HomeMy WebLinkAboutPermit 310B12
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--o-~~ri~- m. APP~~~~~~~~~:'U~~~I~~6~1MIT -----~1~MiT~~~~--nmn
Owner, ~:::-!!"1':~:__;:::::~::::M;:::::;;::n-..-nnn:::::.:::::::::::::::::::-:-::::n-:~n__~~:~~,_::~:L~:-~-~-_:~~!?
Applicant, (If other than owner) Nome, m _ A ~mm..m~_~...m__.__..__..mmnmn.n.___m_nmnm.n_....__m.__.mmnnnm_...mmnmn__
The above Aad:;~::;;n~~~;;~:n;~~..:n~~;~;;--;:.:::::::::--.z::.zl'.'.'.'..g__....~...:..:i.-.:j..I..X....j-~._:~.~~:::::::::::::::::::::.
.__.__..__._u_..un_________n_______________n.._.____n.n_._.n.n__.n_.__.'>..______n___..u.___u...un_.._n..U_nnU__________u______._..__..._..........___...u_u___u___u_u__u___n_
(E!uild, alter, repair, wreck - as case may bel &'(
PERMITS APPLIED FOR, ICheck those applicablel BUILDING (Estimated Costlm_nmnnm....nZ~..LQ..m_mnmm...m..h_.mnn
iND. SEWAGE DISPOSAL SYSTEM,mnnm.m..::::nn.n..mm...mm_mnnn.._nm_
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Number of Bedrooms: .m_u____________..__~____________________h__h..____ General Contractor: _______~__..m-------n--------------.h..--m_----
legal Description of Property, ....n.nmn..m__h_....mmm.m.nm.__.._.nm_..mm..n.nnm.n__......m.n .nm..m.__mnh....nn.mn.....n._.m.._
TownshiP,mm._/1V_m.n. Section, .LLm. Range, ..?cnkor Lot, L"khm Block, ...mnh.. Subdivision,A?~:t~(~
Zoning District: Agricultural: ________n______nHom Residential: ___~m__. Commercial: ___om..._____~__hn Industrial: ____________~o_______
A Plot Plan showing the following must accompany this application,
1. North Direction 5. Street nome or rood number
2. Location of Proposed structure on lot 6. locations of existing structures
3. Dimensions of front and side set. bock 7. location and size of Septic Tonk and Drainfield
4. Dimension of structure 151 8. Location of well.Distance from Septic Tonk and Drainfield
Applicant hereby agrees that, in case above permit is granted, that 011 work sholl be done and 011 materials which sholl
be used sholl comply with the plans and specifications herewith submitted and with the Ordinances of Said Township
and County applicable thereto. .X--;t'&i:nn.ezm.~' .. .mn.__..hmnnm.~n~J.s;_I2.7.L
---~l' APPlitfls~s19~a~re (," Date .
TOWNSHIP USE ONLY
Recommend Approvai,m_.mm1C.n__mm.m..m. Recommend Disapproval, m__.nnn..nmmmnmn__m. Approval recommended
subject to the following conditions, .S ~ .-f2-,Rd.n..~~' -n~'~"l----nn--.--------nm
:~~~:~u::r ::s;~:~v:~E.~.~,;~;..;:~;~:~~~~~~~:;.:::.n:.::m::::::-::n::..._.::::::::::::::::::::::::::::::::::::::::::::::::::::'-'~~~~:'::--.s:zil?1
/. COUNTY USE O~L Y '. . . . . .
Approved,mmn.m.nn... Denied, m.nnm..____n. By Planning and Zoning Coordinator sublect to eXisting regulations and the
following conditions, .nnd~.m-:'!..JZY.:n.=r.::::.L~mmm.{~~~._.~J.
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WEll ..nnn.m.h_m.mm ii 0 ~"..//,,4
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FEES PAID,
BUILDING PERMIT nn.. $
IND. SEWAGE DIS. m'
INSPECTIONS,
Type, m_....nmn....mmm.n...__n__.._.n.m. Dote, n......__..n.nm____.__.____......mmm...
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fOlM NO. 1
1Rev. 11-14-69)
1. COUNTY COPY