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ROAD
ROAD AND
Subdr vrsiontl3t3
E*nst,tpLl% Secrron
Block b
BaumberSecrion
Ut
LEGAL DESCRIPTlON:
othet specil,c l*dtton or ltndmark
NE t
S W SIDE OF FEET
BOAO
l. LOCATlON: geographrc name
NE
SW FROM INTERSECTION OF-.._-
II. TYPE AND COST OF BUILDING
MOBILITY
E N"- CountY Besidenl
Druo
at eilher .S. Naw'r Ttidenr or
the resrdentialls this slrucl
s ol those employedor comme
acilrtiesTlndian I
TYPE OF IMPROVEMENT
D tt"* building
! Alteration
D Bepair. replacement
[--'l Wrecking
f] Moving (relocarionl
E Foundarion only
Fooo,t'on
BUILDTNG TYPE
[--l Srngle Family
E Mulri-Family
number ol units
-
! Horet, Motel, DormitorY
number of units
I Mobile Horrr
Orher - SpecilY
UBC OCCUPANCY GBOUP:
ffPrir"," (individual, corPoralion,/ \onprof rt institution, etc,l
E Prbli" (Federal, Stare or local gov'r-l
OWNEBSHIP
(Omit cents)
USE
oodo{use bu rd .9ibedtai I 9t ingsdentialDescrNonresi
tala1 elementaryneruchiundrylabuildinghospishopntplaprocessinglorgara9eparkingschool,collegeschool parochialsecondaryschool ntUIbtdiatndplaustrialreotfbuiceoIlngstorentailding,rl rlendepa enler useinproposedchaxistbuitdbeingisnged,utetf ol rng 9
Residenc,
permanent residence
Home: Recreation Cabin, etc.
Home: Future conversion lo
in the aboYe cost
a. Electrical.
b. Plu116ing.
c. Heating,airconditioning ......
d. Orher (elevator, etc.l. . .
. TOTAL COST OF lMPROVEMENT
IIt. SELECTED CHARACTERISTICS OF BUILDING -
Cost of improvernenl.. .......
To be installed but not included
cosT
a
L BUILDINGS ONLY
ZIP code
,
n
4(
Tel. No.SrateandcityNumberstreetailiMAddressng
Outdoors
TYPE OF MECHANICAL
lndividual (septic lank, erc.l
E Ott,er - SpecifY
TYPE OF SEWAGE DISPOSAL
or Privale
Parr ial
Full.
IV. TDENT]FICATION.
Name
Number
RESID
DIMENSIONS
o Number of Srories
o Total square feet of floor area.
all tloors, based on exterior
Number of
bathrooms
TYPE OF FIREPLACE
,,,
dimensions.
.Total tand area, sq. ft.
NUMBER OF OFF.STREET
PARKING SPACES
Enclosed
TYPE OF WATER SUPPLY
arx;rc or PriYate companY
d lndiiduat (well, cistern I
PRINCtPAL TYPE OF FBAME
I MasonrY (wall bearing)
pwooa rt".t*
E Slruclural sleel
l-l Reinforced concrete
PRINCIPAL TYPE OF HEATING FUEL
DG"s
E oir
E El"aricitv
Dcoat
D ortt"t - SPecilY
s---r-Oryner
{3.p_
-Itare License No.2.
Con t ra ctor
AddressappliBnt
form to all aPPlicable lar,tr-building and the u ndersigned agree to conThe
3-
Arc hir e ct
WATER DISTRICT--
Cdffi l{aLTH
L
efr
b FrRE DtsrRlcr
Prf,rng()K Q<rr
PLANNING AREA
APPROVED BY
ITN RTSSUETE
BUTLDING OFFICIAL 3 .>gu t
Gr.
a
PE RMIT FEE
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WrzG,' 3&l* lb, = 21t2- '
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