HomeMy WebLinkAboutPermit 882B12
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.S~'H~~u, APP~~~";~~~~~:'U~~~~~;;:MIT
Owner, ~:;~:~:'::::~=:P~:~::::::::::::::::::::::::::::::::::. ...... .......~~::~'.:::~.::::::..::::::::..:........:.::.
Applicant: (If other than owner) Name: ...u........UUUhn.m..n...nmmm...unnnn.uu.h......n.....nnn.unmmmunuumuUn.n....umuuu..
Add ress, n4n.nnnnnn.nnn...n""'nnnhnn.n...n..mn.nh..n.m....umn.n..nn....nnn:9'-Cln.nn. Phone, .ununnu...nmum"m.
The above applicant applies far a permit to ...~u~.n.......e..Xh2-.nbn....~m..........nnh
....mm. m2.y:...4..~..s:.._'a~:~~'d.(j;~,,:,~~u~~~';;'~~'~I..u....m,uuh".m...nnn..U....mu...m...........n..m
PERMITS APPLIED FOR, (Check those applicable) BUILDING (Estimated Cost) uu.....3.~..C2.Q.Q.m..........u.mm.....mu....u
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....h____...nn.n.___~.___h___.....__..u.
PERMIT NUMBER
~~~.~u~~n.~~.~~~.R.~~~I~~~:::::::::::~~::;~::::::::::::~~~:.~::~:::..~h.:::~~:::::.=:::::::::::::...:=.:::::::":
Number ,of Bedrooms, ..mm........,3'm.m........n...n.....n..n.uh...... Generol Contractor: ......u.u.um.m......m.n........UhU.U.....muum.
Legal Description of Property: m.u..uu.u_.._uhUh..m..m........h...mumu.mmu...........h..u...._'.n. 'uum..u.....m.u.m....h..muum.u..'
Township: un.unU.mn....Umuu Section: mLa Range: u.m..m. or lot: uuv.=u Block: mu!...m Subdivision: ~.AM.
Zoning District, Agricultural: u.uu...umuu'.... Residential, "'_U"mmmno Commercial, muummumuu Industrial, ..._mum...._m
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. Oimensions 01 front and side set.back 7. Location and size of Septic Tank and Drainfleld
4, Dimension of structure (s) 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
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Applicant's Signature Date
TOWNSHIP USE ONLY
Recommend Approval: ...mmmmu.mu..........muu Recommend Disapproval: ...hh....h.mm.mm.m.u.... Approval recomm""ded
subject to the following conditions: mmS-.f~~.....~./22.,~uu........h...h...UU.UU......u...uumm...
Reasons for disapprovol: u......m...uunn..u.....2=2J::.2G........nu.....g~nQQ...L9.A1muh....n~...m.......mmmm..n.
SIGNATURE OF TOWN CLERK: (Or representative) ..m.m.mum._muu...umummmmm...h.mm.mm.....u..... DATE: uu.....h.mhumu
COUNTY USE ONLY
Approved: uum~h' Denied: ...n....un....m By Planning and Zoning Coordinator subject to existing regulations and the
following conditions: mumu...mu..unun.........un.....um.mhmuu..nnn....huuuhmumu.mm.Uh.h'mu"u"',,'u.mh.mmuuummUh.h'h.
~;~~~~~~~:n::.:~::::<2::::~.:::::::::::::::::::::::::::::::::::::::::::...~~~~.:::~.2:Z:9:.::::::::::
4' 7? ()U ,2 (J,.s0 S~ ~
FEES PAID: BUILDING PERMIT .-... ~ . '1; v.l 00 (J ~ 4r <r -.J ~ ~.J...
WEll m_h.u.......nu_u.. \. ' t'
STATE SURCHARGE FEE ~-L9. \.')-0
, TOT~ ",u,u1' · J:J~~ 60 . . . ~:;IP~.uuu:"JXZX....um'hu"u
Sltel, e.."'''''''':;c.m.'I:kn.Ln~....n Date, ..~;;n.m'_'huuun~ .
Foo ,~g nnO.n.m........m.....mh...h.......... Date, ...~/u!/.~femn.hu_u:-/
Framlno/c;.~nm.uuuu.mu.... Date, ...Y;..z/.....f.......m.u..mu ./
FINAL ..!.!P..":&n.n........u...........h....n. Date: .1c..f.!.G./n7.ku....n"h'C--/
INSPECTIONS,
FOaM NO. 1
lRev.11-14-69)
I. caUNTY COPl'