HomeMy WebLinkAboutBLD1991-00832 SQUARE FOOTAGE PRINCIPLE TYPE OF HEATING FUEL
MAIN FLOOR ELECTRICITY ❑ OIL
2ND FLOOR ❑ WOODSTOVE ❑ GAS
3RD FLOOR 0 HEAT PUMP ❑ OTHER
HTD BASEMENT
UNHTD BASEMENT
DECKS PRINCIPLE TYPE OF FRAME
CARPORT ❑ .WOOD 0 MASONRY
GARAGE MANUFACTURED 0 OTHER
COMMERCIAL ❑ STRUCTURAL STEEL
INDUSTRIAL
TOTAL VALUATION OR ESTIMATED COST
TYPE OF SEWAGE DISPOSAL:
❑ SEWER INDIVIDUAL SEPTIC
TYPE OF WATER SUPPLY:
❑ PUBLIC ❑ PRIVATE COMMUNITY WELL ❑ INDIVIDUAL WELL
NUMBER OF EXISTING BEDROO NUMBER OF EXISTING BATHROOMS
NUMBER OF PROPOSED BEDROOMS M NUMBER OF PROPOSED BATHROOMS
TOTAL NUMBER OF BEDROOMS ,! TOTAL NUMBER OF BATHROOMS _ _
NAME OF ADJACENT BODY OF WATER
BANK HEIGHT SETBACK
-------------
X: SIGNATURE 1/4,1Cat - DATE //MA /
BASE FEE
PLAN CHECK RECEIPT #
STATE SURCHARGE
TOTAL CASH/CHECK #
G:\GROUP\PLANNING\BLDAPP.FRM