HomeMy WebLinkAboutBuilding Permit from Scott County 1978 r _
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00424, APPLICATION FOR BUILDING PERMIT /J2/ - --/
4t►WNSHIP SCOTT COUNTY, MINNESOTA PERMIT NUMBER
Owner: Name: Dnn__Q44-.1tlt_L 73-3 6._f�,� Phone: __yf.
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Address: Ag _-A..18 $, f.A.k11E, ./ *JAW
Applicant: (If other than owner) Name:
Address: .., Phone:
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The above applicant applies for a permit to _Y.ldi ,3 . '
(Build, alter, repair, wreck - as case may be) ti/
PERMITS APPLIED FOR: (Check those applicable) BUILDING (Estimated Cost) I 0"13-9
WELL:
KIND OF CONSTRUCTION- Q ,-A S 1
Number of Bedrooms: ma�yy// f� General Contractor: .
Legal Description of Property- 1_!__
Township: �ly__._____ Section: -___4__.- Range: °2 or Lot: Block: ._. Subdivision:
Zoning District: Agricultural: Residential: _..____ Commercial: Industrial:
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 (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 /3 - 7(
Applicant's Signature pate
TOWNSHIP USE ONLY
Recommend Approval: Recommend Disapproval: ____ Approval recommended
subject to the following conditions:
Reasons for disapproval:
SIGNATURE OF TOWN CLERK: (Or representative)_-- LA2I --- DATE:_ ./. ?
COUNTY USE ONLY
Approved:_ Denied: By Zoning Administrator subject to existing regulations and the following
conditions: _
SIGNATURE: `="4.4°/,..e,214,4444 2427. e2
. � / DATE: — 4
/- 1
FEES PAID: BUILDING PERMIT __.._ $
/0 O°
WELL $
STATE SURCHARGE FEE $ �J,C
TOTAL FEE _______.__. $ /6 RECEIPT NUMBER: 6 / .l V
INSPECTIONS: Site Inspection Date
Plan Review Date
Footing Inspection Date
Framing/Energy Date
Lath or Drywall Date_.__
Plumbing Date
Heating Date
Final/Energy Date
Occupancy Permit Date
1. County Copy
Form No. 1
Revised 2-16-78
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