HomeMy WebLinkAboutBLD1992-00116 SQUARE FOOTAGE PIIPLE TYPE OF HEATING FUEL
MAIN FLOOR 1-5 `-ILL-7 ELECTRICITY 0 OIL
2ND FLOOR ❑ WOODSTOVE 0 GAS
3RD FLOOR ❑ HEAT PUMP ❑ OTHER
HTD BASEMENT
UNHTD BASEMENT
DECKS PRINCIPLE TYPE OF FRAME
CARPORT WOOD 0 MASONRY
GARAGE 0 MANUFACTURED 0 OTHER
COMMERCIAL ?cr.C. STRUCTURAL STEEL
INDUSTRIAL
TOTAL VALUATION OR ESTIMATED COST
TYPE OF SEWAGE DISPOSAL:
❑ SEWER INDIVIDUAL SEPTIC
TYPE OF WATER SUPPLY:
Lu3. PUBLIC ❑ PRIVATE 0 COMMUNITY WELL 0 INDIVIDUAL WELL
NUMBER OF EXIST NG BEDROOMS NUMBER OF EXISTING BATHROOMS
NUMBER OF PROPOSED BEDROOMS 41-?/ NUMBER OF PROPOSED BATHROOMS _+
TOTAL NUMBER OF BEDROOMS TOTAL NUMBER OF BATHROOMS
NAME OF ADJACENT BODY OF WATER
BANK HEIGHT SETBACK
SIGNATURE DATE
BASE FEE l
PLAN CHECK RECEIPT # 6.38 0
STATE SURCHARGE
3qh
TOTAL CASH/CHECK I U
G:\GROUP\PLANNING\BLDAPP.FRM
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