HomeMy WebLinkAboutPermit Building 1975-12-24
NOTI:::
1'1<111-11 T /I ~ :l .
NO PICHMJ T WILL liE ISSUI';1J UNTJ I. TillS AI'l'LICAT LON . liAS 111':1':11 Al'l'IWVEV ~ .7.2---i
-75'
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{( I( ~(_~,5o ~__~~.1._. ._..._~",:Lf.~_.2f./7. 9 9 ?~
Address City Zip Phone .
Z J j.1J /71?~ ; ~-; f3-&f, H 1/ _ ~ vi-f.'.'L-?- '.Yr .J{. 13 ,
Address Clty Zip Phone
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A]'I'I.I.CAT/(ltJ FOH:
CONSTRUCTION [=1
1,10111 LE lIor-IE
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I'LA!l REVIEH
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tit
Cl
OWNER J 9...E:.~_p.
N,lmc
cu,jJv,.
CJ
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CONTRACTOR~
Nnmc
O.S. REG. I!
Twp.
/'7
Range
I? ~ Section
/4
Tax Lot
/~OD
Code
Census Tract
Subdivision
V\.-</
Lot
Block
Property AcrC<ls/J;. /
Width______Depth
ACCESS TO PROPERTY (Road Name)-P ~ oJ.1?LOi J~ PTlrr'f rx-d /f?O
Existing Structures on Property: .#DI/.51 0cJ7- 8/./,. --- i)Y'P ()€,J,.Tb-:tJc-
Property Location - Address/Directlons:_LJ (?Q din '1-1-<1 J Fe () "7- f1f"d . -=ru~..tJ._.rJ.Q.f".. 'T'H
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Below fa r Of f ie e Us e anI Yx1:.XXXXXXXXxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx:\.,xxxxxxx..xx"xxxxxxx..xxxxxxxxxxxxx
Sq. Ft. . UBedrooms Va!uation
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/
5JJ)-C:;
~-'A.J
/
/
/
SEWAGE DISPOSAL:
Site Inspection U
WATER SUPPLY:
Well Sp'ring
Other
Corrununity
or ~~~WR('qUired 0 .
Existing Sewage Disposal System
Pub lic
llame of Community or Public System
FEES:
:J"'{
PLUHBING:
Instal~ed ,by Owner
,.
PLUHBiNG FEES:
II of
/
c:::J IOther
Fixture
/
c:::J Name
Bldg.
Waste Disp.
P!umbing
Plan 'Review
~
Sewage
Connection
Water
Conn ect ion
Mobile Home
U; Surcharge
~ 'CASH
\
c:::J CHECK
PlANS FURNISHED
FACILITY PERNIT
c:::J YES
Cl NO
c:::J YES
[=:J NO
TOTAL
Signature of Applicant:
r-c~
q~ Drninfield Required - Linea! Feet .17() H:lximum Depth ,?h
~A1"J_~,V /~~~_~_2r~~
Q..ab<.AAL/ ,'f.. .A.P~~.:::r:.a.4.1'''. _______....____
Fee Received By:
Uate:.J"':> -1. ....--Zr
MiO. Septic Tank Capacity
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_._-_._------_.~._--_._----
Type of Construction
Group
Fi ro Zone
Use ClaSsification
BIdg Setbac~ t JrAm~nter of Road
Front ~ide Int.
Right of Way:
Side Exterior
Rear
Zone
PlANNING:
~.
05-11
DATE:
2. 2.-De.r'J''7\
LANE
SANlTATI~~ DATE:
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COUNT; ;;;PA~nIENT~NVIRONHENTAL NANAGlCflENT
BUILDING:
DATE: