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CITY OF OSHKOSH N ° - 40253
4101. PERMIT - APPLICATION A RE
AND RECORD
TYPE: BLDG IX HTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS RSb5 -506106<ki PLAN NO.
OWNER_____ EM( C
DESIGNER ��77//�� n ��,,���
USE /NATURE OF WORK 576E (A�3 C /6 (��d� �- •
BUILDING CONTRACTOR nCt.)/
Size Sq. Ft. # Rooms # Stories Height
Foundation Class of Const. Occupancy Permit /.
HEATING CONTRACTOR
Heat ❑ A/C ❑ Vent ❑ Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR
Electric Serv. New ❑ Change ❑ Temp ❑ Type Volts Amps
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR
BT _ WH _ Disp _ WSoft _ CBasin
- Lav _ Sh _ DW _ DF — San. Sewer
- WC _ FDr __SP — Ur _Storm Sewer
Sink _ LTub _. Eject _SS — Water
Other
FEES: Valuation $ /5 • � Permit Fee Paid $ `S '' Park Dedication $ ---
ISSUED BY - Date Vrn 7 Final /O.P. ,
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE -- - _ __ D 71 /Sy
ADDRESS Sv r•-i % �� % ' Y'7/
l TELEPHONE #
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ZONING /LAND USE COMPLIANCE CHECKLIST
JOB LOCATION: ? S7-1C-92601k) ZONING
PROPERTY OWNER/CONTRACTOR: •
CONSTRUCTION DATA: New Construction Addition Alteration
TYPE OF CONSTRUCTION: (i.e. fence, pool, parking lot, sign, etc.)
g ( 1X- / 4-) .f;ak V 612-0 ‘
COMPLIANCE CHECKLIST
DEFICIENT COMMENTS
Use
Lot Width
Lot Area
Lot Area Per Family
Floodplain
Front Yard
Front Yard Side Street
Rear Yard
Side Yards
Building Area
Parking Standards
Off - Street Loading Standards
Vision Clearance
Transitional Yard Standards
Landscape Standards
Height
Conditions of Approval
Compliance with P.C. or
BZA Conditions of Approval
Signage Standards
Drainage Plan
REVIEW AUTHORITY
As per Section 30 -5 Enforcement of the City Zoning Ordinance, the Director of Community Development, or
designee, must approval all plans, except the following: (1) Alterations or interior work when the use is
conforming and when no change in use is proposed. (2) Maintenance items, e.g. siding, windows, etc.,
when the use is conforming and when no change is proposed.
X APPROVED DENIED
Plan Commission Action Required
Variance(s) Requir-
REVIEWED BY: [� ._, DATE: 1
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OWNER lan4 - ADDRESS SO! J1 114
DATE ?is) qU PERMIT # USE C
Work consists of
GENERAL CONTRACTOR
J )C -3 -
MASON CONTRACTOR - ZONE
Width of lot DATE ` = "'"M ' S
REMARKS
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W nt: —KS
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Front of lot
MAILING ADDRESS