HomeMy WebLinkAboutPermit 1759B12
APPLICATION FOR BUILDING PERMIT
SCOTT COUNTY, MINNESOTA
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PERMIT NUMBER
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RECEIPT NUMBER
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PROJECT ADDRESS:
APPLICANT NAME:
ADDRESS:
OWNER (If other than Applicant):
ADDRESS:
CONTRACTOR NAME'.
ADDRESS:
The above applicant applies for a permit to:
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(Build, alter, repair, move, install, as case may be)
TYPE OF CONSTRUCTION: WoOd v'MaSOnry_Other_ TYPE OF HEATING SYSTEM:
DIMENSIONS OF STRUCTURE: J" x':J ~
ESTIMATED COST OR VALUEf) .roo;; (; 0 f>~,OOVNUMBER OF POTENTIAL BEDROOMS:
LEGAL DESCRIPTION OF PROPERTY: tV W 14
SECTION: I ( LOT:~ BLOCK: SUBDIVIS~N NAME: 11t~_ ~
NUMBER OF ACREf\- TAX PARCEL NUMBER'r I J -0 I_~NING DISTRICT:Y - ::L
NOTE: A REGISTERED LAND SURVEY IS REQUIRED FOR ALL NEW HOME APPLICATIONS ON 10 ACRES DR LESS.
A Plot Plan showing the following must accompany this application:
1. North Direction. 4. Dimension of structure(s). 7. Location and size of Septic Tank and Drainfield.
2. Location of Proposed Structure on lot. 5. Street name or road number. 8. Location of well.
3. Dimensions of front and side. set back. 6. Locations of existing structures.
Applicant hereby agrees that, in case above permit is granted, that all work shall be done and all materials which shall be used comply with the
plans and specifications herewith submitted and with the Ordinances of Said Township and County A plicable thereto.
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Date
TOWNSHIP USE ONLY
Recommend Approval: V Recommend Disapproval:
subject to the following conditions: - \
SIGNATURE OF TOWN CLERK: (Or representative)---Lt. )/G g.All~""~ DATE: ?-S-8'L
- COUNTY USE ONLY
Approved: t / Denied: By Zoning Administrator subject to existing regulations and the following
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SIGNATURF.. ~o '7 .4..._ - ( DATE:_'7 - t,--q'{
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Approved. / Denied: By Building Official subject to existing regulations and the following conditions:
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SIGNATURF. orA/..,.:::..L Ar~
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DATE: 7- 9- tr /j
FEES: Land Use Permit
Sewer Installation Permit
Plumbing Permit
Well Permit
Plan Check
Fireplace/Wood Burning
Appliance
TOTAL FEE
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'-19.75'
State Surcharge
Building Permit
Form No.1
Revised 1-84
1. County Copy (White) 2. Township Copy (Canary) 3. Applicant's Copy (Pink)