HomeMy WebLinkAboutBLD1991-00851 Kr
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SQUARE FOOTAGE t 3 (e, PRINCIPLE TYPE OF HEATING FUEL
MAIN FLOOR 7 { ' K 0 ELECTRICITY ❑ OIL
2ND FLOOR '5' j to . Lcvt ,c _ J E c' ❑ - WOODSTOVE ❑ GAS
R� HEAT PUMP ❑ OTHER
HTD BASEMENT i. (, , /&3 1-c ------
•
UNHTD BASEMENT_t
DECKS Tr X /c €' y)c Y '(� 7('' PRINCIPLE TYPE OF FRAME
CARPORT WOOD ❑ MASONRY
GARAGE ❑ MANUFACTURED 0 OTHER
COMMERCIAL ❑ STRUCTURAL STEEL
INDUSTRIAL
TOTAL VALUATION O&D OR ESTIMATED COST "5-3/D D d
TYPE OF SEWAGE DISPOSAL:
.0 SEWER E1 INDIVIDUAL SEPTIC
TYPE OF WATER SUPPLY: —/
❑ PUBLIC 0 PRIVATE L� COMMUNITY WELL 0 INDIVIDUAL WELL
NUMBER OF EXISTING BEDROOMS NUMBER OF EXISTING BATHROOMS
NUMBER OF PROPOSED BEDROOMS -j_ NUMBER OF PROPOSED BATHROOMS _QZ _
TOTAL NUMBER OF BEDROOMS I- TOTAL NUMBER OF BATHROOMS 2--
NAME OF ADJACENT 800Y OF WATER G> W,-/VA,j ,�ll 7
BANK HEIGHT .2 5 SETBACK 3 C.J
SIGNATURE l/ti tAAA 3 DATE / (— 2 ? 9J
BASE FEE
PLAN CHECK g ' Z C RECEIPT #
STATE SURCHARGE
TOTAL ` 7' 7.� CASH/CHECK #
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