HomeMy WebLinkAboutPermit 203B12
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~W~~...m. APP~~~~~~~~~:'U~~~I~~6i~MIT4fR~i;-~MBEf2m-
Owner: ~;::~~:'~7i!i--;t,:~::::::-:::::::::::::::~iiz~:::::':'-----_n___-_:___~~on::_~-=-~~--~~~
Applicant: (If other than owner) Name: ~_n___n_______.______________________________d_nh_____._______________
Add ress: .nnm____mmn._n._nnmn._.__n__n__.nn_m.n__nn__.n__mnn_nnnm_____00__.00_.00__.__000000_00__ Phone: 00__0000_._______00000000.__0000
The above applicant applies for a permit to m_nmLC~_._1_~.-nnnnnmnm.___-.----mmmn-.nmnmm.n-mm
leuild, alter, repair, wrack - as case may be) ~
PERMITS APPLIED FOR: (Check those applicable) BUILDING (Estimated Cost) nmnmn_.?O'....."-'nnn_.nm_mm_m_m_mm_m_
IND. SEWAGE DISPOSAL SYSTEM: n_mn::::::n_mnmn_nnmmn__n.mmm..._.____
KIND OF CONSTRUCTION: hn-kllnl.l-r=::.::::::-'::::::::::::::::::::::'-:::::::::::.::::::::::::~::-:-~n-::::::::::::::::::_::::::::::::-:::-:-::-:00
~=~~:;n=;h~:~;==~~_:'::::::~-_:-_:-_:~-::-::-.'.:-_:-_:__:::-::_:-::_--:-.:-::,::-_:::-_:::-_:-::_n~:~-~-;~;'~~~';;:;;~;'-'::~::::::::::::::::::::::::::::::::::::::::::::-
~::~s~::criP 'on.. Of: i:l:~~~;~~:-:li:::::'-;:~~~:':;il:;-'~'~;:',-_'_-i~::_m~I~~~:'::::---._:::.';~'~~'i-~'i'~;=~:jij;;Z:~::
Zoning District: Ag Icultural: mhmn______nnnn Residential: ____h~_._____________ Commercial: '~h__________________ Industrial: _________mm_____n
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.Distonce 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
v . TOWNSHIP USE ONLY .
Recommend Approval: .m__m____m__.._mh___.m'_h__i?Recomme~d, DISa;'p'jvy. --;.:./-7,:.mn;;----m7=m- ~val rec'lf'm"nded
subject to the following conditions: /1lt-1i.n;.mf-lf-M1:~.-{~.~I.!_~n~~:nm___:__n~n____mm_m
Reasons for disapproval: .m._nnn______________m_J/.Mz=~n--n-n-~-==--------n-----.--n-.-m.h----'.-"-nm-~T-:~---n-.----
SIGNATURE OF TOWN CLERK: (Or representative) nm'y.,<_<.=-=_'m__m._'_.m_m__m__mm.mnnm_._nh__.____nh DATE: llnn{.,n.7I2_._
V /' COUNTY USE ONLY
Approved: m_mnn_nn___ Denied'mn_mmmnn_ By Planning and Zoning Coordinator subject to existing regulations and the
following conditions: mnn__.__.____nn_m.__.m_n____.__'''nnn___m_.nn__ __'___.nn_nn__n_____.___..__mn_____h_m_____'._n___n_____._..__.m_'__m__m___'h._
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FEES PAID:
INSPECTIONS:
BUilDING PERMIT .m__ ~
IND. SEWAGE DIS. .___
WEll O__nm.____o__n________
TOTAL FEE mmOm ~ )/). frO
Type: ~d;-{;,_________.mon__h.mn_'_m__..
Type, ...n__O____m.__m__mmO____hn_.m.____m_
Type, ._.__mmm__mn__o__m.__.m.mm.__._m_
-
RECEIPT NUMBER: .m__n~.7.:?(m'n....m____.__o
~:::: ~~~~~:~=:::::::~:
Date: m.m_______mmm__nm__m.__m___.m__
FORM NO. I
lRev_ 11.14-691
1. COUNTY COpy