HomeMy WebLinkAboutPermit 843B12
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....,"~.f;twTiH/~':""~ APP~~~~~~~~;;'U~~~~~;~:MIT "'''?'~R~i;'N~;e/..{''
Owner, ~::~~:'::~iR;':~~~;~Z~::;:::::::(l:TE.::;l::::::::{g;;?::::~::~2:y:n:'.:n,~~:~~,i~~~:~:~.~~:<~"",
Applicant, (If ather than owner) Name, .....:;::~.t/,l"',~."',::::-.....................................,........,............................................,........
Address, ..~.........................................,.....,........."..,,....,...."............................................. Phone, ................................
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The above applicant applies for a permit to ...!.Q,k4,.c-\........:::::",.:::.,::t-"L;~;~,~~,:.........~2:,z<,,2..G,................................
l!uild, alter, repair, wreck. as case may bel /;f ,I< _, ~ ~
PERMITS APPLIED FOR, (Check those applicable) BUilDING (Estimated Cost) ,......,.."~..~~.lL.....................................,.......,
KIND OF CONSTRUCTION, ..A:..~t.fL'f-jd::r:.,,~~~~.~~~~~~~~::=::::::=::::::::::::::=::=::=::=::=::=::::.~.~~=::=::=::::::=::::::::::::::::::::::::::
.........._......_..................................h.................._.h._.._......................_...............................:.....;.....p.;-............................_...........
Number of Bedrooms, ............,..,....=:::::,.....,.......,.................. General Contractor, ,...."~:~L.t,..............,_.........................
legal Description of Property, ...42L""-.,i"-t;,_..u.~.L::"L!:'.................._...........{0...iJ,...,..,_..... .._......_................................'....'
TO~ship,. ...I.l.s?~....._.._... Section, ..t","-... R~nge'.;2..k::::- or ).ot, ............ BIO.Ck' ......._... Subdivision, ..............................
Zoning District, Agricultural, ........................ Resldent,al, ..._.~........ CommerCia!, ...................... Industrial, ......................
A. Plot Plan showing the following must accampany this application,
1. North Direction S. Street name or road number
2. location of Proposed structure on lot 6. locations of existing structures
3. Dimensions of front and side set. back 7. location and size of Septic Tank and Drainfield
4. Dimension of structure (sl B. location of well.Distance from Septic Tank and Drainfield
Applicant hereby agrees that, in case.t.:' e permit is granted, ':(,t all work shall be done and all materials which shall
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, Applicant's Signaturi Dote- 7..u,
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V TOWNSHIP USE ONLY
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Recommend Approval, .................h..................... ~ecommend DlSapprovj4;al. ................:............:........ Approval recommel'lded
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sublect to the following conditions, ...........-..... ,........,............................ ............... '<.'...""~.,..t.........................................n..'....
Reasons for disapproval: ....n._m.nuu..nu.uh..m_n.m.:nn.~....._mm.m_.)_7mu...~__mnm.."..nn...nm..m.mnm:::m.nnm~_.~.::.
SIGNATURE OF TOWN CLERK, (Or representativel....t.,:.'""."'t.L?:..l,:~::,,:'.,..{.,.I.:;.,:~:............................. DA.TE, :;..:~.2=-ji..'
COUNTY USE ONLY
Approved, .....~. Denied, ........'.........., By Planning and Zoning Coordinator subject to existing regulations and the
following conditions, ,..............................,....,..............'.................,.....................................,...........................,.............................
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FEES PAID,
BUilDING PERMIT ._... t
WELL ..,_............_.._... f
STATE SURCHARGE FEE f
>om ~, ......--, / /J. .or) .,J1.. "''''' "o"~'~" .._...!LJ.'i3i{_.........
Site ,......!!..L;!;".................,................. Date, .~::-y-..~-::.~._;{~_!..:..7J.,.. . ,,0- "
Footing .........................................,........ Date, ...-..-..................................... r / II
Framing unnnu..n.n.uu..nnnnnnn.n_....n. Date: .n_.nn.hh.h__n_n.nn..n..n..nn i../U
FINAL
Date, ."'......,...................._.............
INSPECTIONS,
FORM NO. I
IRev, 11,.4,691
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