COPEMISH VILLAGE
LAND USE PERMIT APPLICATION
FROM:
(applicant)
(address)
(city, state, zip)
(telephone, home and business)
PROPERTY OWNER’S NAME AND ADDRESS: (if not the applicant)
Phone:
APPLICANT’S CAPACITY IF NOT THE PROPERTY OWNER (Check box) **
Builder Have option to purchase Other
** (Applicant must have a written statement from the property owner to act as their agent, use space below)
Parcel Size:
Section:
CONSTRUCTION SITE ADDRESS (if known)
Parcel Tax I.D. Number 51-__ __- __ __
_
_ - __ __ __ - __ __
Zoning District:
Size of Proposed Structure, Building, Addition, etc.:
Height of Proposed Building Structure Addition, etc.:
Proposed Use of Building, Structure, Addition, etc.:
SITE PLAN MUST BE INCLUDED WITH APPLICATION
(SPEAK WITH THE ZONING ADMINISTRATOR TO DETERMINE SPECIFIC SITE PLAN REQUIREMENTS)
AFFIDIVIT: I verify that the information and statements made in this application are true and accurate, and understand if found not to be true,
any land use permit that may be issued, may be revoked. Further, I agree that any permit that may be issued is with the understanding
that I/we will comply with all applicable Sections of the Copemish Village Zoning Ordinance. Also, I agree to notify the Copemish
Village Zoning Administrator BEFORE the start of any construction, when the proposed uses are marked on the ground for the
purpose of a pre-construction inspection. Further, I understand that this is a permit application (not a permit) and that a Land Use
Permit, if issued, conveys only land use rights, and does not include any representation or conveyance of rights in any other statute,
building code or deed restriction of other property rights. Further, I agree that if a Land Use Permit is issued, I give permission for
officials from the State of Michigan, Manistee County and Copemish Village to enter the property for the purposes of inspection.
Applicant:
Date:
WHEN COMPLETED SEND TO: Copemish Village Zoning Administration
Phone (231)723-6041
FAX (231)398-3526
e-mail: planning@manisteecountymi.gov
Manistee County Planning Department
395 Third St.
Manistee, MI 49660
Form - Land Use Permit Application (revised 11-2019 Page 1 of 2
Front: Rear: Side: Road Yard: Water Yard:
Proposed Setbacks:
