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APPLICATION FOR BUILDING PERMIT, DANE COUNTY, WISCONSIN <br /> The undersigned hereby applies for a building permit to authorize the proposed building PERMIT NO. eR. '/— -O <br /> construction described below. The undersigned declares that the statements made below <br /> are true and that the proposed construction work and its contemplated use are all in full FEES <br /> compliance with all laws and ordinances applicable thereto. <br /> Town .1/ /'i3/}in rr._,_ Section /C '/a '/a Nam A/is" <br /> Lot _,�_ Block Subdivision <br /> Certified Survey Map No. /0,2-2- Recorded Volume ,/ Page .29 <br /> Work A/cr j✓ Construction /GR.' F Cost <br /> . I., <br /> District A - / Use V <br /> Apt. . B.R. ? sq/ft = <br /> 0 <br /> v <br /> Apt. B.R. @ sq, ft = 0- <br /> o <br /> Total Width G <br /> Lot area % Coverage <br /> Parking spaces required Furnished <br /> 74-C.- <br /> ..„....-15f-- - s��n <br /> Public sewer A.-/t7 Public water A/cv <br /> Septic tank permit no.52O-2- Well permit no. <br /> Rear <br /> Shoreland Flood plain <br /> (Attach all engineering data) <br /> For area more than 5 acres, show total acreage <br /> for 5 acres or less, show dimensions at right. Depth <br /> Variance granted by Board of Adjustment • roo L <br /> _a v Height n <br /> Date ' g- Side Side Q <br /> Stories <br /> Owner _Pp n//a - Ar. c!_"/2 <br /> Moth <br /> /Cy(J 'w`c <br /> 7 r -2 , - /7.te is //j ,y n • <br /> ili <br /> Bu:Ider C.4'27 E rn <br /> . <br /> Set Back c/I I/I 0 ro <br /> /16'..L-1-- /f J 0 <br /> S se C�u C-L-2.-c--d/ 'Cl-le . <br /> \ 'K -Age o ',7/ /L04 Width <br /> ■ <br /> Permit ssued • i`'?(�� 3�� /o(J /`>. <br /> ,.. -3--1- _ -,---__..--- -2.... ..,.. :',V. <br /> Zoning Supervisor Road 1h'i irh Class <br /> LOCATION INSPECTION <br /> Viid:i Depth Right Left Rear Set Back c.'I I. I Date By <br /> Yard Yard Yard <br /> t_. /- �.2 j 3 ,�7"j <br /> FINAL INSPECTION Certificate of Compliance issued '/--. ? _,v '. <br /> r,.:,:r, By <br /> Zoning Supervisor <br /> Remark ANn�ir 1 ."914 Lez,, svcs.tS_I <br />