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State of Wisconsin
Department of Industry, WISCONSIN UNIFORM
Labor & Human Relations BUILDING PERMIT APPLICATION NO. 9 C)65
Division of Safety & Buildings
Box 7969 APPLICATION
Madison, WI 53707
Wisconsin Statutes 101.63, 101.73 (See Instruction on back)
PARCEL NO.
a
'',. Ri I , �J'1 11 ° ' w c � ,u TRUCTURE IVAC E6E
Owner's Name i Mailin. Address Telephone
6MA'S VH ��cU
b'G? 00r �0. 4 (4 023 i -8ao 3
Contractor's Name ailing Address Telephone
J
'4 ''%, SECTION , T N, R, E(or)W
Building Address Subdivision Name No. Block No.
SIO Al Lot N
tN 4 sue �40„ , ► —. , T kr,
5 ‘o ---
Zoning District p� Lot Area Front Left Right
( Sq. ft. Setbacks o9G j 8.
ft. f t. v C 7 • S ft.
it d '`
on .in le '
- 9 Famil Y Entrance and 0 Forced Air Furnace Fuel S•ace Ht.. Water Ht..
• teration ❑Ad
p iti •Two Family Size: amp ❑ Radiant Baseboard or Panel LP Gas 0 ❑
'Ili -image ❑Raze ❑Other Se ice: ❑ eat Pump Nat. Gas .29— ,
ttached ❑Move N'■ • -derground •::: :oiler Fuel Oil ❑ ❑
❑Detached ❑Foundation ❑Overhead
❑Central Air Conditioning Electric ❑ ❑
❑Master plan no. : . z ❑Other
(If applicable) Wood ❑ ❑
❑Site constructed r .. • crete a - � ` Solar ❑ ❑
�. - _ .r. , i anufactured ❑Masonry Sewer Coal ❑ ❑
# ❑Treated Wood Other
P- umcipal
❑Other ❑ eptic
Basements
' 00 S q. ft.
�� i Permit N
v- -tor Envelope '3 BTU /HR
Living Area 1 e Sq. ft. 02 -Story -,- - Infiltration I O
4,0•.., BTU /HR
�{�f � ❑Other ❑Seasonal
Garage `"[ Sq, ft. t 'ermanent ❑p ivate on -site Well
■Other nicipal Utility
$ COO
The applicant agrees to comply with the Wisconsin U. ormlir 'other Muncipal Ordinances and with the conditions of this permit; understands
that the issuance of the permit creates no legal I'• •ilit '��� •n the Department or Municipality; and certifies that all . e abov- information is
accurate. ,� ''
SIGNATURE OF APPLICANT _ _____ . DATE ( ,
-
CONDITIONS OF APPROVAL This permit is issued pursuant toe the following conditions. Failure to comply may result in suspension or revoca-
t i.n o thi p or o pe
, l c- E ' L- t ► it
a . A.G • . — -- a Lr
SMUG ARSDICTKM
❑V IL LAG E - ITY El TOWN ❑COUNTY ❑STA r�
NAME r S� S MUNIC. NO. 7 v a
iminimunili. ,/I �� I �
S :At,:;.:, I ED BY
Plan Review ) $ 3 .� • struction
AC NAME GD //124) (M r4/.
Inspection $ r:: -ctricai � Q s' •
Wis. Permit Seal(s) .. . $ 3J • - `
- DATE ` -- 3- CJ
Other $ ❑Other `� (�� /
TOTAL $ � `' e, v /- 7 CERT. NO. �° 84 b
DILHR - SBD 5823 (R - 1/82) WHITE — Issuing Jurisdiction YELLOW — DILHR GREEN — Inspector PINK — Owner /Agent
•
ZONING/LAND USE COMPLIANCY CHECKLIST
I. COAL
• Building Permit $ aC S �/ Zoning 0 Conforming Non - Conforming
Job Locationr2g / 0 /4/ f} S7 Lot Dimension
Property - 7 N S SCE} Lot Area
II. • CONSTRUCTION DATA •
Describe work: .OL A k -L .rr Li 4 -r _
_ NEW a lsrmic IcN ADDITION - ALTERATION
_ Accessory Building Pool 1K Single Family
Fence — Deck/Patio _ TWo- Family
Boathouse _ Sign _ Itti- Family •
_
Utility i ty Structure _ Porch Commercial
—
—
Other (Y) _ Manufacturing
a
III. CI u CHECKS
Comolies Deficient Deficiency /Ccim nets
Use
`'> Lot Width
Lot Area
Floodpi a i n
Front Yard
Rear Yard
Side Yard (R)
Side Yard (L)
(-'' Parking
lr - Building Area
lot Area per Family
•
Corner Lot
Other (specify)
—
IV. REVIEW AUTHORITY
The Planning Director, or appropriate designee, must approve all plans, except
the following: (1) Alterations or interior work when the use is conforming and
when no change of use is proposed. (2) Maintenance items, e.g., siding, windows,
etc., when the use is conforming and when no change of use is proposed.
Instances where work complies with the above criteria, the permit can be reviewed
by the Building Inspector without referral to the Planning Director.
APPROVED NOT APPROVED
Plan Commission Action Required
Variance (s) Required
REVIEWED BY: �� � — - DATE: Go 6
City of Oshkosh 1/1/85
PARKLAND DEDICATION FEE COLLECTION RECORD
Address (5 (4i E(/4 Th
Owner's Name �--k)m (> S �C) SG 14
Name of Subdivision 'SG -G 1(F— AJAS`T 1 i k C IT \i
Lot # 0 Bldg. Permit # O O 6s�
No. of Units .k.) E_
Fee :"' Fee
Owner's si gnatu �� 'r�+ Date 7- /� - d'
Inspector's signatur !/ Date 7
Parks Subdivision
Improvement
Accts. Rec.: 362 -041
DATE Q4 i 5i C
NAME 04)1%-ot..4___. (:;):0-4-41-.— ADDRESS C U (,j74 y � rrbR >
LOT 60 BLOCK -- WARD G
S UBD I V .6A- GIa6..,. - _ k�,�s.I aa%!" ZON E EA
STREET NO. e 7 ? -5-1 ° 2 "' LOT DIMENSIONS
SIDEWALK EXISTING YES
LIl NO El
BUILDING GRADE ELEVATIONS STAKES SET AT SITE Cv —Zs , 198.5 BY
FEE: $2.00
DEPARTMENT OF PUBLIC WORKS
1, the undersigned, owner or agent of the above •-.cr' id property agree to have the
grade established before excavation has comm - ced.
Slit / if" ' e /----e-/___