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State Of Wisconsi n
Department of Industry,
Labor & Human Relati.ons
Division of Safety & Buildings
Box 7969
Madison, WI 53707
Wisconsin Statutes 101.63, 101.73
WISCONSIN UNIFORM
BUILDING PERMIT
APPLlCA TION
APPLICATION NO.
o~4-3
(See Instruction on back)
PARCEL NO.
~C
UELEC
DPLUIlABIM'C:i"
~-cR.~T
Yo Yo, SECTION
Od~~:~ LA~\E Es;-~<z-s
Front Hear
,T
Lot No,
'2.'1
Left
ft. ,I; 'Zo-
N, R,
Block No.
E (or)W
The applicant agrees to comply with the Wisconsin Uniform Dwelling Code and other lVIuncipaJ Ordinances and with the conditions of this permit; understands
that the issuance of the permit creates no legal liability, expr~ss 5r implied, n the Department or Municipality; and certifies that all the above information is
SIG~ATUREOFAPPLlCANT~ /c/., DATE ~-e?'/ .-?S-"
This permit is issued pursuant to the following conditions. Failure to comply may result in suspension or revoca-
tion of this permit or other penalty,
DVILLAGE
y
DTOWN
DCOUNTY
OSTATE
2- b r:o
".-
. ." \'
Plan Review rs-:~. . . $
Inspection. . . . . . . . $
Wis. Permit Seal(s) . . . $
Other. . . . , , . . , . . $
TOTAL. , , . . . . $
D\LHR-SBD 5823 (R-1/82)
30
NAME
"'::;; 0 DOther
~O
DATE
~z..g~q
CERT. NO.
WH ITE - Issuing Jur'isdiction
YELLOW - DILHR
GREEN -Inspector
PINK - Owner/Agent
zam~/IAND USE. <.'Qt-1P!.:UINC:l:: caEC!<LIST
I-.
GENE:RAL
Building Permit f: ZOnirlJQ Conforming_ Non-COnfotming_
=:.~r!J:tt&< - :: =ion
==W.~ ~.~. . .
~zr~~.~_1 ~ ,kuJ~<~ a~L
)..c NEW. CCNS'rRI1CnON' ADDITION ALTERATION
II. .
c
_ Accesso%y Build.i.nq
Fence
Boathouse
_ utility Structure
_ other (specify)
III. mMPI:..IANCe amx::t<S
Pool
__ Oeck/Patio
-..:. Sign
Porch
__ Single Family
.2s. Two-Family
_ Multi-Family
Camlercial
__ Mmufacturing
"
"
i
Catplies Deficient
~
7/
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~
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~
~
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Oeficiency/Ccmnents
..............
Use
I.ot Width
I.ot Area
Flcxxiplain _
Front Yard
Rear Yard
Side Yard (R)
Side Yard (L)
Pa.J:Xinq
Building Area
!.at Area per Family
COmer I.ot
other (specify)
.........-----
v
~ j#,,-
_!'(/II -
IV. REVIEti AtmiORnY
The Planninq Director, or appropriate designee, ItU.1St approve all plans, except
the following: (l) Alterations or interior \oJOrk when the 'USe is confonning and
when no change of use is proposed. (2) Maintenance i terns, e. g., siding, winda.;s,
etc., when the use is conforming and when no change of use is proposed. )'
Instances where work c::x:s:rplies with the above criteria, the peJ:mit can be revie\o.'ed
by the Buildil"lg Inspec"-..or without referr-...l to the Planni.z?g Director.
V APProvED NO!' APProvED
Plan Comnission Action Required
Variance (s) Required
~~p,~
DATE :
sb/Bs -
/ ,,/,.
! "-
/U- · DATE~ c9!, /16
. NAME ~/& W ~~~ ADDRESS (~3 '0 ~ .~
~::OIV~~&-~ . ::::K HARD 13
. ' . 'I
STREET NO. 1770 -/77..2:,O.~~t::' C"r'LOT DIMENS IONS {JS"' KI/ 0 (
SIDEWALK EXISTING t...,.,l_"c YES '0 NO 0" .
BUILDING GRADE ELEVATIONS STAKES SET AT SITE 5-2.'2...- ,19eS BY K,r..I
FEE:
$2.00 1~
DEPARTMENT OF PUBLIC WORKS
I, the undersigned, owner or agent of the above described property agree to have the
grade est9blished before excavation has commenced.
,!
?;<1//sf" 33GB
---::J tM ft-
City of Oshkosh 1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address .r'70 f (177 L' ~tQ.cF-(~ 0cu/c-(
Owner I s Name ~Tf<=~ l/(z (A Jr s 'i;' (10 k~_
Name of Subdivision OR-C(A~!L~ L-AJJ~ ~~~T~$
Lot # ~'1
No. of Units 1<--0 c
Fee Re~uired J ~ 0
Fee Paid
Bldg. Pennit # dQ)/42
Owner's signature
Inspector's signature
Parks Subdivision
Improvement
Accts. Rec.: 362-041