HomeMy WebLinkAboutPermit 1098B12
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..h.....~~_~n~_~~___'I'vp~hn APPLICATION FOR BUILDING PERMIT j(Jh.?_F..=__I3__~_/::<
TOWNSHIP SCOTT COUNTY, MINNESOTA PERMIT NUMBER
Owner: Name: ......._P~t.+.i.9J:<;.J~.y@_____........._____.......___...h_........_....00.............________......._____________ Phone: __._447..":~9_92._.______.
Address, nh____?~_~h_L,hhh!:'!~()r.h:;x:m_I:~~~_'h~~_~__m~~~1?_hhhh______h_h____hmhhmhmmh___h_hmmhhm_hh_ n_ -
Applicant, (If other than owner) Name, _____h____nnnhh_hnn__hh______n_h_nn___h____h______n__n_h____h______hh__h_h__h_h_______h__h__h___h________
Add ress, __~n.n_____......nn_._..._...__ _______h_ __ h__..._..._____________nn___n___n__nn__h_______h_n____n_____n_ Phone, _______________nn___n___h_
The above applicant applies for 0 permit to ____m__))1~2_~_~n~h_~~~.'!__'?_~~!ihg~~_EO'.hnnhh_hm.mhhmh____hhum______h___mhhmn_
___n___n_n__n_nn____nn...______n__._____nn___________n_u.n.h_h____--------------------------h---.--n----n-znn---h---.n.hh-.-h-.-n..nn_________h_______...___h______
lE!uild, alter, repair, wreck. "as cose may bel
PERMITS APPLIED FOR, (Check those applicable) BUILDING (Estimated Costl_ _.._"/t?1J::(2___..___mn_______.hm____h____mhhmn_hh_
WELL, ________.hhh_______nh..__________.._.._.__..__._n_____n_____.._.______.n____mm______n__.__
Frame
KIND OF CONSTRUCTION, n__._h____.___.._________..____.___nnnn___.___...n_n___._______n_nnn____.nnn____nn._________n.__h___..._._._h__..._________h_h_.n
___.n_.n____.___________nnnnuun____n_..__n_n__________..un__._____Uh_+___uu___n....__n_uu+nuUhn_h_...+..nhU.+___UUh _____unn_nn____n_..n_.._u..nn___
Number of Bedrooms, ..n___nnn______._________m____mh_._____h___n_____n General Contractor, ___.n_n.___________....______n___h__________n________n.___
Legal Description of Property, _______NWi._n_h_nQ!!~::_.I:}~f___~~.:r~hh_______.__h_____n...___nh____hh_ ._._n...__......nn____hh___n____h_hh___h
Township, .h___U.fl,h_____n____.u Section, ._l~n___. Range, '__??___h or Lot, _.__...___.. Block, ___n_______ Subdivision, _m_h______m_hn.._.__n
Zoning District: Agricultural: mn_.n__Unm____d Residential: m_~:-_~______m. Commercial: mmnmn__m..n Industrial: m__m_mm._n_
A Plot Plan showing the following must accompany this application,
1. North Direction S_ Street nome 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 Droinfield
4_ Dimension of structure Is) 8. Location of well.Distance from Septic Tank and Drainfield
Applicant hereby agrees that, in case above permit is granted, that 011 work shall be done and all materials which shall
be used shall camply with the plans and specifications herewith s mitted and with the Ordinances of Said Township
and County applicable thereto. .._..___________@~h-#h---- _.._________m_____u_____m.___.._h.....__
Applicant's Signature Data
TOWNSHIP USE ONLY
Recommend Approval, h__.___m."_____hh_hh___hh.... Recommend Disapproval, ___..___...___________.__m______.___ Approval recommended
subject to the following conditions, ___m__.....~______..._!'~:r:_..P.~~~~...c.~__.___..__________.._h__h_..........._...__.....__________..______.._
Reasons for d isa pprova I, ____hh____hh._....__._.hm_h___m_h__h_h___m_________h__h__h__hh_........_.___h______..____m___mhm___.____m.hh_______......_.__
SIGNATURE OF TOWN CLERK, lOr representativel..___..________Wi_lJ_~g_fl_:r~Qi________.._u_____________..__________ DATE, __..~?-::?9.=7.7..._
COUNTY USE ONLY
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FEES PAID,
BUILDING PERMIT .n___ ~
WELL ..____........___..____ ~
ST ATE SURCHARGE FEE t
TOTAL FEE ..__.._h__ ~
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6'7 yt
RECEIPT NUMBER: ___.......___n.._______u______.._____h_h
INSPECTIONS,
Site Inspection m_......hm_..._________hhU__________________..._h___._____..______________.______m_Datem__ _h.._h_____..________....n__
PI an Review ....._n__n_..u_n_n._n_..nun___nnn_.___n_n_nun_n___.._______n______dn__._nn_ Date_n_n__n__n___nnn.n.n__n...
Footi ng Ins pection _U___n_n....___nnnU..__n_nnn_Uu._n.n_nnnn__U______n___.nuh_._n_n. Datennn_hn_n_____n_nn_.n____.
Fro m i ng /Energy _mhh_hh_.._hh_m_h__.._m_hh_mh..__.m_...__.._h_m_______..___m___n___ Date____...._h._m.__hh_.___h__..___
Lath or Drywall _mhmh_......__mmh_hhhh_h__h_...._..___hh_____hh___..___..h..._____..._n Date...______.._____.._h....h_____..._
P lu m bi ng _h___m___h__h_.h..hh_hh_____hm_h___hh_..mhm_.__hm______..._h.___m__.._h.._h Date _____h_____.h_h____h___hhhh._
H eati ng ____ _h_h__m__h____h___hhhh....m__h_h.__h_..____m________h.hh_h_h.___h____mh___h. Date __h__.._h____m___hhh____...._
Final/Energy------h.m-h-hh---m-h-mh-..--h--hh-h--.....--______h_h_hhh___hmhhh....__hDateh_h___m________..___._______..___
Occu po ncy Perm it __n___nu___U..__u____n._.n______...__n____n.....__._______n________n_n_nn_____ Date..h______n.________________________
1. County Copy
Form No. 1
Revised 5.18.77