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OSHKOSH
ON THE WATER
GRADE STAKE FORM
Grade Stake Number
7240
Name WAUKAU LLC
Address
3125 WHITE TAIL LN
Create Date 01/13/2005
Lot
Block
Ward
Subdivision
Zone
Street Number
Lot Dimensions
I I Sidewalk Existing
Building Grade Elevation Stakes Set At Site
01/13/2005
Set By
Department of Public Works
I, the undersigned, owner or agent of the above described property agree to have the grade established before excavation
has commenced.
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OSHKOSH
ON THE WATER
PARKLAND DEDICATION FEE COLLECTION RECORD
Job Address
3125 WHITE TAIL LN
Date 01/18/2005
Name
WAUKAU LLC
Address
100 N WESTHAVEN DR
Oshkosh
WI
54904
Subdivision
Lot
Building Permit Number
0112354
Number of Dwelling Units
4
Number of Structures
Fee Required
$660.00
Fee Paid
Owner's Signature
Date
Inspector's Signature
Date