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CITY OF OSHKOSH
AND N° 17121
PERMIT - APPLICATI
O D RECORD
TYPE: BLDGHTG ❑ ELEC ❑ PLBG ❑ SIGN ❑ ZONING FLOOD PLAIN HEIGHT
ADDRESS I* lO f e t eto OL cr0(° PLAN NO.
OWNER <- TCV `F— d"2 Cl f Q j'4 GL.sO £1
DESIGNER n
USE /NATURE OF WORK ....S /0 ic ra- //C� c2-G- ! --U�.4 c. JI i 2
r
BUILDING CONTRACTOR 6e� CA. 'eY�'
Size / 0 lc r � Sq. Ft. (ZC # Rooms # Stories Height / D
/
Foundatiorr / QS -/'
/ 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 ____J- __
BT WH Disp WSoft CBasin
Lay Sh DW DF San. Sewer
WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
FEES: Valuatio __�� / Pe ; ' ee P aid --- $ 7o " I Park Dedication
ISSUED BY �� _ ._�.� �.r � Date AV Final /O.P.
i ii In the performance of this work I agree perform all work pursuant to rules governing the described construction.
SIGNATURE d' -- .- / - 3/ - 9
AGENT /OWNER DATE
ADDRESS / ��� / fVi
G 7 i 05Ks,/ 4 x '�
i ',- 23/ eV
TELEPHONE #
Revised: 8/89
ZONING /LAND USE COMPLIANCE CHECKLIST
JOB LOCATION: j -17l06 y/o ep t ZONING:
PROPERTY OWNER /CONTRACTOR: �� -� r'� .s CPI
CONSTRUCTION DATA: ANEW CONSTRUCTION ADDITION ALTERATION PARKING LOT
TYPE OF PROPOSED CONSTRUCTION: (i.e. fence, pool, sign, deck, etc.)
/(° f i �/ ' Q . r > X 4 4 7(6c r /-
COMPLIANCE CHECKLIST (Check only those applicable)
COMPLIES DEFICIENT DEFICIENCY /COMMENTS
Use
Lot Width
Lot Area
Floodplain
Front Yard
fq2/A4- Side Street (front yard)
Rear Yard
Side Yard (R)
Side Yard (L)
i't///g- Parking Spaces
Building Area
______ Lot Area Per Family
Corner Lot
Landscaping
Transitional Yard
Off- Street Loading
Vision Clearance
Height
REVIEW AUTHORITY:
The Director of Community Development, or designee, must approve 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.
Instances where work complies with the above criteria, the permit can be reviewed by the
Building Inspector without referral to the Director of Community Development, or designee.
'APPROVED DENIED
Plan Commission Action Required
Variance(s) Required
REVIEWED BY: el/.
.
....�� ,. _. ..�� DATE: AOC,
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