HomeMy WebLinkAboutPermit 1324B12
\1~L1lP
1"/) V " L Af'ie...
. .J.~.~... APPLICATION FOR BUILDING .....,T .J;:,~,::.1):::!.~...:....
!, T~:~.~~Ui"'~""'''' ...C.~~~~~:..:;~~.~.~S~~~~~.:......,:.. ''''''. Ph.O::~~;~M;i.?i:?~
Add-... h"J <?il /"oVIn, tI.., \, .,..:23.1.,............,.
,~ ,.....p..:;l.'o..~I.... . .<&.:.:CI<........ .... ....... . _........ ............ ......... . 'rJ~.-
Applicont, IIf other than owner} Nome, ........................................................................................................................................
The above ~:;~:~;~~;~;;::..~:~.:..;:;:;;;..~.::C!.~::::.~......~~................~..~~.:::....~.~.~~:.:::.~:.~:::::::~.::::::::::::::
~~;~:..:~.;~;~~..:~~,..;~::~~:~:..~~~;;:~~.}~I;~;~~~::i.~:~;;:Yr~~~:::~~~~F~::g::9~:~~~c:-
I'
. LJ o-dl ~~......_..............~:::~....~::=.~........~.~.........::=:::::~=::~:~~~~~~~~~~~~~~:::~~~::~~~:
KINO OF CONSTRUCTION. .......................... p............_.._......_.................._.........._........_......_. ...
~=~;;:,~..:;._~~;:~~.::::~:~~~~~::~..~.~:~~:::~.....::..==.:.~~...:~~.~::~::::....-;:,~;;;;..~:~;;:~:;:Ti1!.~I1Z;;;;;]Jj;Jijf;.~
~:.::~::~:il.i.~~~.:.~~i:~.:~jl~~:-;:~~::.::;j:'f.:r-.~:~,~.1-;;..~~..;;:,.:......._..... ~~~~:;:~Ji;~~~
Zoning Di.trict, Agricultural, ....................,... Re.identiol, ..._..~.." Commercial, .......... Industria, ..'-""""''''-'''
A Plot Plan showing the following must accompany this applicotion:
1. North Direction 5. Street name or road number
2. Locotion of Propo.ed .tructure on lot 6. Locotions of exi.ting .tructure.
3. Dimen.ions of front and side .et.back 7. Locotion and .iz.. of Septic Tank and Drainfield
4. Dimen.ion of structure (s) 8. Locotion of well.Distance from Septic Tank and Dralnfield
Applicont hereby agree. that, in 'n _~ .'.. permit i. gran d, that 011 work .hall be done and all material. which shall
be u.ed .holl comply with plans and specificotion. he ~With, bmitted and with the Ordinances of Said Town.hip
and County applicable the to. ' , ' .
.. .... m....n .9j/)12f""""'''''''h
Applicant'. Signature .0- .........
TOWNSHIP USE om y
Recommend Approval, h._..........~......... Recommend Di.approval: .._.........._._.................. Approval r&COmmended
.ubject to the following conditions: ..........._......n.............._..__......_........__..........m...._.........._......_.........._..._._...
:~:;U:r o:i.;~:~v~~~;~.;;;;..:~;=:::~~~~.::::::7~.)}lf;;..;)I:EB.~::::::::=:::::...~~;~:~~;~~i:i.::::
COUNTY USE ONLy
Approved: .....L......... ~enied: ..........._....... 8y .Zon~ng Administrator ~~ct ~xisting regulations and ,!,e following
conditions. ....LJJ..~....~9.r....~ ';....... ..~..~.~...F./,...f...m..."..&:-f-.~.'7.i,,+"- 7~...~y::~_
:f~~~:.=~;zj.:;::~::::1!;::l::-:..~..:::::.:::::::::~::~~:::::::::::::::::::::::::~::::::=:.:...~~~~:.::::::~~:~L~;.:i.-:;'=::::
V . COUNIY USE. ONLY . . " .
Approved: .................... Denied, ......._........... By Budding OffiCial sublect to eXlstmg regulations and the followmg
conditions:
___._________~_h___________.___._________~____n____________h____________ ._ ___.
Sig natu re, .....................................................m....................
FEES,
Zoning Permit
Plan Check
u (::). 1')..59........
.::5.o..{;2............
.......9..:.<;:0..........
..a3.C20...........
JJ.Q..6Q.........
....,.~.."O.Q........
Me-1t-
/}S)/
Sewer Installation Permit
'~~ f2-'~
~\J~
Plumbing Permit
Weli Permit
State Surcharge
Building Permit
TOTAL FEE
.......;.r-.........n........
.3.~L~~_.........
1. County Copy (White) 2. Town.hlp Copy (Canary) 3. Applicant" Copy (Pink)
Form No. 1
R.vised 3.2.79
No. 2.94 Miller-Davis Co., Minn~;:;floli_,
~_~....~"<-c._ "ll:!c'=~'____-.r I~
$"u"u~~'~'~'~'()'h"'''''''h nO.jJ:l.'f.~#..~/:?-::'hh" l~
~ &tate of :fflinnesota, ...............of....oo.........m............................... rj
j County 01. .m._...m.S~1!;tt......mmm Office of........~ooll.1dH.~lt~..9.fn,,~.~~............. I!
I .,.,..,. .....h.,.,J!.1djJ!HD.g.........hn.......~ermlt I
..m......I~.<::~~~~:~~~~~!!~F~~~~s~:~~~~~Q:;~~~~~.Wi:::~~.~~.:.~:.s~~~~::::::::::::::::::::::::=::::=:::::::: I ~
I =RMisSI~NJf:E;r~~&~:;;::::~!:~:~n~rebY;.".PM~ ":~~:; II
I ~~~~.~h~~-;~~~~..~fi~~d..d.~~~~ib;d..~~.f~il;;~;.L;~....:.'Bi~~k :::.:.:.:......:.;..;i~~.~;.~ddi~i.~~... . .:...... ..:::' ~
I ~~~~s:~a~~~:~i~~~.~~~~~d~::~::~::ci.fi~d..i~..~~id.~~~ii~~tio~:""OO.. .h. mm.. .. .m..... ..00... m. . I
I This permit is granted upon the express conditions that said owner and his contractors. agents. j
~ workm::..~:~..em~I~~.~es.. shall compl~o;t~l.res~:c~~ ~i.~\;fi .~r.~inan.c~~..~f t:e . . ... .:: ..m: I
& Given under the hand of the.uBuilding,.Offii:U1L....n of said ....Qo.uitl$y, and its corporate ~
I) seal an~t,,::,::;ted\ by itsNllflning.D!!,e"t()l'this .1. mm-4a~nm" u_/! /1-..,. m 19., I
I . f::-~0A~',oJhCXJo':."'."...::.,-..; .. .~~..1ztm~ J~
I~~~~~::::::;~~~~~~;+:::::~';::~~~~
~'
,
/3hlj /g-/,;J-.
COUNTY OF SCOTT - BUILDING INSPECTION DIVISION
PLUMBING INSTAllATION PERMIT
'.
Permission is hereby granted to install plumbing at the following location:
LEGAL DESCRIPTION: L - \ L\ Su L ~ \ \ f'r\A'ul ~ 0 , r~
'\ " -
OWNER: r? ~n..w Sx~.h,_.
ADDRESS ~ PHONE: S 3 ~ Y. rY\aN"l(~ ~ n-ncO L,5 . e~ rJoJ& ~ .
PLUMBINGCONTRACTOR:X Ac.t,',-- p}bqc Co, L1c.No.I 2o[{'~
ADDRESS & PHONE: \I q3~o .-.2 ,,-"d 1////)"" /11715. 11. ~~/l/.
. {, . " /
S"tf/- Z-'f)-J
Applicant hereby agrees that, In case above permit Is granted, that all work shall be done and all materials
which shall be used shall comply with the plans and specifications herewith submitted and with the
Ordinances of the State a~" unty a,p~abl~]i8to. ~
'l '-J.~ ,( {. ~" /1 ~ j 1L,~ >-) 9
~.()O f Applicant's Signature ~ ~ ~te
BUILDING OFFICIAL
DATE