APPLICATION FOR REGULAR ZONING PERMIT

Receipt No. Fee Date Date Permit Issued: Certificate of Compliance: Date Floodplain Zoning Permit: Date DOOR COUNTY LAND USE SERVICES 421 Nebraska Street Door County Government Center Sturgeon Bay, Wisconsin 54235 Phone: (920) 746-2323 - FAX: (920) 746-2387 APPLICATION FOR REGULAR ZONING PERMIT TO THE ZONING ADMINISTRATOR. The undersigned hereby makes application for a REGULAR ZONING PERMIT for the work described and located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Door County Zoning Ordinance. 1. OWNER NAME AND MAILING ADDRESS Name No. Street City State Zip Home Phone # - - Daytime Phone # - - Cell Phone # - - 2. BUILDING SITE LOCATION Fire # Road Town of Local Phone # - - 3. BUILDER NAME AND MAILING ADDRESS Name No. Street City State Zip Phone # - - Cell # - - 4. PROPERTY IDENTIFICATION Parcel No. - - 5. PROPOSED USE OR PROJECT 7. TOTAL NUMBER OF BEDROOMS Existing Proposed 8. BUILDING PLANS & SITE PLAN - REQUIRED (Must be drawn to scale) (For requirements see forms attached) 9. FEE SCHEDULE: Note: The footprints of multiple structures shall be added together to arrive at one total square footage. Please complete a) or b) as appropriate. a) Footprint of structure/use - please check. 120 sq. ft. $ 75.00 121-999 sq. ft. $175.00 1,000-1,999 sq. ft. $250.00 2,000-4,999 sq. ft. $350.00 5,000 sq. ft. and greater $500.00 b) Misc. uses/activities $150.00 Note: Double fee will be charged for projects started without permit. Make check payable to the Door County Treasurer in the amount of $. 10. AUTHORIZATION FOR INSPECTION I hereby authorize the Zoning Administrator(s) to enter and remain in or on the premises for which this application is made at any reasonable time for all purposes of inspection relative to this petition. 6. SANITARY PERMIT Type of System Sanitary Permit No. Date of Issuance Approximate Date of Installation 11. SIGNATURE OF APPLICANT OR AGENT Date Shoreland Zoning Yes / No Zoning District (FOR OFFICE USE ONLY) Inspections: Date Inspector Remarks Permit Issued: (by) (date) (for) (w/conditions) Permit Denied (by) (date) for the following reasons:

DOOR COUNTY LAND USE SERVICES 421 Nebraska Street Door County Government Center Sturgeon Bay, WI 54235 Tel 920-746-2323 Fax 920-746-2387 BUILDING PLANS OWNER: DATE: Below or on a separate sheet attach a scale drawing showing each of the following as applicable: All floor plans. At least two elevation views. FLOOR PLAN Scale: FRONT ELEVATION VIEW Scale: END ELEVATION VIEW Scale:

DOOR COUNTY LAND USE SERVICES 421 Nebraska Street Door County Government Center Sturgeon Bay, WI 54235 Tel 920-746-2323 Fax 920-746-2387 SITE PLAN OWNER: DATE: Below or on a separate sheet attach a scale drawing showing each of the following as applicable: Boundaries, dimensions, and area of the site. Location of public roads and right-of-ways. Location of private roads. Location of easements. Location of navigable waters. Location and dimensions of all existing structures. Location of existing or proposed well and waste water disposal system. Location and dimension of all proposed structures and additions. Location of rockholes. Location of proposed and existing road access points, parking and loading areas, and driveways. Distances from proposed project to: Abutting public roads and right-of-ways. Private roads. Property lines. Well Waste water disposal system. Ordinary high water mark (OHWM) of navigable waters. Indicate North arrow..impervious Surface Ratio PLEASE STAKE LOCATION OF PROPOSED STRUCTURE

DOOR COUNTY LAND USE SERVICES DOOR COUNTY GOVERNMENT CENTER 421 NEBRASKA STREET STURGEON BAY, WI 54235 (920) 746-2323 Grade Sheet for Regular Zoning Permit Application Complete and file this form for new Principal Structures only. Owner of property: Tax parcel number: 1. Benchmark. a. Describe benchmark and location. b. Elevation of benchmark: 2. Preconstruction Grade. Elevation of highest natural grade around footprint of new structure: 3. Plans. a. Show benchmark location and elevation on site plan. b. On side elevation view of building, show preconstruction grade elevation (#2 above) and highest and lowest finished grade elevations. 4/18/17

County of Door LAND USE SERVICES County Government Center 421 Nebraska Street Sturgeon Bay, WI 54235 Phone: (920) 746-2323 FAX: (920) 746-2387 Website: map.co.door.wi.us/planning Please provide a description of your project. PROJECT SCOPE DECLARATION [2017 Wisconsin Act 68; Effective November 29, 2017] 66.10015(2)(b), Wisconsin Statutes, provides as follows: If a project requires more than one approval or approvals from one or more political subdivisions and the applicant identifies the full scope of the project at the time of filing the application for the first approval required for the project, the existing requirements applicable in each political subdivision at the time of filing the application for the first approval required for the project shall be applicable to all subsequent approvals required for the project, unless the applicant and the political subdivision agree otherwise. Please check which of the following two statements applies to this project. This is the first application filed for the project in which the full scope of the project has been identified. I acknowledge and understand that, for purposes of 66.10015(2)(b), Wis. Stats., the full scope of the project is identified in this application. This is not the first application filed for this project where the full scope of the project was identified. The first application was filed with the Town/Village/City/County/State of on the day of, 20. I acknowledge and understand that, for purposes of 66.10015(2)(b), Wis. Stats., the full scope of the project was identified in the first application. This Declaration is incorporated into and made part of the associated Door County application. Property Owner(s) Name(s): Signature Signature: Date: Date: Parcel Number (of Project): - - Fire Number & Street Address (of Project):

County of Door LAND USE SERVICES County Government Center 421 Nebraska Street Sturgeon Bay, WI 54235 Phone: (920) 746-2323 FAX: (920) 746-2387 Website: map.co.door.wi.us/planning WETLAND NOTICE & ACKNOWLEDGMENT According to 2009 Wisconsin Act 373, no permit may be issued until the property owner signs the statement below acknowledging that s/he received the following notice: 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 at http://dnr.wi.gov/topic/wetlands/identification.html OR CONTACT THE DEPARTMENT OF NATURAL RESOURCES SERVICE CENTER. By signing this, I acknowledge I have received this notice. PROPERTY OWNER NAME: SIGNATURE: DATE: PARCEL NUMBER: - - FIRE NUMBER & STREET ADDRESS OF PROJECT: M:\FORMS\Wetland Disclaimer Act 373-2010.Doc

Waking Up to Wetlands Know Before You Buy or Build A helpful guide for determining wetlands

Wetlands may not be obvious. You can take some simple steps to learn if property you re interested in buying or building on has these valuable natural resources that are protected by law. In addition, all the maps and other information you need can be found on DNR s website at dnr.wi.gov/wetlands. Click on Getting Started. Step 1: Review Maps If the maps show a wetland or a potential wetland, consult a wetland professional to verify that you have a wetland and to identify its boundaries. Step 2: Put Boots on the Ground Walk the property with this checklist*, and look for wetland clues. Photos of common plants, wetland soils and evidence of water can be viewed on DNR s website on the Physical Clues page. *This checklist is not intended to represent an inclusive listing of all wetland characteristics, but is a rough guide. You must get a professional to verify a wetland is present and determine wetland boundaries. Step 3: Explore Your Options If the maps indicate wetlands and/or you answered Yes to any wetland clue questions, a wetland is likely present. If you re buying land, please consider completing a wetland real estate addendum, found at DNR s website and attach it to your offer to purchase. This addendum allows more time to consult with a professional to verify if a wetland is present and if so, you can renegotiate or rescind your offer. If you re planning to build on land you already own, consult a wetland professional to verify wetlands and mark their boundaries so you can plan your project to avoid them. If you can t avoid them, apply for state and federal permits detailed on DNR s website and contact your local government to see if any local rules apply. Half of Wisconsin s original wetlands have been destroyed, so permit applications are reviewed carefully and are not automatically granted. Wetlands are wonderlands that are great places to enjoy and explore. Some wetlands may be in poor health making them good candidates for landowners who want to restore or enhance them. To learn more visit DNR s website. Wetland Clues Checklist Is there evidence of water? Yes No Are there ponds, lakes, streams, springs or seeps? Are there low spots where water collects or the ground is soggy for at least a week? Are there drainage channels or has the site been ditched or tiled in spots to dry it out? If the site is a farm field, are there areas where crops do not grow or the plants are stunted or yellowing during years with normal rainfall? Are there water marks or stains on tree trunks? Do trees have a shallow root system? Are there areas where water has scoured away plants and leaves, flattened vegetation or where no vegetation is growing? Are sticks, leaves, soil and other debris deposited by water in a line on plants and trees? Are water-loving plants present? Yes No Are these plants present: cattails, reed canary grass, sedges, rushes, blue flag iris, joe-pye-weed, new england aster, sensitive fern, skunk cabbage or sphagnum moss? Are these shrubs present: dogwoods, willows, alder, leatherleaf, spiraea or blueberry? Are these trees present: willows, silver maple, box elder, black or green ash, cottonwood, elm, balsam fir, tamarack or spruce? Do plants have roots growing from their stems above the soil? Do trees have multiple trunks or are the trunks expanded or swollen at the base? Are there wet soils or signs of them? Dig a hole down 20 inches: Yes No Is the soil dark brown or black? Does the soil feel moist or can you squeeze out water? Is the soil primarily peat (decaying plants) or muck? Does the hole fill partially with water or does water trickle down the sides? Is the soil gray, gray-blue or gray-green or marked with reddish or yellowish spots or dark streaks? Are there crayfish burrows -- mounds of dirt with a hole?

TM It Pays to Save Wetlands Landowners can Get a higher price for homes next to wetlands See birds and other wildlife right out your back door Avoid soggy basements and shifting foundations Get financial and technical assistance to restore or enhance wetlands Local communities benefit Wetlands reduce flooding Wetlands filter polluted water, keeping lakes and rivers clean Wetlands provided recreational opportunities Wetlands provide nurseries for fish and homes for wildlife For more information on locating and identifying wetlands please visit DNR s website at dnr.wi.gov/wetlands and click on Getting Started. Dave Menke, (USFWS) Joanne Kline Thomas Meyer Nan Rudd Wisconsin Department of Natural Resources P.O. Box 7921 Madison, WI 53707 The Wisconsin Department of Natural Resources provides equal opportunity in its employment, programs, services, and functions under an Affirmative Action Plan. If you have any questions, please write to Equal Opportunity Office, Department of Interior, Washington, D.C. 20240. This publication is available in alternative format. PUB-WT-899-2008 Printed on recycled paper Wisconsin REALTORS Association