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Return to:
117 E 5w Street, PD Box 58 Bayfi E"Dning and Zoning Department
Washburn, WI 54891 LAND USE PERMIT APPLICATION
permits@bavfieIdcounty.wi.gov JUN 09 2026
County Use Only:
Submission #: LU- o??≥3
Permit #:
Date:
SECTION A: General Information
Property Owner Name: Authorized Agent Name (if aooticable)
S'rtt SHntZE SCffC\OL t ( /CQI t uc
Telephone Number: 7/5 —`7i -q- 3/6 7'
Telephone Number: , 7!S' - 3/6 7
E -Mail Address: ,1 A
E -Mail Address: A s ; L c, h & S ho/e , / tt . w r
Mailing Address: Y 13 S
Mailing Address: q/ 3 -
City, State, zip: YOB %i (r , L✓r sL($63
City, State, zip: obi- VG , Ws. 5t/ b & S
Contractor: ,..L. r A �tF�ltSo.'-'
Telephone Number:�≤ T_3Cc ens
E -Mail Address:
_Me.! ke'otiose,
SECTION B: Property Information
Project Address (if different from mailing address):
Legal Description (if additional space is needed attach a separate sheet):
Lot 1 CSM 2410 V14 P28
Section, Township, Range: 528 T50N R08W
Townof: Town of Port Wing
Tax ED #: 39662
Lot Size (Acres/Square Feet): 21.866 acres
SECTION C; Project Information check all that 1
Project Use is: El Residential ❑ Commercial X Municipal If Commercial, estimated cost of construction: $
Project Type is: 0 New Construction ® Addition/Alteration (existing structure)
❑ Change Use (existing structure) El Relocate (existing structure) El 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): °per- 4
required (Total sq ft): required
SECTION D; Structure Information not apply to RVs and Signs, go to Section B)
Structure Type is: O Residence El Principal Structure (describe):
S-(EEc ZVESI .P jc(4sennu/
❑ Accessory Structure (describe): ❑ Shoreland Exempt Structure (describe): ❑ Mobile Home (provide manufactured
date):
❑ Shipping Container O Other (describe):
Foundation Type:
❑ Basement O Walkout Basement ❑ Slab ❑ Crawlspace ❑ Ground ❑ Skids ( Other (explain): 4tosr 4t/A'S
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: 0
1"` Floor Sq Ft:
Loft Sq Ft:
I 2°" Floor Sq Ft: 0
3'" Floor Sq Ft: 0
See other
21.86 ac
es
Garage Sq Ft: 0
Porch Sq Ft 0
Deck Sq Ft: 0
Other Sq Ft (describe):
Other Sq Ft (describe):
New - 14,115
New - 58,300
Total Sq Ft: 72, 415
Overall Height (finished grade to peak): 2 8
# of Stories: 2
Existing # of Bedrooms on property: p
Proposed # of Bedrooms in project: 0
SECTION E: RV and SIgn Information (check all that apply)
cigJss
RV is:
❑ New ❑ Replacement
❑ New 1 El Replacement
❑ On -premise mise
❑ 1 -sided 0 2 -sided
Year: Vin #:
❑ On -building ulti-Tenant
Length' Width: Height:
Make: o -.
'Cs
(cam
Application Page 1
SECTION F: Site Plan — attach a site plan or draw site plan in box below (See pages I & 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) O Existing Structures O Well (W) O
Septic Tank (ST) O Drain Field (DF)
❑ Holding Tank O Privy O Lake 0 River OStream/Creek ❑Pond ❑Flood lain ❑Wetlands Dslopes over 20%
N
;I
ian
!
.
nI
o'f C
I W
y
ai
aemmvnxe:— mr.In ww,,
=_�=
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.
3 ft.
Notes/Comments:
Front Lot Line/Right-of-Way
ft.
ft.
Side Lot Line 1
ft.
ft.
(North East South We*, circle one)
Side Lot Line 2
ft.
/O tt.
(North East South West. circle one)
Rear Lot Line
ft.
ft.
Septic/Holding Tank
ft.
ft.
Drainfield
ft.
ft.
Privy
ft.
ft.
Well
ft.
ft.
Existing Structure/Building
ft.
ft.
Wetland
ft.
ft.
Elevation of Floodplain
ft.
ft.
Ordinary High -Water Mark (OHWM)
ft.
ft.
Other (describe)
ft.
ft.
Application Page 2
RECEIVED
'.. n n 9fl9F
SECTION
G:.Additional Questions
❑ Yes
P No
Has the location of the proposed proj ,pioluding eaves and overhangs and the sanitary system and well been
staked? If no, what date will tiij flllttts' 7t5G' r - aoa Co
❑ Yes
ti3 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.
❑ Yes
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.
J9'Yes
❑ No
Is there an existing sanitary system on the property? If yes, what kind?
❑ Drainfield 0 Holding Tank tWMunici al/Public ❑ Other (describe):
'Yes
O 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 O Holding Tank lB Municipal/Public ❑ Other (describe):
❑ Yes
M' 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:
❑ Rezone 0 Class A Special Use O Class B Special Use ❑ Conditional Use ❑ Variance
Fee payment will be made via: /irrr 4cxrcc ea. AC ms's 7I K
M>Chec attac ed ❑ Cash (attached) 0 debit/credit/echeck (department to call once payment is ready to be taken)
How would you like to receive your permit card?
Jnsonco✓
❑Mailto:ORl3Emailto: iwiJ+�+anw@tn+f
O Property Owner Address ❑ Agent Address O Contractor Address O Other (provide name and email or address):
Section H: Acknowledgement and Siznature
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.eov/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.
Z't't KN't
Owner(s) or Authorized Agent Printed Name: ,t4
Date: l 3l a 6
Owner(s) or Authorized Agent Signature:
NOTES:
1. If you are signing on behalf of owner(s) a letter of authorization must accompany this application.
2. Specific conditions/instructions maybe 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
RECEIVED
MAY 042026
SECTION
G: Additional
Questions Bayt5eId Co.
❑ Yes
JD No
Has the location of the proposed project including eaves and overhangs and the sari
staked? If no, what date will this be completed: _tam ;ZC;J 6
❑ Yes
I$ 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.
❑ Yes
W)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
O No
Is there an existing sanitary system on the property? If yes, what kind?
❑ Drainfield ❑ Holding Tank 1WMunici al/Public ❑ Other (describe):
O'Yes
❑ 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 1H Municipal/Public ❑ Other (describe):
❑ Yes
® No
Will sleeping occur in the structure? If yes, contact local Uniform Dwelling Code (UDQ for approval and
inspection requirements.
Is the project associated with any of the following:
❑ Rezone ❑ Class A Special Use ❑ Class B Special Use ❑ Conditional Use O Variance
Fee payment will be madam tttlauircn Atr rt&'s T"
®Chet attar ed ❑ Cash (attached) O debit/credit/echeck (department to call once payment is ready to be taken)
How would you like to receive your permit card?
❑Mailto:ORMEmailto:
O Property Owner Address ❑ 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, dnrwi.uov/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.
-Y' iG$WtA)
Owners) or Authorized Agent Printed Name: F
Date: 9 13 /a
Owner(s) or Authorized Agent Signature:
NOTES:
1. If you are signing on behalf of owner(s) a letter of authorization must accompany this application.
2. Specific conditions/instructions maybe 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
Please note: A location survey by a licensed surveyor, is required at the property owner's expense if your project is
within 10 feet of the required setback line. Property owner or applicant should mark the property line if your
project is within 30 feet of the required setback.
NATV' T.M. he1nw is for reforenrn m,rnnaes_ Additional rennirementaatandarda and excentinns may be anni cable.
MINIMUM SETBACK REQUIREMENTS
ZONING DISTRICT
R-RB, R -I, R-4,
M
F-1, F-2, R-2, A -I, A-
2, M -M
R-3
I, C
Principal Structure Setbacks from adjacent property lines
Side/Rear Yards
10 Feet
75 Feet 20 Feet
5 Feet
From Other Structures
5 Feet
5 Feet 5 Feet
5 Feet
Accessory Structure Setbacks from adjacent property lines
Side/Rear Yards
10 Feet 30 Feet
20 Feet
5 Feet
From Other Structures
5 Feet 5 Feet
5 Feet
5 Feet
Road/Street/Highway Setbacks (From Centerline or Right -of -Way Line, whichever is greater)
Centerline
Right -of -Way Line
State & Federal
110 Feet
50 Feet
County
75 Feet
42 Feet
Town
63 Feet
30 Feet
Private/Driveway Easement
40 Feet
Cul-de-sac
75 Feet
30 Feet
Sign Setbacks
3 Feet from adjacent property line/right-of-way line
Septic System (POWTS) Setbacks RECEIVED
Septic/Holding Tank
5 Feet
Drainfield
10 Feet NAY 0 42026
Privy
15 Feet
Other Setbacks baytieid Co.
Wetland
25 Feet
Ordinary High -Water Mark
lake, river, etc.)
75 Feet
BluffBank
75+ Feet
Note Lake Superior lots may e a greater setback due to active/potential erosion
- -
RECEIVED
SITE PLAN EXAMPLE htEtlud 2026
*Sec Sec. 13-1-60 for side (SY)/rear yard (RY) building setback requirements. Some increased
setbacks may apply. o au r
BENCHMARK
UTILITY DISCLAIMER:
Land Use Permit Application Information Page 3
The following information is required to be provided on the floor plan, if applicable:
• One floor plan for each level of building on which work is being done (print/submit completed page 3 for each
level proposed or attach applicable floor plans)
• The floor plan shall be dimensioned or scaled using an engineering scale (i.e.: 1 inch = 10 foot) or architect scale
(i.e.: ''4 inch = 1 foot).
• Labeling of all internal rooms.
• Provide exterior dimensions sufficient to calculate floor area (square feet) for each story and basement.
• Include any attached exterior components (i.e.: decks, porches, attached garages, etc.) and their corresponding
dimensions.
• Floor plan(s) for one- and two-family dwellings shall be submitted as per the Uniform Dwelling Code (UDC) size
requirements.
sue
7 OVERALL FLOOR PLAN an
Provide side views/building elevations of all sides of the exterior of the proposed structure. Elevations drawings must be:
• Dimensioned or scaled using an engineering scale (i.e.: 1 inch = 10 foot) or architect scale (i.e.: %4 inch = 1 foot)
• Elevations show the level at which the ground (finished grade) meets the building and the overall height to the
peak. Walkout basements should be shown and included in the overall height from the finished grade to peak of
the roof.
• The views shall accurately reflect the overall size/dimensions, wall height, roof pitch, appearance, doors/windows,
.' WEST ELEVATION - SEGMENT A
2 WEST ELEVATION-SEGMENTB
3 SOUTH ELEVATION- SEGMENT B
BSS
D �
[]
5 LOGO SIGNAGE
4 SOUTH ELEVATION- SEGMENT
S ,. o d ..tee
LgvEL o_ -•O_
� wre,ev.raV.aer.�e�rc
._ RECEIVED
I
2 %IQ_
MAY 0 4 2026
:.— • 7— — — — — — . — - Bayfield Co.
Planning and Zoning Agency
3 am EI1VA..an. aeernel.r.
xmation Page 5
4 wA..e.EV.rION.SEG„e,,.c
RECEIVED
Letter of Authorization MAY 0 7 2026
Bayfield Co.
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, A9 \V \ \ (property ow,�n�ert�),,,a�uthorize\ ui 'c\
(authorized agent) to submit a *Rfftk \- Qt\,NA\ `1\ (Example: land use, special
use, conditional use, rezone/map amendment,appeal, a ppeal, variance, text amendment, etc.) for the
following described project (Example: construction of residence or other structure, short-term
rental or other use change, etc.) ''fY\O0k. o &s €&4 a n) application on my behalf for
the following described property: /sjfA twDM$
Legal description of subject property: / l Sto'c `ODI ► )ic ctI
��Z19
Dated
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 %7Plo
(
Is lot s bstandard (does not meet current zoning dimensional requirements)?
Deed of record:
❑ Yes o
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 C "°o
Is impervious surface required? (Required if riparian lot OR lot is entirely within 300 feet of OHWM of
navigable waterway)
❑ Yes o
Is the project located in the Floodplain? Zone:
❑ Yes o
Are there wetlands on the property?
❑ Yes o
Is project associated with a nonconforming use or structure?
❑ Yes No
Is project associated with a variance? Case #:
❑ Yes o
Is project associated with a Special B or Conditional Use Permit? Permit #:.
❑ Yes No
Is the project associated with a Special A Use Permit?
❑ Yes o
Does the project require sanitary?
0 Existing ❑ New 0 Intercept ❑ Reconnect 0 Non -Plumbing ❑ Public
Sanitary Permit #: # of Bedrooms:
❑ Yes [%%o
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 74o
Did applicant/property owner mark lot line(s), if project is within 30 feet of required setback?
Project use is? O Residential O Commercia Municipal
Project type is? ❑ New Construction,,-&"Addition/Alteration O Change Use ❑ Relocate O RV Placement O Sign
O Establishing a Business O Temporary O Shoreland Grading 0 Other, describe:
Structure Type is: ❑ Residence RPrincipalStructure O Accessory Structure O Boathouse (one story only)
❑ Open-sided/Screened Structure (gazebo, etc.) ❑ Stairway to navigable waters 0 Mobile Home
❑ Shipping Container 0 Other, describe
Total Sq. Ft. of Project: S 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
$0.50 x sq ft
(minimum $125)
$
❑ 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 ❑ Special Use Permit - Class A O Floodplain O Shoreland - Impervious
Surface O Shoreland - Non -Conforming, etc. O Tower Siting/Collocation 1 O Tower Collocation 2 O Metallic Mine
❑ After -the -Fact (ATF)
I $
Inspected by: II
Scp %204S�
Date of Inspection:
� 4 u
Re -Inspected by:
Date of'Re-Inspection:
Denied by:
Date of Denial:
Reason for Denial:
Date Denial Letter Mae
Approved by:
Date of Approval:
S
2
Condition(s):
`IVlust meet and maintain setbacks from furthest extension of structure including eaves and
overhangs.
❑ For personal storage only.
❑ For personal residence only.
❑ 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.
Uniform Dwelling Code (UDC) Permit from the locally contracted UDC Inspection Agency must be
obtained prior to the start of construction (if applicable).
Jse 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.
�lo be constructed per plan.
❑ 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).
k C�1and use permits shall be required for any new residence, any building or structure erected,
relocated, rebuilt, or structurally altered
and 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
It LYFIELD 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:
SOUTH SHORE SCHOOL DISTRICT
9135 SCHOOL RD
PORT WING, WI 54865
Description
Non -Habitable Residential Principal and Accessory
Structures - $0.20/square foot (minimum $75)
Submission Number:
LU-02223
Transaction Number:
LU-02223-47660
Amount
$0.00
Total: $0.00
Payment Amount: $0.00
Reference: - +✓x��
Paid by:
Payment Type: Cash
Transaction Date: 6/9/2026
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 I Nonconforming — No
Shoreland — No! Impervious Surface — No
Floodplain — No / Wetlands — No
Mitigation — No / Affidavit #:
LAND USE -X
SANITARY —
SPECIAL A —
SPECIAL B/CONDITIONAL —
BOA —
No. 26-0241 Tax ID: 39662
Issued To: SOUTH SHORE SCHOOL DISTRICT
Location: S28 - T50N - R08W
Town of Port Wing
BAYFIELD COUNTY
Legal Description: LOT 1 CSM 2410 V14 P28 IN DOC 2025R-608310
PERMIT
WEATHERIZE AND POST THIS PERMIT
ON THE PREMISES DURING CONSTRUCTION
Municipal Structure in R-4 zoning district
For: Addition/Alteration [2 - Story ], Principal Structure [72415 Total sq. ft. ] Height of 28' (School Addition & Remodel)
(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
June 09, 2026
Date
Condition(s): Must meet and maintain setbacks from furthest extension of structure including eaves and overhangs.
A 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.
To be constructed per plan.
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.