HomeMy WebLinkAboutPermit Building 1977-12-5
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WTl.tten Drrect:L.ons No 12TH DD..l
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33 ~ I 3L(7f-77
CoOD Job Location 3 3 49 OA L.)) Y '/I1=.J,AJ 1-.A~~
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INFORMATION SHEET '
(Y) BUilding Permit
Acreage or Lot Size { I '2. B Ae:--RE:C>
Partitioning 'f)(Y} J t.f-75( X:) Completed
7 Ct../'L, I () Pending
APPLICANT S NAME AND ADDRESS h. RAt...) DAJ.....L BRAtu r
OWN ER S NAME AND ADD R ESS If different from applicant s ~1\A..e;.
CONTRACTOR S NAME AND ADDRESS ~tvtE.....
Mall permit or results of site feasibility study to ( ) Applicant ( ) Owner ( ) Contractor
("/. ) Prefer to pick up Call i 4 L. - '101 I.J 7~ (owner etc ) when ready Contractors 0 S #
STRUCTURES NOW ON THE PROPE RTY "L g e.bJ?OGl '" }\.e>U t E: 1- ""2. '-A12. (....Ar2.A'~t;.
(lrt J) ~(;:u ~ FD ~rfc-6 au- (J(/A'
PROPOSED USE (thIS perm,t) 'i2A ItI~"""'A.L. ",'h7@'l ~ /\ ~ * eb-~ -z..
WA TER SUPPLY 1? A. 11\.\ ~uJ - t:::x ',Tt/J '- (existing or proposed well etc If publiC name of system)
SEWAGE DISPOSAl C'")(\,T' IV~ S \":.bILL Tt> --gE ~6PLAc...ED (existing or proposed septic tank etc) S I #=
PLUMBINGBY NF7....("),-ItA-i?L~ _ Address
) Site FeasibIlity Study for Septic Tank Number of sites
Test holes wIll be ready
SubdivISion,
Lot
Block
Phone 7%- 49'-/Z
Phone
Phone
( ) PROPERTY IS WITHIN ONE MILE OF CITY (
*
*
,.
*
**
)
OFFICE USE ONLY BELOW THIS LINE
( ) Ne~, '_~regJssary
ZO N E-+-1 f..-:::::::' SE TB AC K S
) FacIlity Permit Necessary
Front, Side FaCing Street
(FROM CENTERLINE OF ROADI
) Specla I Perm It Area
MlrllmUm Elevation
Intertor Side Yard Rear _
(FROM PROPERTY L1NESI
To Planning/Building Inspector/Sanltartan/Surveyor
ThiS applicant appears to have a problem With
Your assistance will be appreciated
By
_ Permit Processing Section
Response
C5512
By
DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
Permit Processing Section
125 East 8th Avenue
6874394
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