HomeMy WebLinkAboutPermit 554B12
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Owner, :::~~~!:i!J;7::Z~i:L:::::::::::::::::::::::::::::::::::::::::::::::.:-::n.n:n~~~~~,.~~~~~~~Zn
Applicant, (If other than owner) Name, .n_._~~.mhnnnnnnnnnn_...n.nnn. nnnn.nnnnnnnnn...n.nn..n..nnnnn.
The above~:;~:~;-.:~~;;~~n;~;.=n~~;~;;..;~.::::::::::::~;Z.~~::::H...~:::':.1:::.::.:::.......:
leuild, alter, repair, wreck - as case may bel
PERMITS APPLIED FOR, ICheck those applicable} BUILDING IEstimated Cost) nnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn.nn
IND. SEWAGE DISPOSAL SYSTEM, h_J-.Y...$.m...hnnnn.nn.nnnnnnn
KIND OF CONSTRUCTION, -lIJ~h.~~.:--:::::::::~::::::~::::::::::::::::::~::~:::::::~~-.~:::::::::::::::::.:::::::::..:::::::::::::.:::.
Number of Bedrooms, nn.h.n.nmh_..__.n.__._.......n...........nn.... General Contractor, nn.n.....h._...nnnn..h....nn_.nnn.nmnn..
Legal Description of .Property, nn_nnnn_';lh~7J!.P.-.':..n'<jjn'-I-1:.mUnnnnnnnnn.nn.hnnnn..h..nn.nnnn.nn~'
Township, n.n.JL!j.n___m_ Section, n1Jnn Range, k.k._ or Lot, h"'?'m_._Block, mm_hh Subdivision, ..~.nnnn.
Zoning District, Agricultural, nnn.h._nn__n Residential, .n1L.mnn Commercial, nnnnnnnnnn Industriol, nnhnnnnnn
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 Is} 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
be used shall comply with the plans and specifications herewith submitted and with the Ordinances of Said Township
and County applicable thereto'_'J"m!2.p.~cJ:...&.nn nnnn..'zLnnn__n...h...h~{n~h.rn..lf:.Z~
Applicant's 19nature Date
V TOWNSHIP USE ONLY
Recommend Approval: huo--_mu.__mm----;'::;J..hO Recommend Dlsa~roval: .h_H__mmn_nmn___u._______ Approval recommended
subject to the following conditions, _.K~n~n~p~n."'~~._rnnnnnnnn.nn.mn.h..
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Approved: m____~enied: __mmmmn.___ By Planning and Zoning Coordinator subject to existing regulations and the
following conditions, .....m.....nn.n.nnmn...._.u_.............h..n.nn..u...umn.nn...nnm.m.un.n....m.._.........mh.nm..n.nm..u..u.............
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SIGNATURE, ....\~n.aLn~.\,Nn.\\.'~............un.nnnmhdunmnnm...d. DATE, .}J!:?n)l7.:l..;;..
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WELL ..dnnhh..hnnunn ~-.: '77.6"0 cf2-'/,
TOTAy'F~E m....... ~ RECErlilT N MBER, _mnnm"'h..qz.2um..._.m'hd
Type, ..#m_~..:.r!;hm..,........... Date, ..1.,1/J11'":;;'r .. , . n hh ,. I /C
Type, "~.h_mm..mlJd(ymunn.n Date, .If.~'''7f1J.. '" t-,.../,-,~
Type, h.._m.n........d.m.......hn.m.n.nn.u. Date, m..mun...nn.nn..m............uu...
FEES PAID,
BUILDING PERMIT h"_. ~
IND. SEWAGE DIS. n..
INSPECTIONS,
FORM NO. 1
(Rev. 11.14.69)
1 . COUNTY COPY