HomeMy WebLinkAboutBLD1991-00837 • III
StIL'AftE FL'v 1� PKiNCIPL� IYrE uF HEATING FUEL
-.+:iC
MAIN
FLCCR 0 ELECTRICITY 0
2:10 -L CCR --- 0 WOCOSTOVE a GAS
3R0 FLOOR 0 HEAT P 0 OTHER _
HTD BASEMENT _
•
UNHTD BASEMENT
DECXS ____� 'RINCIPLE TYPE OF FRAME
CARPORT WOOD 0 MASONRY
GARAGE _ _ M 0 , • ACTURED 0 OTHER_____M
COMMERCIAL M___ _______ 0 STRUC I' STEEL
•
INDUSTRIAL-----------
TOTAL VALUATI . OR ESTIMATED COST____
TYPE OF SEWAGE DISPOSAL:
0 SEWER INDIVIDUAL SEPTIC
TYPE OF WATER SUPPLY:
EPUBLIC ❑ PRIVATE 0 COMMUNITY WELL ❑ INDIVIDUAL WELL
NUMBER OF EXISTING BEDROOMS y NUMBER OF EXISTING BATHROOMS _ a
NUMBER OF PROPOSED BEDROOMS a NUMBER OF PROPOSED BATHROOMS ___Q
TOTAL NUMBER OF BEDROOMS TOTAL NUMBER OF BATHROOMS
NAME OF ADJACENT 800Y OF WATER
BANK HEIGHT SETBACK
SIGNATURE '121-3.,Js,,' DATE I I/ail ai
BASE FEE 2.5
PLAN CHECK
RECEIPT 6734 /
J
STATE SURCHARGE
TOTAL __ CASH/CHECK
G:\GROUP\PLANNING\BLDAPP.FRM