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NAME .~du ~.
LOT Y ,;1
SUBQIV. ~~
STREET NO.~YY'tJ .. 4 ~
DATE
$-/
LJ' '3
SIDEWALK EXISTING
YES
~ /Jf-<
\<1ARD /c::.2.--
ZONE G? - (..B
I t
LOT D I MENS IONS ~() X (L ()
D NO~
S-/I
BLOCK
ADDRESS
/
BUILDING GRADE ELEVATIONS
FEE: $2.0~
STAKES SET AT SITE
,19 83
BY
)<~ ~
~~
. OEPARTMENT OF PUBLIC WORKS
29~1
yt~
agree to have the
I, the undersigned, owner or agent of the above describe
grade established before excavation has commenced.
STATE OF WISCONSIN
DEPARTMENT OF INDUSTRY. LABOR AND
HUMAN RELATIONS
DIVISION OF SAFTV AND BUilDINGS
201 E. WA'SHINGTON AVE.
BOX 7lNIB
MADISON. WI. 63707
WISCO~SIN STATUES 101.83
PERMIT NO. 1;;( ();2.. ~
WISCONSIN UNIFORM
BUILDING PERMIT
APPLlCA TIQN
PARCEL NO.
PERMIT REQUESTED
. /' Cu G k::...
contr;;:~ ~\J sc{.-j Co
CONST
Mailing Address
~ 'DOVE
Mailing Address
ST..e-oCTlON 7-:7fe>o
PROJECT LOCATION
S'T
1. PROJECT
%
Building Addres
::<~'8o
ZO~g~itB
Lot Area
'77-00
2. TYPE
3. ELECTRICAL
~New DAddition
,Qf.\lteration
~,e
~Attached
o Detached
o Other
o Master plan no.
(if applicable)
Entrancr Panel
Size: _ 00
Service
o Underground
o Overhead
6. CONST. TYPE 7. FOUNDATION
~ingle family
'ElTwo family
o Other
EC
_.npll")MB --
Telephone
"731 -2749
Telephone
;;{3J-
203
S"-r
$T MOo~
%, SECTION
,T
E(or)W
Block No.
N, R
LO~O~
~
ft.
I FiN A 'ST PLAT
Front
:26"'
Rear
47]
Left
Right
ft. "g
ft.
ft.
4. HV AC EQUIPMENT 5. ENERGY SOURCES
.
Forced Air Furnace Fuel Space Water
AMP o Radiant Baseboard or Panel Htg. Htg;'
o Heat pump LP Gas ~ i
o Boiler Nat. Gas
o Central Air Condo Fuel Oil 0 0
o Other Elec. 0 0
Wood 0 0
8. PLUMBING Solar D D
Coal D D
Sewer Other
~unicipal
o Septic
o Permit No. 12. WATER
oncrete
o Masonry
OTreated Wood
o Other
Basement -100& 1 sq.ft. '~-Story 11. USE
~ ~i.;)qb D2-Story 0
~'Living Area ~. sq.ft. DOther Seasonal 0
d 430 ~Permanent Private
j,.aIGarage ' sq. ft. DOther ~MuniciPal
he applicant agrees to comply with the Wisconsin Uniform Dwellin Code and other Municipal Ordinances and with the conditions of this permit; understan s
that the issuance of the permit creates no legal liability ,express Imp' epartment or Municipality; and certifies that all the above information
is .accu rate.
SIGNA TURE OF APPLICANTV"'
DATE
CONDI.TIONS OF APPROVA' L This pe~mit is is~ued pu~suant to the following conditions. Failure to cOmply m;w re ult in suspension or
revocation of thIs permit or other penalty.
13. ISSUING JURISDICTION DVILLAGE
GSfI/UJstt"
NAME
FEES
PLAN REVIEW
INSPECTION
WIS. PERMIT SEAL(S) ~
OTHER ( )
TOTAL $
DILHR-SBD-5823
:J:'Y
DTOWN
DCOUNTY o STATE
IO-Q~ro
MUNIC. NO.
PERMIT ISSUED BY
NAME
r:z. . ~\ M. (CJL..
'S - '2.. ~- 13
0840
DATE
CERT NO.
ISSUING JURISDICTION/AGENCY
i 1
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