HomeMy WebLinkAboutPermit 515 B 12
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Applicant, (I . :::s:~ ,~~.~'~n:=~~:~,,~::~',::,::~~::::~:::~:~~~t:',',:',:'.',:::::::':':,,',::::',,',:::,,:.:,',:::::"n~,~,~~:.'::::,':~:::",:::::,:,:"::,:::
The above dpPlicant applies for a permit to '~n~'~,u,umum,uhnmmhnnnm'mh,mmn'nmnmuu..
hnnnm'mmn IqntXn3..cl'~hnmum,n'num.m__huuum"umm'mnn'_nmmn.nn"'_nmm'mnnh,m'Un unhn'n,nnmm""nnnmn'mm
(euild, alter, repair, wreck. as case may bel ~
PERMITS API'LlED FOR. (Check those applicable) BUILDING (Estimated Cost) --nmn~CLZ2,,"mh,'mhnmnmhmnu..mmnm
IND. SEWAGE DISPOSAL SYSTEM, .mCmnh,mm,nnm"mm.mnmmmnnm,m"
KIND OF CC NSTRUCTION. hn?!J~m__nm:,E,~~',:,',',','::::::::::::::=::::::::::::::::::=::::::::::::::=:':::::::::::.':'''~::::,':.'::'::"n"u"
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Legal Descrif -tion of Property. n,S,G.~nA/4.L7nmh'''hhnmn'nm'mmh,mm'mmuh,m O,m.mmn,__nmmmmuhnnnm,m
Township, __n u_Uum'uhnnhm Section. /Om Range. unmun, or Lot. ,mhmm Block. 'uum'm Subdivision. ,m'mhhnmmnn'mn
Zoning Distri:l. Agricultural, m'hnhn~ Residential. mnnn.....hn.h, Commercial: 'mhnn'hmnhU Industrial: __hnmumm.m'
A Plot Plan S10wing the following must accompany this application,
1. North IDirection 5. Street name or road number
2. Locatie n of Proposed structure on lot 6. Locations of existing structures
3, Dimen ;ions of front and side set, back 7, Location and size of Septic Tank and Drainfield
4. Dimen ;ion of structure Is} B. Location of well.Distance from Septic Tank and Drainfield
Applicant he. eby agrees that, in case above permit is granted, that 011 work shall be done and all materials which shall
be used shal comply with the plans and specifications herewith submitted and with the Ordinances of Said Township
and County c pplicable thereto,>cnXJ:\.",..~.C',..0-.L~~.Qm:t.~,nmmhmmhnu.8'/~h.2, (2,;;Zun
-~ Applicant's Signature ~, /u /D~te
TOWNSHIP USE ONLY
Recommend .\pproval, n__.nmn~.nm'hum Recommend Disapproval, nnnmnmmuhmnnhnnhn Approval recommended
subject to the following conditions: m'm'm'hnmnn.m'__m'm'mnmnm'h__mmh,'m'u__nnmh.mnh'nnn'h'nmu'mnm'mnUhnm'__mn'n
Rea sons for J i so pprova I: ____n_______._.___n__ ---.-n--_n__.___n___uh___nn________._nh___u___n...hh____..._______.h_______u_~__n_____+h_ ________________n_.____.______
SIGNATURE C F TOWN CLERK: lOr representative) --U--Uhmnuunnmm,nmmnmuuum'h.hm'__m.hnumnuu. DATE. n'unnn'UUnnun
. COUNTY USE ONLY
Approved, 'hh"~ Denied, OUumm__muu By Planning and Zoning Coordinator subject to existing regulations and the
followi ng cor d ition s: .nm'h..uuh.muh.noum..ou__n.nu.hOUuuh.nh..,.".n'unm.nu..umnuuu..n'uuu'n_.u.nu..,.u_u_u,.'uu..nu.'nn..h__..,.,
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FEES PAID,
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BUILDING PERMIT .m__ ~
IND. SEWAGE DIS. nu
WELL UUUmmnnh'm__u
TOTAL FEE m'__m. ~ /C). f') n RECEIPT NUMBER, uunu,;?g,/LZunn__hun,
Type, ~~m~.~.Q.'.~.-dL~~, 'n'mumuU.nu.mm'.m.u'uh.nu.h.
Type: u--hnu'u"..__mu.hnu__n.'hnnu.u__.., Date. mhnm."uu.hn'_u'h..mu..u"hnu__
Type: .u-....u.un"uh.uhm'hm.mh..uu.n' Date. .nunnu.uuu.nuumhu_'umu'mu__.
INSPECTIONS,
I'OIM NO. 1
(Rev. 11-14-69)
1 . COUNTY COPY