HomeMy WebLinkAboutPermit 1212B12
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Applicant, {If ather than ownerl Name, ....nnn...nnuhn.uum.....uuuumumumh...d.hh..........n.....nnn..nnn.....muUUn.n..U..U.....n..
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(euild. alter, repair, wreck. as case may bel Y-f-' ~
PERMITS APPLIED FOR, (Check those applicable) BUILDING (Estimated Cost) m.mma.1~.~ndmm.uhnmnmnmnnnm.m.mu
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KIND OF CONSTRUCTION, m.m.u.W.~.1J.~u_..hmu..muu_hhnnn_mh..u_nm..h....___...mm.m......._._.nn..
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Tow.nship,. ..-:m~nJLtf.-mu:_ Section, m.LL. R~nge,...~P...~-mmm. BI~Ck: mum.m Subdivision, u:m..m..nnmn.nnnn
Zoning District. Agricultural. nnn.n._ddmnuu ReSidential. u.__h.U_.mm___ Commercial. hUh.nn_.nm.m Industrial. n._nnmmnd.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 B. 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
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Applicant's Signature /~' iir~'
TOWNSHIP USE ONLY
Recommend Approval, mnm--:-:~n.nn71h:.~n 5eco~end Disapr;roval, mumnnmumummn_hn.d Approval recommended
sublect to the follOWing conditions, ~"M.-~h~.m.mummmu.n.mmm.h--
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COUNTY USE ONLY
Approved, mm.~ Denied, dn.m.nnmhh By Planning and Zoning Coordinator subject to existing regulations and the
following conditions, u.muhnmnn__UUh.nnn_.m.m.m. -P'P'R' -V -- __mmudhn__nmm.U.n.m_nmm.nh.
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FEES PAID,
23121
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BUILDING PERMIT $ tlUildlng 0ftIcI8I
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STATE SURCHARGE FEE · /.SO No.0510 t c
TOTAL FEE nnnnn_.. ;:;).5, $'0 RECEIPT NUMBER, nnnnmn_~.IJ'..m.n.n.nm
Site ......nu..n...n__m..A(lA.mnn. Date, n._n.nn.mnm_..n_.n......nd.nn
Footi~g mnnmnnm_n.~~.--um. Date, nnm--..n7~:.:~~]J:.nh-.
Framing u....m.n..'N;:J.n__nnn.n.nmnn Date, .d"uu...1.m3_n.n.3.....unn
FINAL m...--..m.V.m:s!J!1.~m Date, nj~l:!=L?.nm__m
1. COUNTY COPY
ATE, mh?--:..i!.?h-:'.?'r..
INSPECTIONS,
101M NO.1
(Rev. 11-1.4-69)