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V . <br /> APPLICATION FOR BUILDING PERMIT, DANE COUNTY, WISCONSIN • <br /> ,he•undersigned hereby applies for a building permit to authorize the proposed building PERMIT NO. , ,,''-7<R"--v.. -- <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 FEE AB a 4 <br /> compliance yw�ith all laws and ordinances applicable thereto. (.S Po) <br /> Town /�rz i'�y Section / + /v/t_- At J <br /> �4 �� <br /> Lot Block Subdivision <br /> Certified Survey Map No. /-2 o 4. Recorded Volume '- Page /o <br /> Fork . /VF h,"." Construction it---.427 m r Cost i SV GC u s <br /> District - Use O U / <br /> -Apt._ B.R. @ so/ft= <br /> 0 <br /> _Apt.- B.R. a so/ft= o. <br /> N <br /> Total H <br /> Width U <br /> Lot area % Coverage <br /> Parking spaces required Furnished L - <br /> Zz.= � <br /> Public sewer J'�v Publi water ti 0 �� <br /> /5 <br /> Septic tank permit no.4I'7 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. <br /> Depth <br /> Variance granted by Board of Adjustment o <br /> 0 <br /> n v Height £ <br /> g i l <br /> Date Side Side <br />! C, <br /> Stories <br /> Vi ath Owner .l"111 n/ i7J=D.L, r A. <br /> 4!v ?v 2-'4 y7 <br /> m <br /> ��t ac-;»„� c_�� ` ��,ti Set Back c/I I/1 v <br /> I <br /> m <br /> 0 <br /> Ce <br /> Z 7.•e C4,\/ ...XL/1,-.") 7,-;"Vt--/Le.-- <br /> Owner-BL-!der-Agent Width <br /> ''e:n , .ssued �--4- . i L� / 7 723 <br /> TIC <br /> Zoning Supervisor Road Width Class <br /> { LOCATION INSPECTION <br /> i Depth Righ: Left Rear <br /> Yard Yard Yard Set Bask c/1 I.!i Date By <br /> FINAL INSPECTION Certificate of Compliance issued /:'- 3G- 73 <br /> /r7 ,5e .' :S By 7 <br /> Zoning Supervisor <br /> R e-ark s <br />