HomeMy WebLinkAboutPermit 1618B12
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S 0' \rI\<\- r~..,~L APPLICATION FOR BUILDING PERMIT / b / j/ - V-I .:2-.
TOW!JISHIP P SCOTT COllNTY, MINNESOTA PERMIT NUMBER
Owner: Name' A ~ ~A_ ~)Phone:
Address:_/7'.7;t./ ~ /..1 t:, z:>L.. ~_" ~.. -./' / h,"'2c--.
Applicant: (If other than owner) Name: tQ.()b -t ~. ^",-+-\-
Address:_=l:J~\ to. 1~61' ?)'hlOOlP., ~"^. Phone:~~_
The above applicant applies for a permittp ~.~ ~~
(Build, elter, repelr, wrKk. as c... may bel
PERMITS APPLIED FOR: (Check those applicable) BUILDING (Estimated Cost);=::'(),("f"'0 . 00 ~
WEll'
KIND OF CONSTRUCTION:
Numberof Bedrooms'
Legal DescriptiO{l of Property: \\\ wV+
Township: i 11-\ Section: \ \ Range: ~ or Lot: ,In Block:
Zoning District: Agricultural: Residential: _ Commercial:
A Plot Plan showing the following must accompany this application:
1. North Direction 5. Street name or road number
2. Location of Proposea Structure on lot 6. Locations of existing structures
3. Dimensions of front and side set-back 7. Location and size of Septic Tank and Drainfleld
4. Dimension of structure(s) 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. L<f'*",/ ~_:3 c;L,~~~. 2-21 -83
General Contractor:
SUbdivision:mr~r>)o. .
o.c (-Q5
Industrial:
Applicant's Signature
Dale
TOWNSHIP USE ONL"
Recommend Approval' /' Recomm~nd DiJjapproval:ry- n_ ... Approva~ rec~m~nded .
subject to the following conditions: flf'i{ b;:(1llA./'JlL/7j ... ~ ... __"P~a..,.<-",.A-7..L...:-. kJ ~
Reasons for disapproval' . _ <f
SIGNATURE OFTOWN CLERK: (Or representative) t.<..J I..fj~~~ . DATE:;l-::l.. 1-72-
COUNTY USE ONL'
Approved: ./ _ Denied: __--;::- By Zoning Ad'}li.nistrator subject to eXiS~ing regulations and the following
{~;~;:,::;~~,,~~<, :/:!::;J::L~ - ~..-
SIGNATURI=' ~=.L, n_--~JZ.- I. DATE: ::L-2"">--/,;?J
COUNTY USE ONLY
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Approved: _,'
conditions:
Signature:
Denied:
By Building Official subject to existing regulations and the following
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FEES:
Land Use Permit
Sewer Installation Permit 40 . no
L1 q b()
~~ - () 0
as ,00
'iXt3 . ry'>
l.:Lf \.50
Receipt #
/D.,) (0-0
;
~p~
~.... \) 0J.J4
Plumbing Permit
Well Permit
State Surcharge
. I
~ ttll f^'
~\JV\ ~~
v
Building Permit
Plan Check
Fireplace/Wood Bumlng
Appliance JILl
TOTAL FEE ,t:)~7 .60
1. County Copy (White) 2. Township Copy (Canary) 3. Applicant's Copy (Pink)
Form No.1
Revlssd 7.82
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