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ONE- & TWO-FAMilY DWELLING
PERMIT TO START CONSTRUCTION
Permit No.: dO J 43
5-d~'-O~
Date:
FEE $ ;;:2.. 7 IN ADDITION TO PLAN EXAMINATION/INSPECTION FEES
UISS L1J~
STREET & NO.
\ VIe l 7 7 '7-
SJ;ATE & ZIP
lA}LS'C{):...{ .s'iA.) ~qo I
C.' STREEl'& NO.
OJlL::f"
UVIL(
{Q.J
~
COUNTY "
W ( .I\.)jJ i€Blh Gs. a
STR~ET& NO.'
i II 3> CjLCsO,,;J ~TR...f--d'L-
STATE & ZIP
t,AJ t S<:..oJ-..f 5"'\ "-.J f;;}-f q0
~ .......-
.asS
I, the undersigned, request to begin footing and foundation work prior to the approval of the plans and issuance of the
UNIFORM BUILDING PERMIT per Ind 20.09(5)(b)2.
I have reviewed the specific code requirements of the Wisconsin Uniform Dwelling Code, Chapters Ind 20, Ind 21, Ind
22, Ind 23, Ind 24 and Ind 25, as applicable and have shown compliance on the drawings.
i agree to make any change required after the plans have been reviewed and to remove or replace all noncode complying
parts of the footing and/or foundations.
I agree to proceed with the footing and foundations only and will not continue with the remainder of the dwelling until
approval and a BUILDING PERJYlIT has been issued.
.~
I also understand that prior to the start of any construction, a zoning permit and a domestic septic permit has.been
obtained form the local authorities having jurisdiction in accordance with their laws and ordinances.
NOTE: Complete building plans are needed for issuance
of this permit. Footing and foundation plans submitted
prior to fi nal plans will not be accepted for issuance of
this permit.
~~~Pl-~
OWNER/AG T 51 NA URE
S-/~ pJ )17-5-
DATE I I
UNIFORM BUILDING PERMIT APPLICATION NO.:
ZONING PERMIT NO.:
SEPTIC PERMIT NO.:
AUTHORITY HAVING JURISDICTION:
OFFICIAL r-=:
~1o.J'~'L.D
ISSUED DATE
'-'t\(v'\ R"-
!}r- 20 8{r
:;;:;:>- _-U'- '.~
NOT ISSUED BECAUSE:
FE
DILHR S8D-6072 (R.10/801
ISSUING JURISDICTION