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DEPT, OF BUILDING INSPECTION <br /> Marion Csur~W <br /> <br />R.H. WITHROW, BLDG, ADMINISTRATOR <br /> ~88-§147 <br /> <br />APPLICATION FOR BUILDING PERMIT <br /> <br /> Erect <br />Application is made to Alter <br /> Repair <br /> <br /> ~"-¢ <br /> <br />Relocate Buildln9 <br /> O <br />Demolish Structure <br /> <br />(;olf Club Rd-~tayton <br /> <br />Valuations 15;000.00 <br /> <br />Su,c.ar._ /, ¢'Z <br /> <br /> Septic Tank <br /> <br /> Total Fee $ <br />This permit covers <br /> <br />Conslrucfion ~" <br /> <br />Lot -- Bbck <br />Lot Size .... ~,np~o~ 6 ~'~rr~,~ , <br /> <br />Add~t;~n -- <br /> <br />Size of 81dg, <br /> <br />Number of Stories .... ~n~, 8asement Height in feet <br /> <br />Occupancy or use barb' & hobb.~Lf~rea <br /> <br />Sewage Disposal <br /> <br />Water Supply <br /> <br />Value of entire work when ccmpleted, including labor and materials: $ ~5.000.00 <br /> <br />Builder & No,--,, ~mo Address <br /> <br />Address Rt. 1 Box 88 Woodburn 970~one 981-9581 <br /> <br /> DESCRIPTION OF WORK <br /> <br />· -, b ~ on vaca. nt property (house to be built later) FiO~ .,~.~J~t~4.~ ........ <br /> <br />.~¢B~.&S~:~¢~¥ 4~ .~._vo ~~T_~ ....... <br /> <br />Conditional Use .... Partitioning __ Variance Case No, __ <br /> <br />ONLY WORK DESCRIBED ABOVE INCLUDED IN PERMIT <br /> <br />APPLICATION RECEIVED <br /> <br /> ,SEPTIC TANK <br />Approved · Not Approved <br /> <br /> By <br /> <br /> 8/Z9/75 <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPARTMENT: <br /> <br />Heotin~ <br /> <br /> ~_BIJM~XAMINER <br /> ~ot ,,~rov ed <br /> <br />Date <br /> <br />(T ISSUED <br /> <br /> <br />