WASHINGTON COUNTY PLANNING AND PARKS DEPARTMENT
APPLICATION FOR SHORELAND ZONING PERMIT
Sanitary Permit # _____________
Receipt # ____________________ email: __________________________________________ Tax
Key #___________________________
Please type or print neat
ly, provide specific answers, and complete entire application. Work Phone: ________________________
Owner(s) of property: ______________________
_____________________________________ Home Phone: _________________________
Owner(s) mailing address: ______________________________________________________________________________________________
Street City State Zip
Address of Property Involved: __________________________________________________________________________ _____ _________
Street City State Zip Lot # Block #
Subdivision/CSM #_______________________Location: _______1/4 _______1/4 Section: ______ Municipality: ____________________
Zoning: Shoreland Wetland Floodplain
Setback from water________ ft.; Setback from wetland: _________ft.
Proposed Use/Project(s) Be Specific:
___________________________________________________________________________________________________________________
Typ
e of Project: New
Addition Renovation F
ill/Grade/Excavate Total Extent of Disturbed Soil: _________ sq. ft.
Size of Project(s): L ________ x W ________ x H ________ Elevation of Structure(s) Lowest Floor (NGVD): _________________________
Parcel Size: _________ sq. ft.; Impervious Area: ________ sq. ft. _____% of Lot
For Floodplain Structures: Structural Component $________; Equalized Assessed Value $_________; Percentage Value of Project ______%
Have you or previous owners completed any addition or remodeling to this house? _______ If yes, month/year: ________________________
General Contractor’s Name: ___________________________________________________ Contact Person: ________________________
Address: __________________________________________________________________ Office Phone: ________________________
Proposed Start Date: _________________ Project Staked Date: _______________________ Fax: _____________________________
THE FOLLOWING ITEMS MUST BE PROVIDED ALONG WITH THIS APPLICATION:
1. ___ Full legal description of property.
2. A survey or plot plan (top/bird’s-eye view), drawn to scale which clearly shows the following:
a) ___ Boundaries of the property. Arrow indicating North.
b) ___ Location of existing and proposed building/structures.
c) ___ Location of private sewage system and water well.
3. A Grading Plan/Erosion Control Plan (and Stormwater Management Plan, if applicable),
drawn to scale, using a top/bird’s-eye view which clearly shows the following:
a) ___ All existing and proposed impervious surface areas.
b) ___ Total extent of disturbed areas for all proposed projects, including soils/backfill areas.
c) ___ Erosion control method and location.
d) ___ Existing and proposed drainage swales, terracing, retaining walls, planting beds, downspout
locations and clear water sump locations.
e) ___ Current and proposed stormwater runoff drainage patterns (use arrows to show).
f) ___ Site restoration plan.
g) ___ For proposed structures/buildings/additions that will be greater than 20’ tall from final grade to roof peak, as viewed from
the water body, provide a detailed vegetative screening plan.
4. ___ A drawing or plans which show a north-south and east-west cross-sectional view to the property lines, or a topographical map,
showing proposed cutting and filling encompassing the entire project area. Label existing and proposed surface elevations,
including drainage swales.
5. ___ A drawing or plans which clearly show a north-south and east-west cross-sectional view of the proposed
building/structure. Label the proposed building/structure.
6. ___ For projects proposed in floodplain, floodfringe, or floodway, additional detailed survey and/or engineer work will need to be
completed and documentation provided to this office. Please contact this office for requirements specific to your project(s).
Any modifications, expansions or alterations in the scope, scale, or methods of operation of this permit shall require additional review
and approval by the Wash Co Planning & Parks Dept (PPD) before being implemented. This permit expires 18 months after date of
issue. The applicant must notify the Wash Co PPD at 262-335-4445 for an inspection and posting of the permit prior to starting the
project (after the proposed structure is staked and/or after erosion control is installed, if applicable) and call for an inspection after the
project is complete. Applicant is responsible to obtain all other required permits from the Town, DNR and/or Army Corps of
Engineers.
**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 or contact a department of natural resources service center. The webpage is http://dnr.wi.gov/topic/wetlands/identification.html
Owner or Agent Signature:____________________________________________________________ Date: _____________________________
**By signing this you acknowledge you have read the above statement concerning construction around wetlands.
…………………………………………………………………………………………………………………………………………………………………………………………………………………………
DEPARTMENT USE ONLY FEES PAID
Individual Reviewing Plan:_________________________________ Date Issued :___________________ Structure(s): $__________________
Posting Date: ____________________ Inspector: _______________ Approved Disapproved Minor Grading: $__________________
Follow-up Date: _________________ Inspector: _______________
Approved Disapproved Total Fee: $_________________
Remarks:__________________________________________________________________________________ Date Paid:_________________
_______________________________________________________________________________________ Received By:________________
White - Department Copy Yellow - Owner's Copy Pink - Town's Copy Form 536 (Rev. 04/02/2021)
“rough sketch” of the
proposed project be
completed and that you meet
with the Land Use Inspector
before final plan submittal.
