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/ DATE �,�r( / / ! f D
NAME d,
/1 ADDRESS /10/ '‘.4.-(Arzep./Z
LOT �!,r / / /- / / Y l BLOCK
— ' WARD /(Q.2 SUBDI� /. � �
1L. .� `• 4 , 1 L /9) ZONE --
STREET NO. / GLV , 1
� -. LOT DIMENSIONS 3� ` / I 7 o?
SIDEWALK EXISTING YES a NO f J
BUILDING GRADE ELEVATIONS STAKES SET AT SITE
,19 BY
FEE: $2.00 /
I Ze - kir d-e
•EPARTMENT OF PUBLIC WORKS
I, the undersigned, owner or agent of the above described property agree to have the
grade established before excavation has commenced.
D 3c ,
ONE- & TWO - FAMILY DWELLING Permit No.: 1c -a 1 (v
PERMIT TO START CONSTRUCTION Date: 3- ( - 1=83
FEE $2 7.00IN ADDITION TO PLAN EXAMINATION /INSPECTION FEES
OWNER STREET & NO.
CITYJTOWN STATE & ZIP TELEPHONE
®S 5 1 n! / c! o 1 2-3 I — 05807
I DWELLING LOCATION STREET & NO.
1 t C -1-1(312.-- . AvE- 1 Z t L . 'c4o n. - c 4v& -
CITY /4 COUNTY
C� si.4 s 14 LJ (AI .Al o
AGENCY (B IJ.,DER, ARCH. OR ENGR.) STREET & NO.
A r s'M, -rat 8u►(rrS.1 _ h 1 o Iv0, '(� Si
CITY STATE & ZIP TELEPHONE
q O 1 -44;:c7
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 the drawings.
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 zoning
permit and a domestic septic permit has been obtained from the local
authorities having jurisdiction in accordance with their laws and .
ordinances.
NOTE: Complete building plans are /% ICJ
needed for issuance of this permit. ► ER /AGENT SIGNATURE
Footing and foundation plans submitted
prior to final plans will not be 3- -17 -Y
accepted for issuance of this permit. DATE
UNIFORM BUILDING PERMIT APPLICATION NO.: r1551,
SS(c
ZONING PERMIT NO.: SEPTIC PERMIT NO.:
AUTHORITY HAVING JURISDICTION:
OFFICIAL TITLE p
kvt/Vt rut- C I,1 ( ttia
(��' 13 (Jc. tX15sPtc Co-
ISSUED DATE . 1,7_ F S RECEIVED DATE
NOT ISSUED BECAUSE: Z 3 - T? - 3
- -
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