HomeMy WebLinkAboutPermit 4165B11
APPLICATION FOR BUILDIN~" IB8EDWIC "'. .' yA-yjAV ~:)
T_.hlp/CU, SCOTT COUNTY, MINNE. ~' A ",.., ~~'
,pc:: ~~~:;;::h~~LY ~_~~:, :~\:J "'
BIJII,DING INRPEC1l0NR
Project Address /7n.:J ~ /'n,~""d<.^,~ ~ Permit number ~/ti:6'-8-//
Post Office City Pr' -<>Y ~~ /"Y> ~ :lIp S S 3 "7 ;;>.... Receipt number
~~~~-
APPLICANT FILL OUT INFORMATION BELOW:
Applicant ,Ii m s"'x'"
Address ....l1..(l?'i M""l:>t,own Rn
Owner (il other than Applicant)
Add ress
Phone (Home) 447 'lRF;2(Work)
City Pri or 1."k:9ta1e M~T Zip """7')
Phone (Home) (Work)
City State Zip
Phone (Home) (Work)
City State Zip
r -. 101= 'i.
(9VV f f . 5
Parcel No. 1/, If'! /, O:JJ. - ONo, Acres .
Contractor Name 'tJ; l' ~D--hi1'l'lC'c' F
Address
State Contractor's License Number
Project Legal Desc, same as address nw1
Sec I (Lot Block ~ Subdivision Name
The above applicant applies lora permillo: build deck attached to exist.inn no""",
(erect, construct, enlarge, alter. repair, move, Improve, remove Of convert.1 case may bet
Type 01 construction: Wood xx
Dimensions 01 structure 16 X
Masonry~Olher ~ Type 01 heating system
Ux 2:~.300.00 0~~V
NOTE: A survey Is required by a registered surveyor lor all new home applications on 18SS than 10 acres.
II a survey Is not required, a Plot Plan must be submitted. Please contact the Building Department lor a complete list
01 items required lor permit approval.
estimated cost orvslue
Numberof Bedrooms
Applicant hereby agrees that, upon issuance 01 this permit, all work shall be done and all materials used shall be In
compliance with any applicable township, city and county ordinances, The applicant agrees to abide by all zoning
regulations, and utilize this structure lor its permitted use.
/ (i /!(!II(I 4/1/,
.(~~icant's Signaturi" -
12-27-96
Date
~~
~ TOWNSHIP OR CITY USE ONLY _~~.-..
/
Recommend Approval XX Recommend Dlsapproval~ubject to the lollowing conditions:
/1
SignatureofTownshiporCltyClerk(orrepresentative) /~~ ~;-- - Date' ?-?7.=.9.6.
~-"""'-'-~COUNTY OR CIMLANNING USE ONLY ~~~~~
Minimum setbacks: Road Side/5' Rear' 36' Lake/CreeklWetland Zoning district A - ::l
Approved /' Denied By Planning/Environmental Health, subject to existing regulations and the
following conditions:~ IM.I,.I .....ILII 0\'
SIgnature Planning) Q, N.....-. /YII), J.J. 0
Signature (EnVlronmenta~ealth)
Date _"I-_J.J- 99
Date
~~_~COUNTYBUILDINGUSEONLY. ~~
/J7P YBuildi~;f~_x;::;~~~~~ndltlons:
"~Ig:tu: _ _ _ _ _ _ _rt_~_ _',~ _ _ _ _ _ _ _ _ !a~3__~-~7
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Additional Comments: lPoJ~/c tplC-
FEES: Land Use Permit
Sewer Installation Permit
Plumbing Permit
State Surcharge
Building Permit
Plan Check
Erosion Control
TOTAL FEE
06600,2805 (10,95 1M)
White.County Yellow-Township Pink-Applicant Gold-Township