HomeMy WebLinkAboutPermit 208B12
~ I ! --I I II -==-, ' ) . I Q.,
_m _:m__ m264-.L-----m_ A~.-LICATION FOR BUILDING PER. r
T WNSHIP SCOTT COUNTY, MIt-lt-lESOTA
Owner: Name: _n_~nnr;4.._~n_m___n_____n____ __n_n_nnnmmn_mnn_mmm_nnnm__. Phone: _f!/..n&"_:,;;.l~ 7
Address, mmnn~n_~_mlmJ!d: _';::2",_mmn___ mnnmnmn.mm.mnnnnnmnn_nmnmm__.n
Applicant: (If other than owner) Name: ___mn___nnn___. _m___mnn____n___________m____ n_n__n_______.____ __.,n________n______________m________ _._n_______
The above A::;~::~;m~~~;;:~--~~;-~--~:;~;;--;~-::::e;;::ll:~:------.--_-_-_-_-_-_-_-_--_--:-.-_-_--_-:_-----:.__p_h_o_n_e:_:::::::::::_-::::::::::-:::::::-
n___,2r2'iL~ LL/.2.
PERMIT NUMBER
(euild, olter, repair, wreck - ';"5 case may be)
PERMITS APPLIED FOR: (Check those applicable) BUILDING :"<timated Cost) mnmm,p_~n<!!?::flnmnnmmnmnnnnnm____m_
IND. SEWAGE DISPOSAL SYSTEM: nn__m_~-------__--mm__------mnmmm.
KIND OF CONSTRUCTION: __LUeC:~:!Ll~LL:_::_-:::::::::::::::::::::::::-:-:::::::::::::::::::::::::::~::::~:::::::::-:::::::_-:::::::_::::::__
.~=~~:;--:;--~:~;::~~-:-::::-_:-_-_-_-_-_-_-_-_-_-_-_-_-_-:f-_-_-_-_-:_-n_-:_-_-_-____-_::-_-_-_-_-_:-_:-_:-_:-_:::-_:--~:~-~-;~I---~~~;;:~;~r:._:jj:~:~::::::_::_::::
~::~s~::~~I:C.~:~i-~~:n-::j;2.:--~:~~::-::::::::::;;--~~-;,--_-_-_~:::::-m~;~~~:-:::::z:::--;~-~~;;i-~;:~:~:al.J _
Zoning District: Agricultural: mhmunm__.__.m Residential: ________mum__n_ Commercial: __mumO.Um_.m Industria: mmm____mn____
A Plot Plan showing the following must accompany this application,
1. North Direction 5. 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 I~) 8. Location of well-Distance from Septic Tank and Drainfield
Applicant hereby agrees that, in case above permit is granted, that all work shall be done and all materials which shall
~~du~odu~~a~p~~~~e ~~:r:~ ~-~-?~s-;z-k:e-d--~-~-~---~-i-th--the ~:K~~O~:i~;wnshiP
Applicant's Signature Date
V TOWNSHIP USE ONLY
Recommend Approval, nmnnnmu_mm_mnmnn_m_ Recommend DISapproval: nunnmmm____m_U____mnu Approval Jie~o,^,mended
subject to the following conditions: um~-n~--1-~-~-'m:~nm'~m~__L~/€<1
Rea sons for d, sa pprova I: __uu___nnnn____n_u__n__u_U______u___u_n_____unn__u______nnnm__U__m___U_nn____.___m__nmunnu_._umm_u____mm_uu
SIGNATURE OF TOWN CLERK: (Or representativel mnnm___m~-mm-mmmmmm---m DATE: }f/?:7/Z-11
/' . ~~~~.....
Approved: UUhHnnU___..- Denied: u.___________~~Un By Planning and Zoning Coordinator sublect to eXisting regulations and the
following cond itions: ummmUmum_.umm__n__m__m_____m__m_h______._nnn_nnmm____nmu___u__u__m__mn_____nmnmm__mnnnmnunn__u_h_m
~;~~~~~~~:--::::~:::::::::WdYk:::::::::::::::-::::::::::::::::::::::::::::::::::::::::-::::::::::::::--~~~~:-::~/:7ij:::::::
36-0-0
IND. SEWAGE DIS. nn J ').. .0-0
WELL _mmmh____hhh_m S . /l"t) / / I
TO~L FEE h____"m ~ # . lJ'1L RECEIPT NUMBER: _________CP._JZ__h__hjf___m _mh
Type: '_ JL}(.7J--mLOl~-!lt~-. Date: --- -. - - - --nm~7l---mm.m-n-n ~"
Type: . m_m__m _m9:~___&.!.(Date: m_ h_ - -m-7f21/1Im \ M \
FEES PAID:
BUILDING PERMIT m_h S
INSPECTIONS:
FORM NO. I
(Rev. 11-14-69)
,. COUNTY COPY
"