HomeMy WebLinkAboutPermit 661B12
,,--'" .....-r- '\
I ~ ! r!)./[ - ,.L <~U ~,' ('
, ..-:!..:....... ....1.~ APPLI~ATION FOR BUILDING PERMIT 0 /.q.. / -8,~-:j;2 .
~~HIPI SCOTT COUNTY, MINNESOTA ... '" PERMiT NUMBER ..,
Owner, ~:::~~'5~~;;~:}::l:t~""'''::'B~'x'i3,. ....~~~ne' ,.. ..U.n............,
Applicant, (If ather than ownerl Name, u~........m......m.m....m...um..n....,u,..u,u......um.......'.,.....u.uu..,..uu...,
The above~:;~:~;u~~~;;:~";~~"="~:;~;;";~'::.:~::t'i:.:;'~:,':/'.2:J4":":4"'i,~':': "."".,.,."".
,...'....m.........'...m...'mu..-....................'.....ie~.iid:.~1;~;,.;~.~~i;:,.;;~~k....~~.'~~;~';;,~~.,;;.;;..."."~'.2""" ',.,.,.:.::'...,',.. " ,..,,'...',
PERMITS APPLIED FOR, (Check those applicable) BUILDING IEstimated Cost} n.........3....f.aLUL...u.....,
IND. SEWAGE DISPOSAL SYSTEM, ..m.m.....mmye.$..,.......'...m'..m..,m....
KIND OF CONSTRUCTION, .01,.d..~L,.:::::::::::::..::::::::::::::,:::::.:::~:::::::::::::::::.':::.::::=:~:::::::::::::::'..:..':'.:::'.::,
~=~~:~..~;..~:~;~~~~',.::::..::.::::,:..:.:.:::;i:::..:::::.:'::...:::::.:':,.::.::..:..:.:,..:'..~:~.:.;~;.~:~.;;=~tor,::S:t~:::~::::::::::::::.:'
Legal Description of Property, m.m.......'..........mmm......mm....'.............m..mu................,....... ..'_mm............n,.....u....."m..
Township, <........1.{t/........... Section, ../.0.... Range, .h.kor Lot'm:?:::m Block, .m........ SUbdivision'~.llb.Il},'-
Zoning District: Agricultural: ...mmmn.H___._.. Residential: _____h~__m_ Commercial: mu___._.mhhnn Industrial: ________un_n___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, Dimensions of front and side set. back 7. Location and size of Septic Tank and Drainfield
4, Dimension of structure (sl 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 materiols which shall
~~du~:u~~a~pc:I~~~e ~~~r:~:' ::lZcli,fi~:tl:,d;a,s~,b~':e~..:.n.d..~~:.h,..the ~7Z~C.~..;f;J~,,~o=ns~'~
7m'(5 Appli,ont'. Signotu," Dot.
Recommend Approval, ......n........~..nm...~ R:::::~~ D~::P~:~:I' .n'nnn........nnn.n.,... Approval recommended
subject to the following conditions, n...mn.....nnh..m..n.....m.'mn'mnmn..n..'m.m.n.m..h.....'mnmmnmmn............n.m..nnn.
Rea sons for d isa pprova I: n ___n_nn_nn__n____n___n__n_nn_uu____u u_________n__ __n__no ____n__._H__._~___________________________u_____ u,u_____n__u._nn_____.
SIGNATURE OF TOWN CLERK, (Or representative}... n.. .. n ....... ....m.....n...nnn.'mnm.m..m..nh._n.., DATE, ,L?::.~l.f-:.7.S
COUNTY USE ONLY
Approved, ..nm~... Denied, n.m.nn....m By Planning and Zoning Coordinator subject to exisling regulations and the
following conditions, n.nmnn...........mn..'mm.........mn.....nn..........nh.....m..h...m..nn..m.....n_m'mm,nn.m.........mm.mnmnn
~.I~~~~~~~:n::~::cL:::~~:.:':.:,::.::,.:.,..:::::::.,.:::<.n.n:'.n'.:.'n:"._..nu~.~~~,..L;',~'.;'P.;.2i
FEES PAID, BUILDING PERMIT m... ~ 1IJ,rl
Iz"n
IND. SEWAGE 015, .m
WEll m........m.....mm J I) f: ~ 3. 7 ?:' /
TOTAL FEE .....nm S RECEIPT NUMBER,m................n...?':n..nnnn.
TyP:f~n.~.'.~nm....mmnnn... Dale, m......, ..nnnnI"b:~:[0:~? 3 .
Type, ~....Q".!C......m..nnnn..m Dale, m..... .. ._m.LL:::.lZ..:.ZJ
Type, ..~n.4.ll(......mm Date, m.....m. .........).2.:::.L1~73
FORM NO. I fA' I cJ K' "3 .1-7'!
IRev, 11.14.69) ~ 1 COUNTY COPY ~ s-. 7(
_____.___.__.__~~~>( . ~__l~~;-?f
INSPECTIONS,
~