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SUrnet'4 County Office of Zoning Administrator m W f o <br /> APPLICATION FOR — LAND USE — PERMITS a 3- <br /> z s <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and - c <br /> located as shown herein.The undersigned agrees that all work shall be done in accordance with the requirements of the Bur- 3 a <br /> nett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the laws and regula- - 0 <br /> tions of the State of Wisconsin. m m m <br /> Thomas E. Trost o <br /> m o <br /> OWNER(Please Print) Contractor or Surveyor or Agent o. f <br /> Rt. 2 ,a <br /> _ m <br /> Address Address <br /> Webster, Wi. 54843 <br /> City,State,Zip Code City,State,Zip Code y <br /> 71r,_34o_Fn3n o <br /> Telephone Telephone w <br /> _ rn <br /> Permit(s)Applied for: ty <br /> New Building Filling/Grading <br /> H <br /> Addition Moving o 0 <br /> Sanitary X Camping Unit <br /> Privy Subdivision o <br /> Structure Use: 1__A"_t1j t s-'�LI ON 0 <br /> (fam y hometcabin,garage,addition,etc.) Z o <br /> P <br /> 1. Show the location and size of all existing buildings(EB)and all new buildings(NS)and indicate North (N). .� o <br /> 2. Show the location of the well (W), septic tank(ST), and drainfield (DF). `- <br /> 3. Show the location of any lake or flowage-if within 1000 ft. and the location of any river or stream -if within 300 ft. <br /> 4. Show dimensions in feet of the following:(a)building to all lot lines,(b)building to center line of road,(c)building to lake, <br /> river or stream, if applicable. <br /> 5. If,separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be signed and dated by W <br /> the owner. <br /> (b <br /> 0 <br /> o <br /> v o <br /> Z <br /> 0 <br /> w <br /> Cn <br /> m � 0 <br /> o � <br /> 0 <br /> w C <br /> � N <br /> W � <br /> ti 1 T <br /> Z <br /> O <br /> Z <br /> D <br /> W <br /> m c9vm�cc�� <br /> m m aa� <br /> O N i Q <br /> N­ <br /> '0 <br /> Z O : 1 <br /> O n : <br /> 2i m <br /> o O <br /> P c <br /> I(we)declare that this application(including any accompanying schedule)has been examined by me(us)and to the best of <br /> my(our) knowledge and belief it is true,correct and complete. I(we)acknowledge that I (we)am(are)responsible for the ,� m <br /> detail and accuracy of all information contained in this application (including any accompanying schedule) and I (we) O <br /> further declare that I(we)recognize that this information I(we)am(are)providing will be relied upon by the County of Bur- `� <br /> nett Wisconsin in determining whether to issue a permit. I (we) further accept all liability which may be a result of the EQ <br /> County of Burnett relying on this information I(we)am(are)providing in this application.I(we)agree to permit county off!- ;m <br /> cials charged with administering county ordinances or other authorized person to have access to the above described pre- <br /> mises at any reasonable time for the purpose of inspection. ' <br /> SIGN HERE Ca`/'� - 7 O c <br /> (si ture of owner or Ildi c ntractor) (date) <br /> ` o <br /> o: E o <br /> ZONING ADMINISTRATOR - �� � <br /> i <br /> TOWNSHIP PERMITS MAY E REQUIRED <br /> Ll000 oogfma <br />