HomeMy WebLinkAboutWingenbach_17000020022000_Shoreland Permits_SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone 218-739-2271 - Fergus Falls, Mn. 56537
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY
White - Office
Yeilow — Owner
Pink — Assessor
Goidenrod — Inspector
//S^oMees c.6^*ree. cP aoh.
/A 6^UT. AW SistiY^v e f 0lf£<y//U S£C
Permit No„LEGAL /^3Date.DESCRIPTION
AND
LOCATION
fs ^ iPiyi-*n hi 4^/P</
Lake No.Lake Name Lake Classif.Sec.TWP Range TWP Name
IDENTIFICATION: Please Print All Information
Last Name First Initiai Mailing Address— No, Street. City and State Zip No.Tel. No.<Fll t6UU^[eg-*/ JOAf^rt AA£e^S7>22C1Owner
S£rL fNam6Contractor
SYiLculS, Mo^ &0 , Rg>g<S- h^C.Architect Name.
TYPE OF IMPROVEMENT:
( ) New Building
(^Alteration |
CPA. d«£H *
RESIDENTIAL PROPOSED USE:
One Family Dwelling
( ) Multiple Dwelling
NON-RESIDENTIAL PROPOSED USE:
Specify:,
Units
( ) Other ( ) Other Size
4.0£>0» COESTIMATED COST OF IMPROVEMENT $(omit cents)
PRINCIPAL TYPE OF FRAME:TYPE OF SEWAGE DISPOSAL:DIMENSIONS:
Basement: (JK) Yes ( ) No
Stories above basement:
Sq. feet (outside dimension)
Bedrooms
.4?./^^........
AX^.......
( ) Masonry
Wood Frame
( ) Structural Steel
( ) Other — Spiecify
( ) Public
(^ Individual Septic Tank, etc.
WATER SUPPLY:
( ) Public
(^ Individual Well
MECHANICAL EQUIPMENT :
Elevator: ( ) Yes
Air Conditioning: ( ) Yes
( ) Central
')C
/Baths
HEATING:
( ) Electric
( ) Coal
Other:
(' ) Oil<XType of Roof:( ) No Gas
(Vi No ( ) None
( ) Unit
CHARACTERISTICS:
lly.A4.M&.S <S.M.RMtSS")Lot Area is square feet.Water frontage is
feet. (Building Line)
.....feet
feet — from road or street is
feet.
feet from septic tank (Sewage System Permit must be obtained before installation). ^ ^
feet.
Building set back from high water mark is
Land height above high water mark at building line is
Building set back from State highway is
Side yard is
Building will be located
Building will be located
y/o
l.C>.€f..L
feet.
SCO’..upoandfeet. Rear yard is
ia
feet from soil absorption system (Cesspool, Drainfield, etc.).
Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed
forth and according to the provisions of the ordinances of Otter Tail County, Minnesota. I further agree jhat^my plai
shall become a part of this permit application. I also understand that this permit is valid for a period of sixfe
rk in accordance with the description above set
i^nd specifications submitted herewithinths.,
u'73 aDated,
Signaturejof uwner
Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted UF>on thePermit:
express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the ordinances of Otter Tail
County, Minnesota. This permit may be revoked at any time upon violation of said ordinances. /-v
A>3Dated
Shoreland^anagement Official
Ji&c h)o /7 ^ ^Permit Fee $.State Surcharge $.
. VJ£LL . 3Su^ /^D iPCO/L\ /inP/liiAJ
(3t^ iV iuLtuuG>ft A42> ius^ lo/yoTl^ oc muj IS
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Comments:
Form
-V
SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone 218-739-2271 - Fergus Falls, Mn. 56537
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY
White — Office
Yellow — Owner
Pink — Assessor
Goldenrod — Inspector
, i yA T ^'’ •J, Acye*> rf Lroy.
' /i< C:<^U f h <■' T t F* 'I i,. Yi ^
Permit No.
Date_____
c . 'Jj
tLEGAL
DESCRIPTION
AND
^ 2.LOCATION
-■1L/ • I ■■ V i / < 7
Lake No.Lake Classif.Sec.TWPLake Name Range TWP Name
IDENTIFICATION: Please Print All Information
First Mailing Address— No. Street, City and StateLast Name Initial Zip No.Tel. No.
A'•;' 0k. !i A, 'Owner
'-‘6^ pNameContractor
• >r . -r •k‘.:/' /‘ v_Architect Name..Ail
TYPE OF IMPROVEMENT:RESIDENTIAL PROPOSED USE:NON-RESIDENTIAL PROPOSED USE:
( ) New Building
( ) Alteration
( ) One Family Dwelling
( ) Multiple Dwelling
Specify:.
Units
( ) Other( ) Other Size
ESTIMATED COST OF IMPROVEMENT $(omit cents)
PRINCIPAL TYPE OF FRAME: TYPE OF SEWAGE DISPOSAL:DIMENSIONS:
Basement: (f) Yes ( ) Not
Stories above basement: .....L
( ) Masonry
O') Wood Frame
( ) Structural Steel
( ) Other — Specify
( ) Public
) Individual Septic Tank, etc.
WATER SUPPLY:
( ) Public
(,\) Individual Well
MECHANICAL EQUIPMENT :
Elevator: ( ) Yes
Air Conditioning: ( ) Yes
( ) Central
Sq. feet (outside dimension)
Bedrooms ! , , .'I Baths..../.
HEATING:
( ) Electric
( ) Coal
Other:
{)q Gas
( ) None
Type of Roof:( ) No ( ) Oil{5 / #U tV L ^fv:') No
( ) Unit
CHARACTERISTICS:
t^\UCA^)Lot Area is square feet.
jr‘“'
Water frontage is
feet. (Building Line)
feet
feet.A
Building set back from high water mark is
Land height above high water mark at building line is ...
IJIQ.Building set back from State highway is
Side yard is...................
Building will be located
Building will be located
feet — from road or street is feet.
yffandfeet. Rear yard is ...'.if...;;
feet from septic tank (Sewage System Permit must be obtained before installation).JUAAjCit
feet from soil absorption system (Cesspool, Drainfield, etc.).
feet.
Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set
forth and according to the provisions of the ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith
shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months.
:■-?i \' VDated.
Signature of Owner
Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon thePermit:
express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the ordinances of Otter Tail
County, Minnesota. This permit may be revoked at any time upon violation of said ordinances.
NOT CALLED filed 4 IS 77
Dated
Shoreland Management Official
Permit Fee $.State Surcharge $.
i /-■
/ jy /i i ■* *>»•* fTt '■ —.f , / ii
/y.
'17 .pn LComments:
.> .*/j k i L. / /X 1^ <1
\^’ P L A
/•i Liy Ly ^. ■f V
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■J hP i^T ■ ilfForm No. MKL-0771-002 158899IVICTO* LUNOCtN 4 CO.. Mlnrcitl. fCItSgt FALLl. UlON
INSPECTOR'S CHECK LIST
Make all measurements and computations
ACTUAL
IS i
MINIMUM
Shall Be 4-Sq. Ft
Lot Area (Square feet)Sq. Ft.Sq. Ft.
Ft.Water Frontage Ft.
Building Set Back from High Water Mark Ft.Ft.
50 Ft.Building Set Back from State Highway Ft.
40 Ft.Ft.Building Set Back from Street or Road
Side Yard &Ft.&Ft.
Rear Yard Ft.Ft.
Occupied Building to Septic Tank 10 Ft.Ft.
Occupied Building to Absorption System 20 Ft.Ft.
Elevation at Building Line above
High Water Mark_____________Ft.3 Ft.
Inspector's Comments:
Inspector's Signature
Title
Inspection
Dated 19
Agency
VICTOR UfMOCCa 0 M-. RRIMTIRO. RtROU* RALU. ttlHII.
SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone 218-739-2271 - Fergus Falls, Mn. 56537
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY
^^hite —.Office
Yellow — Owner
Pink — Assessor
Goldenrod — Inspector
fiSudr ^ t ^ f it No__________
/3 7| 7. ^2 cu^ !/l. ^ ^ _LvA. '7<T'
^ i li Mc^Uuu^ Ac^ ^ -
PpTl
3.250
LEGAL
DESCRIPTION
AND
LOCATION
II I’i'l 4X. ■ J20/I/PiSPrJ^A^
TWP NameTWPSec.RangeLake Classif.Lake No.Lake Name
IDENTIFICATION: Please Print All Information
Zip No.Tel. No.Mailing Address— No. Street, City and StateInitialFirstLast Name
Owner
67/3 f hY-9iS
72/cNameContractor
\^A-P^AJ/3r ^Architect Name.
NON-RESIDENTIAL PROPOSED USE:RESIDENTIAL PROPOSED USE:TYPE OF IMPROVEMENT:
New Building
( ) Alteration
^/iSO
poe.
Specify:( ) One Family Dwelling
( ) Multiple Dwelling Units
( ) Other Size( ) Other
akSjg a-^COESTIMATED COST OF IMPROVEMENTS (omit cents)
DIMENSIONS:TYPE OF SEWAGE DISPOSAL:PRINCIPAL TYPE OF FRAME:
Basement: ( I Yes (Jp No
Stories above basement:
Sq. feet (outside dimension)
Bedrooms .....^k?...................
( ) Public
( ) Individual Septic Tank, etc. yVUi/vcA*
( ) Masonry
(^ Wood Frame
( ) Structural Steel
( ) Other — Specify
/
WATER SUPPLY:
( ) Public
( ) Individual Well
MECHANICAL EQUIPMENT :
Elevator: ( ) Yes
Air Conditioning: ( ) Yes
( ) Central
l\yO-y'^Ju Baths ...O.
HEATING:
( ) Electric
( ) Coal
Other:
yijuk (X No ( ) Gas
None
( ) OilType of Roof:
(K) No
( ) Unit
CHARACTERISTICS:
* square feet.feet.Water frontage is ,
feet. (Building Line)
...............................feet
Lot Area is
Building set back from high water mark is
Land height above high water mark at building line is
Building set back from State highway is US'....feet.feet — from road or street is
Side yard and
/K^»vs»A.
Rear yard isfeet.feet.
feet from septic tank (Sewage System Permit must be obtained before installation),
feet from soil absorption system (Cesspool, Drainfield, etc.).
Building will be located
Building will be located
Agreement: 1 hereby certify that the information contained herein is correct and agree to do the proposed <
forth and according to the provisions of the ordinances of Otter Tail County, Minnesota. I further agree th^ any plans and specifications submitted herewith
shall become a part of this permit application. I also understand that this permit is valid for a period of sivJiQj months.
irk in accordance with the description above set
L
Dated.
Signa^re of Owner
Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon thePermit:
express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the ordinances of Otter Tail
County, Minnesota. This permit may be revoked at any time upon violation of said ordinances.
Dated
Shoreland Management Official/pic. I^a - 5 9S3'State Surcharge $.Permit Fee $.
Comments;
Form No. MKL-0771-002 ,158899
VICTOM U/HOCIH k CO.. aaiHTCK*. Ftoau* FM.Lt.
White — ^Office
‘Vellow — Owner
Assessor
SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone 218-739-2271 - Fergus Falls, Mn. 56537
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY
Pink
Goldenrod Inspector
^350\ i ^ ■
7,■ i-iJt 'h ' ■
■Permit No..LEGAL
' iC4.DateDESCRIPTION
AND
IIKf)LOCATION
T /mo
Lake No.Lake Name Lake Classif.Sec.TWP Range TWP Name
IDENTIFICATION: Please Print AH Information
Last Name First Initial IVIailing Address— No. Street, City and State Zip No.Tel. No,
Owner
NameContractor
Architect Name,
TYPE OF IMPROVEMENT:RESIDENTIAL PROPOSED USE;NON-RESIDENTIAL PROPOSED USE:
( ) New Building
( ) Alteration
( ) One Family Dwelling
( ) Multiple Dwelling
()Other
Specify:.
Units
( ) Other Size
ESTIMATED COST OF IMPROVEMENTS (omit cents)
PRINCIPAL TYPE OF FRAME:TYPE OF SEWAGE DISPOSAL:DIMENSIONS:
( ) Masonry
( ) Wood Frame
( ) Structural Steel
( ) Other — Specify
( ) Public
( ) Individual Septic Tank, etc.
WATER SUPPLY:
( ) Public
( ) Individual Well
MECHANICAL EQUIPMENT :
Elevator: ( ) Yes
Air Conditioning: ( ) Yes
( ) Central
Basement: ( ) Yes ( ) No
Stories above basement;
Sq. feet (outside dimension)
Bedrooms Baths
HEATING:
( ) Electric ( ) Gas
( 1 None
J2JvType of Roof:( ) No ( ) Oil
( ) No ( ) Coal
Other;( ) Unit
CHARACTERISTICS;
Lot Area is square feet.Water frontage is ,
feet. (Building Line)
...............................feet
feet.
Building set back from high water mark is....................
Land height above high water mark at building line is
Building set back from State highway is........................
Side yard is....................
Building will be located
Building will be located
feet — from road or street is feet.
and .......................................feet. Rear yard is
feet from septic tank (Sewage System Permit must be obtained before installation),
feet from soil absorption system (Cesspool, Drainfield, etc.).
feet.
Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set
forth and according to the provisions of the ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith
shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months.
Dated.
Signature of Owner
Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon thePermit:
express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the ordinances of Otter Tail
County, Minnesota. This permit may be revoked at any time upon violation of said ordinances.
Dated
Shoreland Management Official
oPermit Fee $.State Surcharge
Comments;
\0
\
Form No. MKL.0771-002
VICTOR LUHDCCH 4 CO.. RRIHTfUR. PCRCUS PAULS.
1158899
INSPECTOR'S CHECK LIST
Make all measurements and computations
ACTUAL IS i MINIMUM
Shall Be 4-Sq. Ft,
Sq. Ft.Lot Area (Square feet)Sq. Ft
Water Frontage Ft.Ft.
•? O c vBuilding Set Back from High Water Mark Ft.Ft.
Building Set Back from State Highway 50 Ft.Ft.
/SLiBuilding Set Back from Street or Road Ft.40 Ft.
cX_&cA_Ft.Side Yard &Ft.
Rear Yard Ft.Ft.
Occupied Building to Septic Tank Ft.10 Ft.
Occupied Building to Absorption System Ft.20 Ft.
Elevation at Building Line above
High Water Mark_____________Ft.3 Ft.
Inspector's Comments:
9Inspec^r's Slgn»ure7
Title
Inspection
Dated a r)o i9~7S’
Agency
vicToi unteccH > m . MiHnat. rcMaut ihnm.
}SHORELAND MANAGEMENT - COUNTY OF OTTER TAIL
COUNTY COURT HOUSE
Phone 218-739-2271 - Fergus Falls, Mn. 56537
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY
White — Office
Yeliow — Owner
Pink — Assessor
Goldenrod — inspector
1X13^ p^ (P~c> V . Lot /
7. ^ i- -y aW Vu /^c/ee /u r e • .
OStFCly (L~i9 /Uc-'/S-TA c E f<£-
Permit No„LEGAL
c^/htPiM^O Date..^/
DESCRIPTION
AND
LOCATION
II ^CO7 a-6 -Vi JOO 'U aJ?
Lake No,Lake Classif.TWP NameLake Name Sec.TWP Range
IDENTIFICATION: Please Print All Information
Last Name First Initial Mailing Address— No, Street. City and State Tel, No,Zip No,
\<CtN Coa/a'OiX fJu x M ff^o! T LAFCfS.NU,61J-2Z6JOwner
SoiAQy/utfQ'gcoA ::z^ F^y2(xo a F/9 4 < 5 , AfNameContractor
a?<l-/(/AAU fJ>kr>6'Cc.Architect Name.
TYPE OF IMPROVEMENT:RESIDENTIAL PROPOSED USE:NON-RESIDENTIAL PROPOSED USE:
■S TO lg A 6: t?/
( ) New Building
( ) Alteration
( ) One Family Dwelling
( ) Multiple Dwelling
( )Other
Specify:.
l3Ui L. 0/A> fj*Units
I ) Other Size
ESTIMATED COST OF IMPROVEMENTS (omit cents)
PRINCIPAL TYPE OF FRAME:TYPE OF SEWAGE DISPOSAL:DIMENSIONS:
Basement: ( ) Yes {)0 No
Stories above basement:
Sq. feet (outside dimension)
Baths P..
( ) Public 0 N £:
( ) Individual Septic Tank, etc.
WATER SUPPLY:
( ) Public
( ) Individual Well
MECHANICAL EQUIPMENT :
Elevator: ( ) Yes
Air (^nditioning: ( ) Yes
( ) Central
( ) Masonry
(^) Wood Frame
( ) Structural Steel
) Other — Specify
S / 0^3 ~t^oo >'iS
L>Bedroomslu o ru <e-
HEATING:
( ) Electric
( ) Coal
Other:
fyl) NoType of Roof:( ) Gas
jX) None
( ) Oil
(y No
( ) Unit
CHARACTERISTICS:
11:7*...O K) (S'Lot Area is square feet.Water frontage is
&..:LLS..f:Pt!SS<seX. (Building Line)
feet.
Building set back from high water mark is
Land height above high water mark at building line is
/V TTBuilding set back from State highway is
Side yard is
Building will be located
Building will be located
.feet
feet — from road or street is feet.
3S-^ <T ’ Oand feet. Rear yard is
feet from septic tank (Sewage System Permit must be obtained before installation),
feet from soil absorption system (Cesspool, Drainfield, etc.).
feet.
/L'c^ <C'
Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set
forth and according to the provisions of the ordinances of Otter Tail County, Minnesota. I further agr^ that apy plans and specifications submitted herewith
shall become a part of this permit application. I also understand that this permit is valid for a period of ax (6)inths.
vWvi-L- Z 0 Vi vUll^'VDated.
Signature of Owner
Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon thePermit:
express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the ordinances of Otter Tail
County, Minnesota. This permit may be revoked at any time upon violation of said ordinances.
^ /7fDated
Shoreland Management Official
(oState Surcharge Sc cPermit Fee $.
rki 1) iS A a/f LU A SComments:
jdS 6 y s/lccq lo/fo p/hsr c>/vh
/*, C Y it- L (1^ ^ S^J pc a; </ CP (J
f? (J I i) i lAJ /F / T g n
Form No. MKL-0771-002 ,158899
VICT9B UJNMtH 4 C0.. PRINTtN*. FCMUS rM.L4.
White — Office
Yellow — Owner
Pink — Assessor
Goldenrod ~ Inspector
SHORELAND MANAGEMENT - COUNTY OF OFTER TAIL
COUNTY COURT HOUSE
Phone 218-739-2271 - Fergus Falls, Mn. 56537
APPLICATION FOR BUILDING PERMIT AND CERTIFICATE OF OCCUPANCY
i' f . ■ /=' O' : U . K ' t- !
•7. "-2- /-i-r-c 7i /-it Of . f O '
' 1 r f f‘,C K 'V C
I f i Permit No..
/«/,
LEGAL
Date.DESCRIPTION f
AND
t ■LOCATION
, 7a. TXy:
Lake No.Lake Name Lake Classif.Sec.TWP TWP NameRange
IDENTIFICATION: Please Print All Information
Last Name First Initial Mailing Address— No. Street. City and State Zip No.Tel. No.
Owner
NameContractor
Architect Name,
TYPE OF IMPROVEMENT;RESIDENTIAL PROPOSED USE:NON-RESIDENTIAL PROPOSED USE:
( ) New Building
( ) Alteration
( ) One Family Dwelling
( ) Multiple Dwelling
Specify:.
Units
( ) Other ( ) Other Size
ESTIMATED COST OF IMPROVEMENT $(omit cents)
PRINCIPAL TYPE OF FRAME:TYPE OF SEWAGE DISPOSAL:DIMENSIONS;
( ) Masonry
( ) Wood Frame
( ) Structural Steel
( ) Other — Specify
( ) Public
( ) Individual Septic Tank, etc.
WATER SUPPLY:
I ) Public
( ) Individual Well
MECHANICAL EQUIPMENT :
Elevator: ( ) Yes
Air Conditioning: ( ) Yes
________( ) Central
Basement: ( ) Yes ( ) No
Stories above basement;
Sq. feet (outside dimension)
Bedrooms Baths
HEATING:
( ) Electric
( ) Coal
Other:
Type of Roof:( .) No ( ) Gas
(',) None
( ) Oil
( ) No
( ) Unit
CHARACTERISTICS:
Lot Area is square feet.Water frontage is .
feet. (Building Line)
...............................feet
feet.
Building set back from high water mark is
Land height above high water mark at building line is
Building set back from State highway is........................
Side yard is....................
Building will be located
Building will be located
feet — from road or street is feet.
and .......................................feet. Rear yard is
feet from septic tank (Sewage System Permit must be obtained before installation),
feet from soil absorption system (Cesspool, Drainfield, etc,).
feet.
Agreement: I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the description above set
forth and according to the provisions of the ordinances of Otter Tail County, Minnesota. I further agree that any plans and specifications submitted herewith
shall become a part of this permit application. I also understand that this permit is valid for a period of six (6) months.
Dated
Signature of Owner
Permission is hereby granted to the above named applicant to perform the work described in the above statement. This permit is granted upon thePermit:
express condition that the person to whom it is granted, and his agent, employees and workmen shall conform in all respects to the ordinances of Otter Tail
County, Minnesota. This permit may be revoked at any time upon violation of said ordinances.
Dated
Shoreland Management Official
Permit Fee $.State Surcharge $.
Comments:
ir^TTClmot C/LLFD FUh
Form No. MKL-0771-002 Vicr»« UUN»I«I 4 00.. PKIOTtat. PCIIOUO FM.Lt. MIIIN.158899
INSPECTOR'S CHECK LIST
Make all measurements and computations
ACTUAL
IS
MINIMUM Shall Be 4-Sq. Ft,
Lot Area (Square feet)Sq. Ft.Sq. Ft,
Water Frontage Ft.Ft.
Building Set Back from High Water Mark Ft.Ft.
Building Set Back from State Highway 50 Ft.Ft.
Building Set Back from Street or Road Ft.40 Ft.
Side Yard &&Ft.
Rear Yard Ft.Ft.
Occupied Building to Septic Tank Ft.10 Ft.
Occupied Building to Absorption Systenn Ft.20 Ft.
Elevation at Building Line above
High Water Mark_____________Ft.3 Ft.
Inspector's Comments:
Inspector's Signature
Title
Inspection
Dated 19
Agency
VICTOR LUHOfCN t CO.. RItIHTtRO. rtROUl rAkt.1. HIHM.
1
Each grid equals
Application for Building Permit Dated
Application for Sewage System Permit Dated
Building Permit Number
Applicant agrees that this plot plan is a part of application (s) indicated abov
GRID PLOT PLAN SKETCHING FORM.feet/inches.Scale:
2*7 9 19I !■I'
!i
Sewage System Permit Number.
-I
44
Ai.-j 1915.
On this form make a drawing of your lot. Indicate all present buildings
with solid lines and ell proposed buildings or additions with dotted
lines. Also indicate in feet; lake setback, side yard setback and rear
yard setback.
k Dated Signature
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