HomeMy WebLinkAboutPermit 501B12
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Owner, Name, ..C:r.w..b~..n.j,....Q...O.CLo.i:._Un~nnu_._n._nnrT_u._._n_n.._. Phone, --'::l.lj-'].-:-~\.~-'l..
Address, ._u'{h~_b.___._a_.~~_c_._.R_1!:_J::..B.Q~__.!.&_~_._r__rU.._Ol\...~~)..rn._I'..~.~.~....
Applicant: {If other than owner} Name: _n________n__n...____....____._..____.hnnn___n_____..__un..n._____________._mn____n________.h___U______________________
The above ~:;~:~~--~~~;;:~..~:~-:--;:;~;~-.~:-::::"E:=l:iA::------.:%~~-~~~-.-----I.--..~*-1--~:~oJI::.::.-::--:::::::::::::::-:.:
(euild, alter, repair, wre,k - as case may bel 1S '1 $t
PERMITS APPLIED FOR, ICheck those applicablel BUILDING IEstimated Cost) unum_y"..L\1LL\~n~nn.mL.l.'.().:n9.~-.n.
IND. SEWAGE DISPOSAL SYSTEM, ____00_._________00___1.1.00______.000000000000.00...00.______
KIND OF CONSTRUCTION, ..___.___.___G:_llD.~.*':-E-~~~-~-::::::--::::::::::::::::::::::::::::::=::=:::::::::::::-.._.__.:::=:::::-=::::::..:::::::::::::::::::::::__::.
Number of Bedrooms, ____n__.___.m___n___nn.nnnII.___n____.___.___nn.. General ContractOjnnn..._._______.mm___nn_jZ;f.________m..________/J_ "
Legal Descrlptlo,n of Property, m....~-.IF..-.~n~.---'---n-~-.(J,--;tin~.~-.-<::.--.--u-c:2::4-...,0-4
TownshIP,.~!U-Q~.Ue.-- Section, .11...---- Range,.-2:-----.- or Lot, .__.m__m Blo.ck, ______/.m ~UbaIVISlon, __:.______000000___0000_____00
Zoning District, Agrlculturol, m..___m_nn._n___. Residential, ...__'-Cn.______..__ Commercial, ___.._mm.m..___. Industrial, ___nn__.__..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 Isl 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 moteriols which shall
~~du~~:~~a~p~:~~e ~~:r:~oe :;p~-a:::Jl;;-i:e-d--.a-n-~-.~.i.~~-.-the ~r~'~~:;~;1_~~i:_2~
Applicant's Signature Date
~ecommend Approval, ___m....tL.._______n___________n R:~::::; D~::P~:~:I, ________m______n_________mh_____ Approval recommended
su bject to the fo II owi ng cond itions, ..._..._....n.._______._____.n_.__________.___.n_____...m.....___...h__n____________.n_.__.._._._n._____________n_____m......h.n.
Reasons for disapprovol, __nh._h_h_______n.___________n________m.n_..hm____ ._______....__...0.__ _ ______.__mh.___________.n....h___________________......____..
SIGNATURE OF TOWN CLERK, (Or representative) ..._....... . .._ .__________________.__m...____.h.___________.m____h.__ DATE, __1p/_Z'L--
. COUNTY USE ONLY
Approved, __.___.__\"______ D:.:zt .__.0.00..______00.. By Planning and Zoning Coordinator subject to eXistin., regulations and the
~~I_IO~~.~.~.~:____::;g::::::~-:-----: ..::.:.--~__~~tJ:::::::::::~:::~:::::~:____:=~-____:________:
SIGNATURE, --------J<~------ _ ~.~-n--m---..---..-.h---hh----.h-----.... DATE'm.7)/]j.ZZ_
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BUILDING PERMIT mh_ t '4S&o -=- Jd.S; 0
IND. SEWAGE DiS. .___
-
WElLT~~;~--~-~-~n:::::::::: ~ Ib,~{) .~.J RECEIPT NUMBER,m.hJ!./f._t.___.__...______
Type, ..h~..----O--lKh---------.... Date, -'-':^.!.'-:-r--.7/L~l7...k-
Type'm..h_h_____.m.h______mh___mm.._____... Date, ____.m______nm_n.___mmmh_______m__ ~ ..
Type, .n____........____n__mm_.m._m_._.....___. Date, __________..________mm..~m.....n.m__m.. '-6~
FEES PAID,
INSPECTIONS,
fORM NO. I
tRev.11-14-69)
1. COUNTY COPY