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ZONING/Li'1>.ND USE COr.1PLIANCE CIt8CKLIST
I. GENEIW:.
Building Permit # Zoning f!..'-'3ConfOrming_ Non-COnfonning_
Job I:ocation~)/ 1" gp3!J/l;e&.1/Lt//e:~, Lot Dilrension 07 Y- 1.:1-9.70
Property Owner ~ ~(jerJSS ..1-1 DH135 Lot Area. fb 94-
II.
CCNS'I'.R'O::nWDATA
Describe ~k: /J~Zi/y<___/...-'
r;:;~oo
~~~
ADDITION' .
ALTERATION
_ Accessol:Y Building
Fence
BoathoUse
_ Utility Structu:re
_ Other (specify)
III. OOMPLIANCE ...<:::ItEX:%S
Pool
Deck/Patio
_ Sign
Porch
_ Single Family
V Two-Family
= l1ulti-Family
Catttne.rcial
____ Manufacturing
Conplies
-1
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-:7
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,Deficiency ICorctnents
,.,
IV~REVIEW Atn'HORITY
The Planning Director , or appropriate designee, must approve all plans, except
the following: (1) Alterations or interior\<.Ork when the use is conforming and
when no change of. Use is proposed. (2) Maintenance items, e.g., siding, W~iS,
etc. , when the use is confonning and when no change of Use is proposed.
Instances where work canplies with the al::ovecr~teria, the permit can be reviewed
by the Building ~~. . r without referral to the. Planning Director.
V APPROVED . NOT APProVED .
;,<-,"'"
:l'
Plan Con:m:i.ssion Action Required
~ar~(~~.~~
F79Y
DATE:
ONE- & TWO-FAMILY DWELLING
PERMIT TO START CONSTRUCTION
Permit No.:
-....
Date:
FEE $27.00IN ADDITION TO PLAN EXAMINATION/INSPECTION FEES
STREET & NO./7 I ()
STATE & ZIP
COUNTY
CITY/TOWN
{/~~
AGENCY (BUILDER, ARCH. OR ENGR.)
STREET & NO.
CITY
STATE & ZIP
TELEPHONE
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 thedl:"awings.
. I agree to make any changes 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 PERMIT has been issued.
I also understand that prior to the start of any construction, a %oning
permit and a domestic septic permit has heen obta om the local
authorities having jurisdiction in accordance wit their aws and
ordinances.
8r-lS--
DATE
t'!i
NOTE: Complete building plans are
needed for issuance of this permit.
Footing and foundation plans submitted
prior to final plans will not be
accepted for issuance of this permit.
ISSUED D FEES
NO.': - -- ---~--"c------'----I'
I
---=.,
...e;,.:.;;.;.";;.......:;:~......,....~~..lii ~ .. ~
UNIFO~t BUILDING PEfu~IT APPLICATION NO.:
ZON LNG PERHIT NO.: SEPTIC PERl'lIT
AUTHORITY HAVING JURISDICTION:
OFFICIAL
5130 - f,r17? ('J c; lOr:'
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State of Wisconsin
Department of Industry,
Labor & Human Relations
Division of Safety & Buildings
Box 7969
Madison, WI 53707
Wisconsin Statutes 101.63, 101.73
WISCONSIN UNIFORM
BUILDING PERMIT
APPLlCA TION
iJ810
174.., '6
APPLlCA T1dNNO':"
(See Instruction on back)
PARCEL NO.
~TRUCTURE ~VAC ~LEC OPLUMBING
Mailing Address Telephone
(/ $~~ iJ/l....
Mai ing Address Telephone
Y.. Y.., SECTION ,T N, R, E(or)W
Lot No. Block No.
/
Left Right
Basements
Livi ng Area
Garage
Sq. ft.
The applicant agrees to comply with the Wisconsin
that the issuance of the permit creates no legal Iia
accurate.
SIGNA TURE OF APPLICANT
CON IT IONS OF APPROVAL
OVI LLAGE
CjcITY
OTOWN
d:~~
Plan Review . . . . . . . $
Inspection. . . . . . . . $
Wis. Permit SeaJ(s) . ',' $
Other. . . . . . . . . . . $
TOTAL. . . . . . . $
_01 LHR-5BD 5823 (R:1/82)
dO
h{)
onstruction
HVAC
Electrical
Plumbing
OOther
J-9b~
$- 2lt-$~
CERT. NO. 256--02-/ t!J4.-
WHITE - Issuing Jurisdiction
YELLOW - DILHR
GREEN - Inspector
PINK - Owner/Agent
/C\
OWNER 144 !~
/1- ~1- 84 . . 1"1 '?J 4-1
DATE I' - ~"1 -!3L. PERnIT" 1'1 ~~ 0
(}_~rV
GENE1U\L CON'rRAC:'tOlt
~ ~ ~-~~
U MASON CO ~. zam
W1d~ of lot (Z/'f/ DAn
- .
fI'(<;+ POOnNG
FD'nT sua
Bo n/...., Ie. '
I ~- BACKFILL
~ ~ STRUCTURE
~ .~ENERGY
1. ;r-r- nMP OP
~ r{w tINAWbp
ADDRESS [IJ/-(o ~. ~~~
USE
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a ~~~JtI ~ fL v
. INSPECTIONS
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