1978, 03-12 Permit App M5812 Residence, GarageCOUNTY ROADS. Work on street right-of-way may not be performed until staked by County Road Department and work must be
Performed in accordance with stakes. Points of ingress and egress must be approved by the County Engineer.
MOVING OF BUILDINGS. A permit is required to move an existing building. When a building is moved on a County or State
Highway, clearance must be obtained from the County Engineer and/or State Highway Department.
ACCESSORY BUILDINGS. Accessory buildings (garages, sheds, etc.) require a separate permit.
RESTRICTIVE COVENANTS. Builders should check provisions of covenants or dedications and easements running with the land
which are enforceable through civil action. County Officials can not bring action to enforce covenants or dedications.
APPLICANT FILL IN BELOW THIS LINE
Name of Owner ( Address % i '�� b �+� J Phone `l. - 1 {1
Architect Address Phone
Engineer Address Phone
Contractor Q/G+t,2/ Address
Legal Deesp tion of Prope y (Give comple
descriptign frpm, ieee�, tax.receipt, etc.) Parcel
_ Phone �/
Number IF '�i�-
DESCRIPTION OF WORK: New X Addition
Size of Lot % 5 V/
Stories / Dimensions 07�/t 6
Rooms
Remodel Moving
Sewage System
Total Sq.
Baths / (F B p irk n Foundation Const
asement /�
/� u l l art no e
Heat. System /f Type of Roofing ti% E t F-
Use of Bldg. /1�(JJ�>_'t,t� r
PLOT PLAN
Draw sketch with dimensions showing: (1) property lines; (2) street or road locations; (3) location of existing and
proposed buildings; (4) distance to property lines aid streets; (5) dimensions of buildings; (6) location of sewage sys-
tem and water supply lines.
h
Bldg. Zone Fire Zone
rE`��C-eJ Const. ./j'4��n-r.-z1
e/ (Fr., COnc., BB etc.)
Ft / � 4 Valuation
Chimney Fireplace'
(Kind) 47 (Number
Int. Wall Finish % 1.(-0+''t!Lt�
No. of Units Bedrooms
m
N
NORTH
I hereby certify inforr tion
as shown.
SOUTH
>. r V
Ind. Ins. Acct. No.
RESIDENTIAL -COMMERCIAL
REQUIRED
Plumbing Permit
rn Heating Permit
NSewage Permit
Plans Received
Plans Checked
Plans Returned
Plans Picked Up
Plans Mailed
r or Agen)- Date
A LAND USE OR STRUCTURE PERMIT MUST BE ON THE PREMISES BEFORE CONSTRUCTION COMMENCES.
THIS 1S NOT A PERMIT.
(19-A. -344,1
Your street address will be /e.) �f-J�ik�e The zone is ).224,LG
Sewage Permit Number Issued Building Permit �_ ; Q /.Receipt r�3/1� Issued
Remarks
DO NOT WRITE BELOW THIS LINE
s correct and there are no other structures located on this property except
7/7s;)
Form 523 Bldg. Code
01- // Sit / Pop?4/ /3 04/ ev
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