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<~j.bJu.h_ n. - .PPLICATION FOR BUILDING 1l~_.MIT
IJnn..-..Td\rNSHIP SCOTT COUNTY, MINNESOTA
Owner, Name, _~... ~~_nn(]~~mmnmnnnn mnnnm Phone,'2I9'2::n2_.s:~_7.
Address, h_3.g_QnnS~,.P~ h~__\.h2:_=-q~{~m nnnnnmmnn nmn m mmnm n
Applicant, (If other than owner) Name, ___.nnS.~.~_mm_......_..._......._.....n._.m..__._nnmnnn.n.._...__hhhhmmmmm_mm__n__.n
Address: .............h.._....m_nmnn_n_.....nn__..........hn.m_mnn...._._.mnnmnmnhh.hmm_nn_h Phone: m_mmnnmnnnnn_m
The above applicont applies for a permit to ml?~ !-rJ -J,n~__nnn._nn__.__._.__._mmn_mm___m..n..__hm__m_m.nm
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PERMIT NUMBER
lI!uild, alter, repoir, wreck. as case may bel.,e/;
PERMITS APPLIED FOR, (Check those applicable) BUILDING IEstimated Costl nmnn3.CJ,.nC2_CJ_CJhnnnmmmnmmmnn__nnn
IND. SEWAGE DISPOSAL SYSTEM, hn"'~"'._"hhm..._'....n......n...nnm_.
KIND OF CONSTRUCTION, m~_~__~m~_.____.:_E_~~:_~~~~~~~~::::::::::::::::::::::::::::::=::=::~_::::::--_._::~~.~:::~~~~~:~~-~_.::::~~::~:~::::::'::~:~_.
::~e~e::ri::~::o:s,~;~~=;;:;:-~::g::~::2::::M~:~=n_~:~_~..~~~t:~~~~.r,_:::::::~~_-_-_:.~~~.:-:.:-_-_-.:-.-.-.:-_-_:._._.__-_._-_..-_-~~~.-_-
Township,m.____m....n_n_....... Section: _LL..._Lkange, ...nnnm or Lot: n...I... Block: n_nn____. Subdivision:~n~
Zoning District, Agricultural, .......n~......_ Residential, ._.__h_..h".hm. Commercial- ......mm....n..._ Industrial, n...nm.n..._m..
A Plot Plan showing the following must accompany this app iication:
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 B. Location of well-Distance from Septic Tank and Drainfield
Applicant hereby agrees that, in case ~~rmit is granted, that all work sholl be done and all materials which shall
~~du~~du~~a~p~~~~e ~~~r:~oX~.a~.tu~:;o_~s __~ere=~~~ .S_U_b~.i.~e_d___a_n_~___~_i_th___:he O~s.;;;:_;=~'.P
If- I Applkon'" 5i otv'" (/ Dot.
~ TOWNSHIP . SE ONLY
Recommend Approval: u...__nmn......_._........_.__..... Recommend Disapproval: um_unh_____m__._______________ Approval recommended
su bject to the fo Ilowing cond itions: _nn_n...__.__m_nn__n.__n._n____..__.n__nn....__..._. __._____. ..____nnnn.__..___._n_n_n_._nnmn_____n...nn_._____n___
:~~~:;U::r O~s;~:~v~~;~~:u;~;--;:~;~~~~~~~~~~;-::~:::::::::::::::::::::::::::::::::::::::::::::...~~~~:-:2/~:;Zz:~
COUNTY USE ONLY
Approved, nmK._____.... Denied: _._.........nn_m By Planning and Zoning Coordinator subject to existing regulations and the
following cond ition s: ..........U..u._nn_nn_n_._n__um__..........u.........nu_._m_.nn.._.nU........n......__nm..._n.__._mu.__.....h........h._._..Unm___.
~;~~~~~~~:.-:::)(=:;~:::::((~h;n=n;f:~.:::::::::::::::::::::::::::::::::::::::::::::::::::::::.-.~~~~:-::i;;y;-:;_:::::::
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BUILDING PERMIT ..._._ S ~~{':(')O IJ.Oc:J 1~7,() O~..J. ~.
, :I., f') CJ .JO
IND. SEWAGE DIS. n..
WELL ".nu...._.n_n......u J. ()C) $ ~O_ 1rILA<,..
TOTA~~E/~......... t //)6'. tJ(} ie/V fJ{J .a.ikRECElPfNUMBER: ....nn...~€/e.h:2,n.mmuu_
Type:~--.....-9-:-.5:-.:-,m-.- Date:.... _"';:,_.._~/.~1/2u~
Type: n4P-.:.....:...-~........ Date:... .Jt~_'...u_.~....!.(I:Z.1:-- ~
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FEES PAID:
INSPECTIONS,
fOlM NO. 1
(Rev. 11-14.691