HomeMy WebLinkAboutPermit 3955B11
AP
ICATION FOR BUILDING PE ~IT
SCOTT COUNTY, MI~NESOTA
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- Cot1NTY USE ONLY -
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Project Address
Post Office City
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Permit number <CJ~~-:g-II
Receipt number 14-6;;Z r<
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~ APPLICANT FILL OUT INFORMATION BELOW:
Applicant .:..JAHt"S ~ cL"J~e 1..,4 n. sot! Phone (Home)'-i'67 673J(Work)
Address j7oJ?O HJH:)L.e L./JI'IC-- City ~1"it.,~<$I!!te HN Zip ':>:::'-37:1-
Owner (if other than Applicant) Sfj M~ Phone (Home) (Work)
Address City State Zip
Contractor Name :s Y!! I. '-' Phone (Home) (Work)
Address City State Zip
State Contractor's License Number
Project Legal Desc.
Parcel No.II-OI~ 1'I.l.l..h. No. Acres
Se"
Lot
Block _ Subdivision Name
The above applicant applies for a permit to:
(erect, construct. enlarge. alter, repair, move, improve, remove or convert as case may be)
Type of construction: Wood ~MaSOnry _Other _ Type of heating system
Dimensions of structure q X 81 ~/ _'SM'RS ( decK)
estimated cost orvalue f .~t:Jo. b 0 0/ NumberofBedrooml;i/ /1}-
NOTE: A 8urvey 18 required by a registered 8urveyor for all new home appllcatlon8 on le88 than 10 aCre8.
If a survey is not required, a Plot Plan must be submitted. Please contact the Building Department for a complete list
of items required for permit approval.
USP'
(house, garage. deck, reroof,elc.)
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Applicant hereby agrees that, upon issuance of this permit, all work shall be done and all materials used shall be In
compliance with any applicable township, c' y and county ordinances. The applicant agrees to abide by all zoning
regulations, and utilize this structure for i ermltted use.
6-1 7-9':9
Date
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Recommend Disapproval ~ubject to the following conditions:
Signature of Township or City Clerk (or representative) ~ /~.,~ Date t,-J 7-'7')
~~COUNTYOR~NGUSEONLY~~
Minimum setbacks: Road
Approved Denied
following conditions:
Signature Planning)
Slgnature(Environmental Health)
~ COUNTY BUILDING USE ONLY _
Side. Rear Lake/CreeklWetland ;O:onlng district
By Planning/Environmental Health, subject to existing regulations and the
Date
Date
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Approved
f1enied
By Building Official subject to existing regulations and the following conditions:
"*.A ?'Z~-:-~L-- 70 ~~ S~/~ ~49 r
o _
Date C-;J..!)...!T~
4U--/..,tJ!#eJA. "-
Signature ~ /i/"L"C
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Additional Comments:
FEES: Land Use Permit
Sewer Installation Permit
Plumbing Permit
Plbg./Mech. State Surcharge
Bldg. State Surcharge
Building Permit
Plan Check
, <:'V
/,;;-, o-V
Erosion Control
TOTAL FEE
/0 c::: !;:D
0660Q-2805(1Q-961M)
WhiteoCounty Yeliow, Township PinkoApplicant Goldo Township