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HomeMy WebLinkAbout026-938-06-5802-LUP-2024-174 SUBMtT GOMPLEiED APPtiCAT10N AND Fee ro: APPLICATION FOR LAND USE PERMIT Sawyer County SAWYER COUNTY,WISCONSIN � Zoning&Conservation Depart. ,� ��r-�,- �- 10630 Mai�St Suite 49 D e � e�v I Hayward,wi sasaa � _�%-`--.�=_�f�,J.._I��� L�B�� s � I � � a-t-1 � (715)634-8288 ��) ���# 1 gp�� � MAY 0 9 Z024 c�1 � —� iNSTRUCTiONs No permits will be issued until all fees are paid. ,, r —`- � ' n��*� ��J d „� � Checks are made payable to:Sawyer County Zoning Department. 7(�� g��t' •- � -� ` - .� DO NOT S7ART CONSTRUCTION UNT��ALL P�ERM175 HaVF BEEN ISSUED 1Q'TS6PC�CAM1TT��L'�'��frglHal'�•Eipiirc#Zion MUST be submitted FILL OUT IN INK (NO PENCIL� Submittal of ih�s apphcation or receipt of fees aoes not constitute�permit issuance. Owner(s)Name: ; Contrector{sj Name � t�i A�R E C H fZ.L - A H!�m ' c.-C, Cb l� � v �'!o�! �L Mailing Address: Mailing Address: z t O � � LN l� v� � � �S b � �.► � l� 3 � r..�,�z� s 3 Phone: ��d� ���—W � /� 9�� Phone: �7��"����(O /� � � Q1 Emaii: �/�/\ Email: Site addrcss: Or Date applied for: i Legacy PIN# � Q h� �7 � Town of: ! PermitdeliveryMethod n Call Owner �Mail Owner �all Contractor ,Maii ContrectorQmA��. Ca rri���/��On S�����, � � �- �f- Is Property/Land within 300 feet of River,Stream i�n�i. Distance Structure is from Shoreline: Is your Property Intermittent) � Are Wetlands Creek or Landward side of Flood lain? �f es--continue feet in Floodplain present? �Shorel2nd p Y zone? �is Property/Land within 1000 feet of lake,Pond or Flowage Distance Structure is from Shoreline: Ye5 Yes �Nr,) If yes--tontinuP —► feet Nc1 ; Non-Shoreland Describe P���e� Total#of Value at Time of projed type Poundation What Type&Capacity is the Completion Number bedrooms (House,garage,shed,deck, (Basement, Sewer/Sanitary System{s) ,,n-,,;,. • � :,: - of Stories Post Addition,etc...) Crawlspace, t�me t���,ace���; ��n separately Slab) construction $��D, oD0 �oF�'1,� �, 3 /3 Ev o�/ tirr,��, � SC �-43 3 J-z Q � /`G Z3 Dweliing 5 Aaessory Bldg $ Addition/Alteration Height: TotalSquare Lowest Proposed Use ✓ Proposed Strudure Dimensions Footage Grade to (multiply per Highest story) Peak 3� xz- ) �(,,� � Residence ( � �Z.� Ft.�-- ! � with 2nd story or loft t �X Z�) Ft.y- with Basement ! { X } Ft. Attached Garage ( X ) � Residential Use Ft. Accessory Structure(eXPia��) ( X ) � Agrieultural (detached garages,zheds,boat houses,etc j Ft• Use { X ) l'emporary Guest Quarters or Bunkhouse(r�cie cyPe� Ft �; Commercial/ � Dec orc Patio { �� X g } 8 D Ft. Industrial Use ( x Z ) �[ {2"d)Deck orch atio � � /Gi � Ft. � Munici al Use �, p ( x ) Other(explain) Ft. _ Other ( x ) Prineipal Strueture(agric�it��a�,Commercial,Munlcipal,Etc.) Ft. Addition/Alteration(expiain) ( X ' Ft. Total habitable square feet: Total Non-habitable s uare feet: � Q ��� (decks,patios,garages,sheds,storage area&other structures) y� ex �„�.11�.� �,as.� � �,�,� by �w���,� ��.s Original Appht.rt��or..��":�:�:'_ ��.ubmittod Attach a Plan or Sketch you�Property on 8.5"x 11"or S.5"z 14"paper.'MusN Indude lontion and setback of proposed and ezisNng structures,roads, driveway,sanitary componeMs,wep,lake,rWer,stream.and wetla�a DescriPuon Setbadc �� SetWdi Meawrame�ts � Meawrements Setback from the Centerline of Platted Road and/or Feet Setback from the lake(o,e�oa�vn�gn-wa�e�ma.k) �� Feet Setback from the Established RighFof-Way Feet Setback from the River,5[ream,Creek Feet Setback from the Bluff�f apoi�cabie Feet Setback from the North�ot Line Feet Setback from the South Lot Line Peet Set6ack from We[land Feet Setback from the West Lot Line �j, Feet Slope wi[hin area of construction/disturbance %Slope Setback from the East Lo[Line � Feet Elevation of Floodplain Feet Setback to Septic 7ank or Holdin`Tank Feet Setback to Well Feet Setbackto Drain Field Feet Setback to Privy(Portable,Composting) Feet - �" ..i�.i,.Nn.., n i�t�on or�stri.n�m�� n . ...,a. ��ne m revu red serna.k.i�. i;nn.,iv i. _ cm i�ric'i�he se[ea�k n,�_oe�easuree must be v sible from one ...� , . ..,.,rectos�nrothe 0'P�oisv���- _r._ .i narkeAny3lcc ser,s��veyor,�t F _�,. _e*pe�se Pr���i^-ne�i..rr nr nst�ic�io�ofasiiu:+u rr��hanfivP(til'rvt���les��'�i� r.,�l(��e.tti�mrhe i requiretlsel�ark,t�eLo!in�fa�yl�ne���inwh�i�h��esetbarkmus:be , . is`bl�l-�r epre , . .��. �. ntnr.n.Y, . ..isl�� i .��:nrn.r.i =.(ahehVt�P��partnen,F. � i .. ..�..�.�(-.�;�known[�rne� t.� __la(tie� 1 e��s�e.�ift� s�ri...�e__ . - .�,. . I__nse... ..��.� . .ean-r�. Calculate impervious suAaces.(Roofed,concrete,paved,and other surtaces that water cannot penetrate.The Zoning Office can help you determine if a wrface is conside�ed impervious) Calwlate lot area: Q� Indicate bt size from CSM�r NOVUS(cirde one):�__qcres;MWtiply hy 43,560=Lot area: 7�y �� I Square Footage Calculate impervious surface area: Determine the total size,in square feet,of your projeRs listed above(indude eaves�: Z Z'T 7J sq ft. Determine the total size,in square feet,ot all existing roofed structures(indude eaves�: �/J O zq ft. Determine the total size,in square feet,of all exis[ing paved/bricked/blocked surfaces: sq ft. Add these measuremenu to determine total impervious surfaces: ✓OG g�_sq ft. Calculate impervious lot percentage Totalimpervioussurface: ��V +Lotarea: 7Zioy5qft.%100=impervioussurface�% IM'���ea��o��s rea„�red'�t�o�ai e��eees isv� '•'Notice a separate grading permit needs m be obtained if dis[urbed area is wlthin the Shoreland dis[rict as indicated on previous page and mee[s criteria below^• Gradin on a slope reater than 20% Gradin of more than 1,000 .Ft.on 12%-20%slopes Gradin of more than 2,000 Sq.Ft.on Slopes less than 12% Grading is in ezcess of 30,000 Sq.Ft. � ' n l�'ifM' ;-.k"� /1N�iRlli:TpNWIiNOU1�VFHMITWILLRESUI�INI'[NALT�FS I(we)dedare that this application(includmg any accompany ng informabon)has been exam ned by me(us)and to the best of my(our)knowledge and belief't�s true,correct and omplete.I(we�acknowledge that I(we)am(are)responsible(or the detail and accuracy of all information I�we)am(are)providing and that it will be relied upon by Sawyer County'in determining whether to�issue a permit.i(we)fu her aaept liabiliry w�ich may be a result of Sawyer[ounty relying on this information I(we)am(are)providing in with this application.I e)consent m munty officials cha ed with administering county ordinances to have access to the above described pro0etty at any reasonable time for the purpose 'spect'n.Addltio ally he de igneE person(s)hereby give permission for access to the property for onsire InsOettion by Municipal Officials. ' Owner Owner �I r- /"/n/ �/ ���/��� Signatu � Vrinted name l�✓1 L f��S ,'`a� ��V/ �'*'l!!�✓lqate—�1=�T_ . ... . .,�E u�ed) rvonct .. ,. . ��_min,.u,i.,. . ,�,�. . . ..�� , � .. . _., � . � . -�•cn �i ,,_. .. „�r.. .,. �ouareresDonsibleforcompiy�ngwiththerequirementsoftheSavryerCountingZ n�ngOrdinanc dlawand egulationsofthe5tateofWisconsin.Vouarealsoresponsib�etor comply'ng w th State and Fede21 laws concerning construttion near or on wetlands,lakes,and sheams.Failure to comply may result in removal or modifcation of mnstruction that violates the law or oMer penalties or costs.For more Information,vislt the department of natu�al resources wetlands iAentification web page or mntact a depanment oi natural resources service center(608)26]-3125 SAn� :l - 1 �o.kc Issuance Information(County Use Only) Sanitary Number: ^Lt.�w aof bedrooms: 3 d• Vermit Denied(Date�: Reason fo�Denial: Permit p: Issuing agent: Date: ��-�-�y � i a� Is Parcel a Sub-Standard Lot �'�.Yes (Deed ot Remrd� � N iC ation Required � �C�Ves '�.No Is Parcel in Common Ownership ���..Ves (Fused/Contiguout Loqsj) o �gatian Attached ' Yes .��.No Is 5[ruc[ure NomConforming '�.��.Yes Granted by Variance(B.O.A.) Gronted by Conditional Use L�Ves "i.No Use M: :"!Yez _'No y�p: Was Parcel legally Created ,::�.Yes O No Were Property Lines ReOresented by Owner �����.Yes No Was Proposed Building Site Deiineated ''Ves ��:"'No Was PropertV Surveyed Yes No OfficeComments ZoneDistritt: Fee: - .�SaS_����w�.S Hold ForSan�itary- Hold ForTBA: �oln�or 4ff�dav-� Hnld F�rFer�s. �Feb2021 ��{��� 5/9/24, 3:11 PM Novus-Wisconsin Access rev. 13.1108 Real Estate Sawyer County Property Listing Property SWtus: Current Today's Date: 5/9/2024 Created On: 2/6/2007 7:55:46 AM �Description Updated: 7/29/2020 '�'� Ownership Updated: 7/29/2020 7ax ID: 27668 � MARY A MARKHAM APPLEfON WI PIN: 57-026-2-38-09-06-5 OS-008-000020 CHARLES E MARKHAM APPLETON WI Legacy PIN: 026938065802 Map ID: :8.2 Billing Address: Mailing Address: Municipality; (026)TOWN OF SAND LAKE MARY A MARKHAM MARY A MARKHAM STR: 506 T38N R09W N210 LIBERTY LN N210 �IBERT'LN Description: PRT GOVT LOT 8 LOT 2 CSM 1/136 #107 APPLETON WI 54915 APPLETON WI 54915 Remrded Acres: 1.660 Lottery Claims: 0 � Site Address * lndicates Private Road First Dollar: Yes 16591W SISSABAGAMA RD STONE LAKE 5467r Waterbody: Sissabagama Lake Zoning: (F-1) Forestry One (RRl) Residential/RecreationalOne JPropertyAssessment Updated: 9/28/201? ESN: 423 2024 Assessment Detail Code Acres Land Imp. �� Tax Districts Updated: 2/6/2007 G1-RESIDENTIAL 1.660 170,300 31,700 1 State of Wisconsin Z_year Comparison 2023 2024 Change 57 Sawyer Counry Land: 170,300 170,300 0.0°r� 026 Town of Sand Lake Improved: 31,700 31,700 0.0°n SR478 Hayward Community School Distrid Total: 202,000 202,000 0.0°/n 001700 Technical College • Recorded Documents Updated: 2/20/2020 �proper[y History O WARRANTY DEED N/A Date Remrded: 6l19/20Z0 424521 � WARRANTY DEEO Date Recorded: 9/14/1998 270746 367/309 WD646/71 0 WARRANTY DEED Date Remrded: 10/1/1984 193121 � CERTIFIED SURVEY MAP Date Recorded: 6/10/1966 000115 https:lltas.sawyercountygov.orglAccesslmaster.asp ��� ����� � � � � �������� � c� #� S�ss �g�-� �- '� ��.� . . � �.-� � ._ � .� _ � �_� � � ; .��. � � `�-�-�-�..��.� :{.�_ A '� �....�Y�.__..-��,� �,�-�-�-.�. � �.,_.�,.._ � �K�..... _..� �� � � � � � � �i � � � �----� �� ' ��` � ; _ _ t ��d �.��� � � � , v���__ .. �� � ; i , �����+��1 � � ��� a8 �'' � +� : � ; �� � � W � � s -�- i � ������ ? � ' 1 2� ' 1 0 � 3 '-� I � � � i x '1 S � � yr � � � � � fri � �1 �� �t . . . .��.� � � � � c SS �t l'ji9-G/�1 �'In f� � � � �� � � � � �� �::. � .r.:s �..f. 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J;. i c�C>0000000 f; : G e _ _ � Id ` -I� � i�� �� n _ m � Q 4 � C I I I � r i '' m , , ; � i� � r--r - I I r _r�'' �--7 i � F �� ', i ' j �w ; I i � i - � � \ -� � � I � '; i , �� � � :F � � .� � �- Y� f i l\ �R' �--- d1 � � � i � � �m �---T �m � a� � � r ' � � � m \ �� m � i ° � , � �� �� i I� \\ � _ . � L i \ �_-- � o i : ' II � _ _ 0 0 Z �--1 - z -_'` � �'� `-- J, '�I T i� �., �; ° _� �-- �� i—— �-- �, � � I �, ll � , �--z 'I II D � � b PROPOSED PROJECT FOR: CHARLES & MARY MARKHAM CODY'S DESIGN --_ _ _ -- - -- -- - � � �,; 16591 W SISSABAC�-AMA STONE LAKE WI 54876 � - - , m h' MAIN FLOOR PLAN SHOPPE _sb,a.t=�,�..w,��,�,. g�P�s�un�.,�,�,;�_:�;�E c; v� i� m 2 --- .. _.._-.--_ _------'__� as �� II p� �s �� I i� r _�,,,. �i`= _ . �� o ( � `-- � �� i �_ I , � t� � I � �� �"' I i NU ' i ! I in j; �m I ' I I n I � � I O I I c ° a i �Z ti i > i - � �_ i.�- , � � � r —, I O I . 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'. � - r m _ ' _ ' ;..� I� _ . -f � I I I }' I 7 £ r .--- -- - 'I ' _ a �_: > �. i .. 9 .-- _ � _ 2- D �q 0 � < � ., � _ ., - . y�:.I . �, � > Z '�._I�__' q,/��, �1 �_..7 , x :: .: � K 3 4..I ' i's!' ��Inl ��J DININ4 �.,� � h � � . � LI� �1 � ° ' �� _ �� - � � ��� 00❑��� - � � ��, _ . --- ----- ---- -- ----- -_ ---------------- --- -��� � � - - � . � m z I'I � m =P. � � I � �� � `E � _ �� � i p - _ < —t� � ��C - I� I _ «.,_ z - �� m- � `o: - � 0 3 �e 2 -`�__ O , i _____ „ A ^• ',I'. � I_ ae ' t � � � oa �:I ��,�h. � �.—__— ` � '. ,, � j � � : O O �� :,o� .�. ��=r i :,� � ---•--.—__ — ' � _— - � ._ ..- �„�� � I __. .:_. ___._—_ - _ I - COVERE�GORCH IW� ___________ _.,I -.rnu<emrvrvrn✓.:.�rr. -.o .� I D 3 ; PROPOSED PROJECT FOR: CHARLES & MARY MARKHAM CODY'���N � — — —-- — ���i 16591 W SISSABAGAMA STONE�LAKE WI 54876 � N I' h� ' FLOOR PLANS sHOPPE �s=��.�,��.«�,�e„«, o Ko��«m,,,�9.�,s= �; �3 vY �} — � r ..._ . I <m I � I �h � �I Ap C� �� � 3;� �__- --__--� �- - _, i #; �N I II I i% ' ;� �I I I , -C I I o v � _ _ � I \�--,., / 9 W� II Q \�\\ . � a � _3 II �/\ e . •e . 9 Q I I �� C r� /�. - m ��� � � °� � I � � � a � I � I I U - D I I � � � I �� ��� a r I i i < —� ' i � �I JI ' � ? I I s �I , a �--� � ` �: o� � o o � o ; i • „.,. � I� �� � � J__r � �,� `��, , ���------- -� J - , �.� ' � � � � - ' i _ � ' . �-� i i `-y — �` i i � i _ i � i i I � �I� }� � _. I . _ � �� � . i i i i '� . . . . e.< : i. _ �_ r_____________I� ___i .I .�—�- __'— i —— _ A. „�� —___ «..,�N� a� ' � i �. i :T I % ' i � �� / =� I � � i �: � I i i i�- i �Z i g �� � :a ; r � � I D I I ➢�V � � I � I I O I � _ / Z I I m I � _ � � � � I � �_ I � � � _ � T � - � � �� 9 r _ � `� D � i T � ac i . i 9', Z � � U I - , . `s �—-------------------------- -- -' �� *r - - ,-- ---�- -- � � 3�a= - , i _ __�: a I i r� T � i � _ � r' � � L� � Q i i 'i II i i _ -� I, I I r� D „ � —� — i � � r � � I � � i , : � �.� � m � � __� � � �, /� � /�1 �--- --_ --— ------ ---- � �}-- --`� i ��.-1 L_T i - i / i � � ,., .,�.__�e�- � �.,.��„ .;,. - , . �.�w�� �:.r. . , ., ..<<,... � .'_____�__��_____ ' � � � z____ _______ _ __ ., � ., �� ?'x'- y � a � _.� si, _-__ _._. __. "_\-1 �-a �w� :: 1_. ,Y:_ —_ :-..,,.-- . _. _._,,. m.. D c - PROPOSED PROJECT FOR. CHARLES & MARY MARKHAM CODY��IGN m N I � m o --- __ --- - - -- -- — — _ m lo�l i 16591 VJ SISSABAGAMA STONE LAKE WI 54876 �� - � ��� � W zl o $ , I FOUNDATION ROOF PLANS & DETAILS SHOPPE s; € .; � z �; _ � . ; ' 2 �ag < J �N _ //�J, I , l , �. � �. � � .� // � ' F/ � ` � � � � � � T �, • z = _ _ \� � _b s 9 0l' �\ r � z � \ E � - s � `� � —— ; , o . �. � . ,- > � , _. � —_ - --,��" v \� � � �j��° �i � P - ����\ ,'_,'o ' ���' -- _ __� � _ __ _ � _— - _�� i � ��, � �� E� " -Z -. _ - � 7 ti'� ..... _. j m I�I � \ D N a �� .m � . n — _ __ � 1 � .,.,a < o _ _. ___ _—__ — — _ _. � , Z I�I �, < 2 n ' o ' 0 3 i� �\• � __ ��i i \�� . ���� _ _— � O � �; PROPOSED PROJECT FOR: CHARLES & MARY MARKHAM CODY'S DESIGN � _— — —-- - _ _ � m i � 16591 W SISSABAGAMA STONE LAKE WI54876�� -�� - - - � o�� SECTION & DETAILS SHOPPE �,s a.. .,_,..,,,�,_�.���Ko�m..���m,,,.�_„s, � Sawyer County Application foriGradir�g �, ` `� .:_�::.._�'_�'.�.:• : � 10610 Main St. Suite 49 � �� � Hayward W I 54843 , . r � ; � � s z�24 � � 715/634-8288 s _ ; . . t �:,,.��;Y � - � CONSTRUCTION SHALL NOT BEGIN UNTIL ALL REQUIRED PERMITS HAVE BEEN --� ISSUED. SIGNATURE OF PROPERTY OWNER IS REQUIRED. o � � � Owner: A2 f �$ q �Iry� Contractor: �(,L �oM -r72U oN (� � Mailing Address: /�l�.!(� (,��1 �1V Mailing Address: �s�/ a Uc� 1-�v.Jy (o � Cit , State, Zip: � LJ 5 �l`�l$r Cit , State, Zip: � ! 1�J/ S� Phone: �D— -���/ Phone: ( - 3�-�7c$ � � -� 1 / � Email: G�,u ar�•Co�'�t Email: r '.� 1�f�lcr�'ii�c�c�t�D�?.ri.�.� CD � Site address: ��p sq f 1� �� 5$W(�F�Gl�lvt�1°� !C'� }' 6� i Calculate grading area: (Total area disturbed including excavation, fill, grading, � landscaping, equipment rutting, and/or other areas vegetation will be removed resulting � in exposed soil) o � Determine width of disturbed site in feet: �ft. x depth of disturbed site in feet:��ft. � Total = 7 O sq. ft. (this is the area calculation) 0�0 Determine Slope of disturbed area: Vertical height in feet_�= Horizontal distance in � feet 7-�= Slope � 0! 3 X 100= I• 33 % Slope � (1V/1 H= Slope X 100= Percent Slope) � � *For any filling or grading of any area which is within 300 feet landward of the ordinary '� high water mark (OHWM) of navigable water and which has surface drainage toward the + � water and on which there is either: F (1) Any filling or grading on slopes of more than 20%. � (2) Filling or grading of more than I,000 sq.ft. on slopes of 12% 20%. �� (3) Filling or grading of more than 2,000 sq.ft. on slopes less than 12%. 3 (4) A Grading Permit is required for any filling or grading in excess of 10,000 sq. ft ,Ay within 1,000' OHWM of navigable lakes, ponds, or flowages OR within 300' of OHWM of � navigable rivers or streams. Date activity will begin if permit is issued: � Z date to be completed: c)�ticE Zo7 S Attach engineering design or complete the following using additional sheets: 1. Describe proposed erosion control installation, construction phases, and finished site grading. cn Include timeline, methods, and materials. (Silt Fence alone is not ample erosion control for c most sites) �� D �r�G C_' �2����� m �N gT�4L Cx /¢� � O/= � �� �� ��,�c E � :� �xc �l�S �o� r►'�RTS C-�°s��'`� �d G S r�-!S r �� ��� � 1 a �= S � �� rEN cE. � 0 � � � � � � 2. List temporary seed type and rate,permanent seed type and rate,fertilizer type and application rate (if applied),and mulch type and application rate. �Ert��nrc--�-r- Coc��GQ.�-n �� w���►�� �vLcN f�f��t�iE�j l " TNrc�. �lo F�e7r��z�. 3. Attach a plot plan of project area including location of any wetland(s)and/or waterway(s)(indicate area between grading project and water body to be left undisturbed),location of excavated material, location of all storm water and erosion control Best Management Practices(BMP's),property lines, existing drainage,post grading drainage pattern,and north arrow.(Silt Fence alone is not ample erosion control for most sites) � cc A��cN�J. EROSIOM —— —— —— � COMfROI RAl1 SAMPIE ER0510N LEGENO CONTROLPIJW � � OR 1 OR� ` cwpofaiv AMILti �. � \ � N _——l�^E bWE1LING5 � I � _ � �._'_.h--+�''�v_ OI�VNY.,c I \`O \.�"T_'—.-xv�� ! orrvvt�.�w �I ` ��� —_— 11 � \��� •I .�..,�rx� __ � �I r�Ur..E �_\j �� • ��x —�o�vo ru.c� e�eiq�� o*micnw 11p - _I �� �n.c..nrm.r.l /j :_ r v J �__ .. �.,..�FF.i; J - .,� m�' n � . �.n�" � � . ,� I � �'T � m�� � -0 �� J_ �-r1� Y 0.N(Ni - � � � . � e SCALE f . . . . . ..L.. ... .�o 4. Attach a cross sectional view of project area including the existing and proposed slope of the bank, water level of any existing waterway,and horizontal and vertical scale. SEE t�rr�C���j. Initial below �All BMP's and erosion control devises will be inspected weekly and after rainfall of Yi or greater within 24hr period. In accordance with the Sawyer County Zoning Ordinance section 4.281(Adverse Effects On Adjacent Properties).I hereby declare that the construction and/or grading permitted under this permit will not affect or interfere with neighboring properties drainage patterns.Any change in drainage patterns which are determined to be detrimental to neighboring properties will be corrected at the expense of the property owner referenced on this permit. The undersigned certifies that the listed information and intentions are true and correct,that all work shall be performed in compliance with the requirements of the Sawyer County Zoning Ordinance and the laws and legulations of the State of Wisconsin.The undersigned person(s)hereby give permissiorvfor a.,!(¢ess to t�prop Ar onsite inspection. � ' �� �� � Original Signature of property owner(or agent with Power of Attorney). Permit Fee: ��0� . ��ate S����a�� Chk# ��N� Rev-l/2020 Ntnt# ISSa _ 0�6��066$O'I � � � 028939a65820 � ao � _S►S"'_S-��-=:��'v`� � � �`~-�--,-- ._ a cri _ v� a� ___ _ _-_--__ — - ; � '� --.. � � � � ��y • 1 Q ....__...»-� �V 1J! 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