on property: Proposed it of Bedrooms in project: O
SECTION E: RY and Sign Information (check all that apply)
Sign is: RP is:
❑ New O Replacement ❑ New ❑ Replacement
❑ On -premise ❑ Off -premise
❑ 1 -sided ❑ 2 -sided Year: Vin #:
❑ On -building O Multi -Tenant
Length: Width: Height: Make: Model:
RECEIVED
SECTION G: Additional Questions CO LULO
fB3Yes
❑ No
Has the location of the proposed project including eaves and overhangs and the Mqigstem and well been
staked? If no what date will this be corn leted: P
Yes
O No
Did a licensed surveyor mark lot line(s) if project is within 10 feet of required setback? See page 2 of Land Use
Application Information for required setbacks.
99 Yes
O 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.
Yes
❑ No
Is there an existing sanitary system on the property? If yes, what kind?
❑ Drainfield Holding Tank ❑ Municipal/Public ❑ Other (describe):
es
o
Will pressurized water be installed in the structure? If yes, what kind of sanitary system will be installed or used
to manage wastewater?
O Drainfield ❑ Holding Tank ❑ Munici aliPublic ❑ Other (describe):
❑ Yes
ANo
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:
❑ Rezone O Class A Special Use O Class B Special Use ❑ Conditional Use O Variance
Fee payment will be made via:
❑ Check (attached) O Cash (attached) O debit/credillecheck (department to call once payment is ready to be taken)
How would you like to receive yqur permit card? n
O Mail to: OR ¢) Email to: )(pr'.rte./2L�%�jn`a• /•<.c•+�
O Property Owner Address O Agent Address O Contractor Address ❑ Other (provide name and email or address):
Section H: Acknowledgement 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 of Natural
Resources wetlands identification web page, dnr.wi.govitopie/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.
k
Owner(s) or Authorized Agent Printed Name: C to
Owner(s) or Authorized Agent Signature: Date:
NOTES:
1. If you are signing on behalf of the owner(s) a letter of authorization must 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.
Application Page 3
JC Yes ❑ No Will new electrical installation occur with project/structure? If yes, contact State for inspection requirements.
EI Yes ❑ No Will new plumbing installation occur with project/structure? If yes, contact State for inspection requirements.
❑ Yes 19 No Is the project/structure to be used for commercial purposes? If yes, contact the State of Wisconsin Commercial
Buildings & Structures to determine if they require review and approval.
O Yes 0 No Is the project located in the Floodplain? If yes, additional materials and fee will be required. Reference the
FEMA Map (https://insc.fcma.gov/portal/hornc) and Title 13, Chapter 2 of Bayfield County Zoning Ordinance
❑ Yes 1 0 No I Is the project located in the Shorelands, within 300 feet of a river/stream OR landward side of floodplain OR
❑ Yes
KNo
is your property a waterfront lot and will any part of your project be located within 300 feet of the water OR is
your entire lot located within 300 feet of the water? If yes to either, complete and include Impervious Surface
Form (https://www.bayfieldcounty.wi,gov/DocumentCenter/View/3 I 5911mervious-Surface-PDF .
❑ Yes
No
Are there wetlands on the property. If yes, wetland regulations will apply. A 25 -foot setback is required to any
mapped wetlands. Reference Department of Natural Resource Surface Data Viewer Map
rlt s://dorms s.wi. ov/II5/?Viewer=SWI)V .
❑ Yes
No
If applicable, did you contact the road authority to see if a driveway permit or regulations apply to placement of
driveway?
O Yes I tM No I Was the property purchased recently? If yes, include a recorded deed. A copy of recorded deed can be acquired
i g Yes
❑ No
Is a site plan included with all information requested on Page I of the Land Use Permit Application
Information? If no, a site plan with all applicable information on Page 1 is required for all submissions.
C9 Yes
O No
Is a floor plan(s) included with all information requested on Page 4 of the Land Use Permit Application
Information? Floor plans are required for residences, commercial buildings, or additions/alterations to these
structures.
❑ Yes
®INo
If structure is in Shorelands, have building elevations with all information requested on Page 5 of the Land Use
Permit Application Information been included?
❑ Yes
N No
is this application to correct a violation or has the project already commenced? If yes, at minimum an after -the -
fact fee will apply. If not permittable, the structure will need to be removed.
❑ Yes
II No
If addition, does the existing structure meet required setbacks, see Page 2 of the Land Use Permit Application
Information? If no, be aware that it is the property owner's responsibility to show the structure was legally
placed and there may be limitations to expansion of the structure, see Bayfield County Section 13-1-40
l Yes O No Is the use of the project/structure allowed per Bayfield County Section 13-1-62
(https://www.haylielcicountv.wi.aov/7 I lffitic-13---/onhta-Codc). If no, be aware it is the property owner's
responsibility to show the use was legally established and there may he limitation to expansion of the use, see
BayfieldCoun Section 13-1-O0 tt :://www.ba fieldcotmt .wi.govi7ll(fitle-l3---Zoni» -Code).
. Yes ❑ No Have all fees been included with the completed application? See Fee Schedule on website
(https:/Avww.haylieldcountv.wi,pov/1389/Fco-Schedule). If no, all applicable fees need to be paid before permit
❑ Yes l�' No Is property owned by multiple owners or is someone aside from the property owner applying? If yes, a Letter of
Authorization Form needs to be included. Form available on website
(http://www.hayficIdcounIy.wi.gov/l340/Applicatioiis-Fonns).
kjYes ❑ No Is property owned by a Trust or Business entity (LLC, Corp., etc.)? If yes to either, an Affidavit of Authority
needs to be included. Forms available on website (lutes://www.bavficidcounty.wi.aov/1340/Applications-
) Yes 1 O No I Is Land Use Application completed and signed?
RECEIVED
FEB 232026
Bayfield Co.
Planning and Zoning Agency
Land Use Permit Application Information Page 6
F EC€IVED
FEB 232026
AFFIDAVIT OF AUTHORITY PBayfleld Co.
lanning and Zoning Agency
(Corporation, LLC, etc.)
PURPOSE. This Affidavit of Authority is used to certify the individual submitting an application is
authorized when the property is owned by a corporate/business entity.
STATE OF WISCONSIN
) ss.
BAYFIELD COUNTY
The undersigned affirms and states as follows:
1. Address of Subject Property: 33 O Pp tytlt(((Ji �_ i�
, VC� ��(.QJ d
W 1 p54 2. The Subject Property Is owned by: I V1 Ei I{'Jt i_Lf_.—
(Name of Company) c
3. The name(s) of the current President or Managing Member: J /1 L --U I. k
4. I certify that the company named in paragraph 2 Is valid and in effect on the date signed below. I
am the duly appointed agent of the Company 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 Company to apply for and bind the Company to the terms
and conditions of any decision or permit 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 Bayfleld County or such person or legal entity
suffering a damage resulting from any illegalities of the application.
Dated:
Print Name
Subscribed and sworn to before me this .2 3rd
day of , 20"
t
Notary Public, o County,Wiseensim
My commission: /r 7 (lnri9
NOTARY PUBLIC -Stale of Kansas
2 MATTHEW A ITZ
NSQ,,S My Appt. Exp
RECEIVED
Letter of Authorization FEB 23 2026
Bayfield County Planning & Zoning Department Planning and zoning Agency
PURPOSE. This Letter of Authorization is used to authorize a single property owner to act on
behalf of multiple property owners or a designated agent to act on behalf of the property owner/s.
If multiple property owners, each property owner must submit this signed letter.
I, os'e •. m (property owner), authorize
(authorized agent) to submit a Lana use (Example: land use, special
use, conditional use, rezone/map amendment, appeal, variance, text amendment, etc.) for the
following described project (Example: construction of residence or other structure, short-term
rental or other use change, etc.) netanIs application on my behalf for
the following described property:
Legal description of subject property: secx+.n 5o Rg o to
Address of subject property: acv.., aa.a e.fl vnsa'.
c
�A.0 �ATIAA.
Signature
2/23/26
Dated
IUCW
P
C7 't'
RECEIVED
lJ�a" FEB 232026
BayAald Co.____ I
Planning and ZOning Agenry
Emily Macgillivray
From: Emily Macgillivray
Sent: Tuesday, February 24, 2026 8:58 AM
To: 'Jack Pearce'
Subject: RE: 33820 Carrier Rd Permit
Hi Jack,
Before I send this to our clerk, Dylan, to have him put in the system, please provide the following:
-What are the number of stories in the structure?
-How many bedrooms are currently on the property?
-How many bedrooms are in this current project?
-How will the "living spaces" on the floor plan be used (highlighted in yellow below)? Are they a
bedroom, office, workout room, playroom, etc. Please either submit an updated drawing or let me know
what to add to this drawing:
Sin pka
\&tfl
-J Q
150"
c P
•63t
00
i '`
Ir
ia" 'd •16d at' ON
-What is the square footage of the habitable living space? What is the square footage of the garage? We
will need to know that to calculate an accurate fee.
-Since there is a bathroom in the floor plan, this should have been checked "yes." Please change it or
give us permission tot change:
U LrdmllieiU QU i1UlUing I ah1R U Ivll
Will pressurized water be installed in the
to manage wastewwaler?
system will be installed or i
❑ Drainfcld ❑ holding Tank O Municipal/Public ❑ Other (describe):
,-, .. v, .. nn,,..: "__._ ._ .A_ ..._.........9 i F . ............ 1.....,t i 1..,F ..., n..mil6.n !'n.i,. /
Once I hear back from you, I'll forward this information and the application to Dylan so we can start
processing it.
2
Emily Macgillivray
From:
Sent:
To:
Subject:
Hello Emily,
Here is the new floor plan.
Jack Pearce <jrpearce2012@gmail.com>
Wednesday, February 25, 2026 7:23 PM
Emily Macgillivray
Re: Letter for REM
'� ,oa
N,+ts C'roulid h.a'c sCa,\e Ys =+'
Fp.,n��ir' F'v u•,\1 r?w"
rrin c-1 wz
✓«II .miar ¢ y
3 ilY 6a.n �y1v.9 1a�
8a[
,. P'"1 an! ro 4e, �w..
wall n ... ..r _
wJ15 ert O.1'
qq eta
4 u3�
RECEIVED
Nine, ri W" . ,
FEB 242026
n �ywP�5 On
yfield Co.
and Zoning Agency
.or ±l r.''"MUpic:�
ii I "tU �
l'++ci
I.4LiiI
y
keci : .
p Vn1' eT3ry
e siTlw Ii v_
• a11vy II
Jack Pearce
On Wed, Feb 25, 2026 at 11:58 AM Jack Pearce <irpearce2012C�gmail.com> wrote:
hello emily,
Number of stories of the existing house is 2.
1
The second story of the house has 2 bedrooms that are already existing the ground
floor(story 1) were we are working has 0 bedrooms.
The Living space I stated on the first floor plan will be a grand family room. NO SLEEPING AREAS are
going to be on the ground floor(story 1).
Also I'm going to be sending you a new floor plan to state what work is going to be done to the family
room and bathroom.
The square footage of the habitable family room is 291.375 feet square. The garage is already existing
and the other highlighted space is an office that is existing. The space around the bathroom is an utility
space.
On section G Addition Questions you stated we have to change the response to yes for the question.
Will pressurized water be installed in the structure? I had it as no because the bathroom is already
existing, so we are not installing any new pressurized systems. But if you need to have it as yes for other
reasons then mark it yes.
Jack Pearce
On Wed, Feb 25, 2026 at 11:16 AM Emily MacgiLLivray <emily.macgillivray(Tbayfieldcounty.wi.gov>
wrote:
Hi Jack,
I got your voicemail.
Attached is a letter you can share with REM.
I mentioned this in the letter, but if REM has further questions, they are welcome to reach out to me!
Kind regards,
Emily Macgillivray (she/her)
Assistant Zoning Administrator
Planning and Zoning Department
Land Use Permit Application Review Checklist
Submission #: LU— 6 at a-3
What zoning district is the project ated in?
❑ R-1 D5r2❑ R-3 ❑ R-4 R-RB ❑ C Dl ❑ 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:
❑ Yes 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)?
❑ Yes No
Is impervious surface required? (Required if riparian lot OR lot is entirely within 300 feet of OHWM of
navigable waterway)
❑ Yes Ei4,Io
Is the project located in the Floodplain? Zone:
❑ Yes 0/Np
Are there wetlands on the property?
❑ Yes Q4Jo
Is project associated with a nonconforming use or structure?
❑ Yes 064o
Is project associated with a variance? Case #:
❑ Yes o
Is project associated with a Special B or Conditional Use Permit? Permit #:
❑ Yes
Is the project associated with a Special A Use Permit?
❑ Yes No
Does the project require sanitary?
O Existing O New ❑ Intercept O Reconnect O Non -Plumbing ❑ Public
Sanitary Permit #: # of Bedrooms:
Does the project require mitigation?
Implementation Deadline: Date of Compliance:
❑ Yes No
❑ 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? esidential 0 Commercial 0 Municipal
Project type is? ❑ New Construction 0 Addition/Alteration IRnge Use 0 Relocate 0 RV Placement ❑ Sign
❑ Establishing a Busi9ess O Temporary ❑ Shoreland Grading O Other, describe:
Structure Type is: Residence 0 Principal Structure O Accessory Structure ❑ Boathouse (one story only)
❑ Open-sided/Screened Structure (gazebo, etc.) 0 Stairway to navigable waters ❑ Mobile Home
❑ Shipping Container O Other, describe
Total Sq. Ft. of Project: G{
Number of Stories: Overall Height:
Fee Type
Calculation
Fee Amount
❑ Habitable Residential Principal and Accessory
Structures -Enclosed Areas — all enclosed areas within
dwelling except attached non -habitable garages
$0.50x ________________ sgft
(minim urh $125)
$ /a5
❑ Dwelling Unenclosed Areas (decks, patios, etc.) or
Attached Non -Habitable Garages
$0.20 x sq ft
(minimum $125)
$
❑ Non -Habitable Residential Principal and Accessory
Structures
$0.20 x sq ft
(minimum $75)
$
❑ Commercial Principal Structures
$250+$0.005 x
cost of construction
(minimum $250)
$
❑ Commercial Accessory Structures
$150 + $0.005 x
cost of construction
(minimum $150)
$
❑ Municipal Principal and Accessory Structures
n/a
$0 (exempt from fees)
❑ Return Inspection 0 Land Use Revisions 0 Special Use Permit - Class A O Floodplain 0 Shoreland - Impervious
Surface 0 Shoreland - Non -Conforming, etc. 0 Tower Siting/Collocation 1 0 Tower Collocation 2 0 Metallic Mine
❑ After -the -Fact (ATF)
$
Inspected by: ,G AC ' 1 V
I "I
Date of Inspection:a Qs a
Re -Inspected by:
Date of Re -Inspection:
Denied by:
Date of Denial:
Reason for Denial:
Date Denial Letter Mailed:
Approved by: Ina0 I U
Date of Approval: ZS z2
Con on(s):
st meet and maintain setbacks from furthest extension of structure including eaves and
overhangs.
❑ Fqr personal storage only.
or personal residence only.
❑ N!Pt for human habitation or sleeping purposes.
IPTown/State/DNR/Federal may require permitting
❑ A Uniform Dwelling Code (UDC) Permit from the locally contracted UDC Inspection Agency must be
obt fined prior to the start of construction.
LDA Uniform Dwelling Code (UDC) Permit from the locally contracted UDC Inspection Agency must be
obtained prior to the start of construction (if applicable).
❑ 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.
❑ Sign must meet the requirements of Article E of the Bayfield County Zoning Ordinance.
Vfo 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
❑ No sewer and pressurized water allowed in the structure.
❑ No 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, an4building 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:
K: Applications and Forms/Applications/Land Use/Updated 2/25/2026 mdk
AFIELD Bayfield County
Planning & Zoning Department
117 E 5th Street
P.O. Box 58
Washburn, WI 54891
Phone: 715-373-6138
Fax: 715-373-0114
Property Owner:
MISKOMEN LLC
4927 W 88TH ST
PRAIRIE VILLAGE, KS 66207
Description
Habitable Residential Principal Structures - enclosed
areas $0.75/square foot (minimum $125)
Submission Number:
LU-02123
Transaction Number:
LU-02123-3F557
Amount
$125.00
Total: $125.00
Payment Amount: $125.00
Reference: 17536
Paid by: Pearce's Carpentry, 50039 Griffith Rd, Ashland WI 54806
Payment Type: Check
Transaction Date: 3/2/2026
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 - No / Nonconforming - No
Shoreland — No I Impervious Surface - No
Floodplain - No / Wetlands - No
Mitigation - No / Affidavit #:
LAND USE - X
SANITARY —
SPECIAL A —
SPECIAL B/CONDITIONAL —
BOA —
No. 26-0068 Tax ID: 6706
Issued To: MISKOMEN LLC
Location: S33 - T50N - R04W
Town of Bayview
BAYFIELD COUNTY
a *;IIf 11l
WEATHERIZE AND POST THIS PERMIT
ON THE PREMISES DURING CONSTRUCTION
Legal Description: LOT 5 OF CSM #919 IN V.6 P.119-120 BEING A PAR IN GOVT LOT 1 IN 2016R-565285 TOG WI& SUB TO
EASE)
Residential Structure in R-RB zoning district
For: Change Use [- Story ], Residence on a Basement [291 Total sq. ft. ] Height of'
(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.
Emily Macgillivray
Authorized Issuing Official
March 02, 2026
Date
Condition(s): Must meet and maintain setbacks from furthest extension of structure including eaves and overhangs.
For personal residence only.
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 (if applicable).
To be constructed per plan.