HomeMy WebLinkAboutBLD1991-00833 SQUARE FOOTAGE PRINCIPLE TYPE OF HEATING FUEL
MAIN FLOOR ❑ ELECTRICITY ❑ OIL
2ND FLOOR ❑ WOODSTOVE ❑ GAS
3R0 FLOOR ❑ HEAT PUMP OTHER rc-Gait'
HTD BASEMENT
UNHTD BASEMENT
DECKS PRINCIPLE TYPE OF FRAME
CARPORT WOOD ❑ MASONRY
GARAGE-__ 171 MANUFACTURED ❑ OTHER
COMMERCIAL TT ❑ STRUCTURAL STEEL
INDUSTRIAL
TOTAL VALUATIk OR ESTIMATED COST
TYPE OF SEWAGE DISPOSAL:
❑ SEWER ❑ INDIVIDUAL SEPTIC
TYPE OF WATER SUPPLY:
❑ PUBLIC ❑ PRIVATE ❑ COMMUNITY WELL ❑ INDIVIDUAL WELL
NUMBER OF EXISTING BEDROOMS klff
- NUMBER OF EXISTING BATHROOMS
NUMBER OF PROPOSED BEDROOMS NUMBER OF PROPOSED BATHROOMS
TOTAL NUMBER OF BEDROOMS TOTAL NUMBER OF BATHROOMS
NAME OF ADJACENT BODY OF WATER
BANK HEIGHT46 SETBACK
J SIGNATUR 6 ?Z7 DATE 41 143(' J
BASE FEE ql
PLAN CHECK `-' RECEIPT #
STATE SURCHARGE 4--
TOTAL 56
I')7CASH/CHECK #
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