The URL can be used to link to this page

Home My WebLink AboutBuilding 02-0362 w ::E >= ~J Ww ~U :)i= ~o OZ -Z ~o Cl.- Ll..1- ofrl ~g, -Z U_ o W ...J ::> o w J: U en en en w ~ o o < ./\ ~' t ~rJ ~...) ~CV") ~\ ~ 0: I- Z o U ~ w Z ~ o t? ...Jf- Z <en 03 ~~~ f-ww- :!:uu< ~~~ Cl.Cl.::i ~o ~ ~ ~ ULl..Ll..t? 00000 o Z I- :E ~ w Cl. D.D....J ::>::>< ~~:!: ~ OOLl....J t? OOt?<z z_J:J:z_ m~~~mLl.. =:J:WIcU=:J: ::>Uf-=:::>U ...JW~W..JW D.=:>enD.=: 000000 o Z w Z o J: Cl. z o z i= 0_ z U o w ~!;(~~ g, i=~:E...J...J:!: o ::> ~ ~~<. ~ ~~Ll..:!: en 0000 0 j t? z D: w > o U w ~ o Ll.. w m z o i= () W D. en o 0 z w w W ~ ~ ~ o 0 ~ ~ ~ 0 Cl. D. Ll.. ~ 0 ...J ~ Z ...J 0<<3 t 5 ':i: < i= ~ l:; U ~ i= < > < f- f- en U U ~ w W 0:: ~ ~ ~~ ~ ~ 1:) Q) c- III C w U Z < > o < Z en ~ ::> o J: ~ N Z o i= U w Cl. en Z f- X W Z W :I: I- ~ o Ll.. C) III II) en ...:. ~ ...J ...J < U ~ ..... ~ ~ "l:l ~ ~ ::t: "-l ~ o ~ ~ ~ ~ ~ kl C< 'q; ~ <. ~ kl e:: ;:;;j OJ kl C< kl l::l 8 i::: ~ ~ ~ w ~ '- J w jltl !< - a 1\ a;o o W ...J => o W J: U en ~ ~ ~ ~ Ww ~u :)i= ~o OZ -Z 0::0 Cl.- Ll..1- ofrl ~g, -Z u_ o Z 0: t: f- =: Z ~ o W u Cl. en en W 0:: o o < o Z ~ W W Z Z 0 ~ J: o Cl. N '-$I f'r) I t? ...Jf- Z <en ...J -~1- ...J ~Ll..~ -f-ww- !:!::zuu< o3~~~ ~D.Cl.D.::i t?=:WWen xog:;g:;< WULl..Ll..t? OO~O ~ Q D.Cl....J ::>::>< ~~:!: 0:: OOLl.....J C) ooC)~ . z_J:J:z_ m~o::~mLl.. =:J:WIcU=:J: ::>Uf-=:::>U ...Jw~w...Jw D.=:>enCl.=: 000 0 O~ ~ ~ Q z U Q 0 W ,n f- C) - D. .....<zf- l/l zo_< Z i=z=:...J..J- O::><=><W 00~l/l:!:!:: Ll..Ll..Ll..~Ll..en oooo.iio :.. (:J ... '-J ~ ~ t? Z D: W > o U W ~ o Ll.. W m z o i= () W D. en o 0 z W W W ~ ~ ~ 000:: ~ 0:: 0 Cl. Cl. Ll.. >-- 0 ..J Z ...J ~ < ~ t 5 ':i: < i= ~ l:; u ~ i= < > < f- f- l/l U U ~ W W 0:: ~ ~ ~ 0:: 000 ~ U U o ~O L: C o o ~ c :;:: o L: o 1:) Q) c- III C W U Z < > o < z en ~ ::> o J: ~ N Z o i= U W Cl. en Z f- X W Z W J: I- ~ o Ll.. C) III II) en . t-. ~ ...J ...J < U ~ ..... ~ ~ "l:l ~ ~ ~ ::t: ~ o ~ ~ ~ C< ~ kl C< 'q; ~ ~ ~ e:: ;:;;j OJ "'-l C< "'-l l::l o v i::: o ~ ~ ~~ ri ~rl , ~ ~~ o ~~ en t4 ~ ~ ('() 41 Ww ~O :)i= 0::0 OZ -z 0::0 Cl.- Ll..f- ofrl ~g, -Z 0_ 0: I- Z o o en en w ~ o o < 0:: w Z ~ o t? ...Jf- Z <en ...J _~f- ...J ~Ll..~ -f-ww- !:!:~OU< O:5:5:5~ ~Cl.D.Cl.::i t?=:wwen xog:;g:;< WOLl..Ll..t? 000000 o Z I- :E 0:: w Cl. Cl.D....J ::>::>< ~~~ 0:: OOLl.....J t? OOt?< z_:I::r:z~ m~O::O::mLl.. =:J:w~=:J: ::>Of- ::>0 ..Jw~ ...Jw D. =: > II\.. Cl. =: oooo~o o Z w Z o J: Cl. z o z i= o z u - 0 w C) !:; t? i= l/lCl. z....z< _c-...J z 5~~::>~w ooo::en~!:: Ll..Ll..Ll..~Ll..en 000000 en I- Z w :IE :IE o u o 0 w w w w o 0 o 0 ~ ~ Cl. D. o Z < o i= o < f- U w 0:: 0:: o o o L: C o o ~ c :;:: o o 1:) Q) c- III E u.i o z < > o < ~ en 0:: => o J: <It N Z o i= o w Cl. en Z l- X w Z w ;;;.; ..... ~ ~ "l:l ~ ~ ~ o ~ ~ ~ ~ ~ Ll.. ~ 'q; ~ ~ ~ e:: ;:;;j OJ "'-l Cl:: "'-l l::l 8 i::: ~ ~ w ::E i= W I- 0( a o W ...J => o w J: o en Ww ~o ji= ~o OZ -z 0::0 Cl.- Ll..1- ofrl ~g, -z 0_ .~ '-J ('\) '\I) en en W ~ o o < 0: I- Z o o ~ w Z ~ o rt ~ (Y) t? ...Jf- :!: ~~ ...J ~iL~ ...Jf- _ iLzww< --oow ~~~~2: ~Cl.D.Cl....J t?=:w~en xog:;_~ WULl..Ll....... 000000 \ ri ~ o Z I- :E ~ W Cl. D.Cl....J ::>::>< ~~:!: 0:: oOLl.....J C) ooC)~ z_:r::x:z_ -O::o::~mLl.. ~5~~~5 3w~w...J~ Cl.=:>enCl."", D~D o z W z o J: Cl. z o i= z z 0 Q 0 W c)!;(~i= g, ~o:Ej...J~ 5~~~~~ ~~Ll..:!:iLen 000000 en I- Z w :IE :IE o u o 0 w w W o o ~ Cl. >- ~ o f- U < Ll.. en i= < en ~ 0:: ~ ~ 1:) Q) c- III C w o z < > o < z en ~ ::> o J: ~ N Z o i= o W Cl. l/l ~ f- X W Z w J: f- ~ o Ll.. C) III II) en ...:. ~ s:: ..... ~ ~ "l:l ~ ~ ::t: ~ C3 ~ I:l., ~ ~ Cl:: ~ kl C< 'q; ~ ~ ~ ~ ;:;;j OJ kl C< "'-l l::l o V i::: o ... ~ ...J ...J < o CITY OF PRIOR LAKE BUILDING PERMIT, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE AND UTILITY CONNECTION PERMIT Date Rec' d I{-~- Od- I. White File I PERMIT NO I 2. Pink City . QI'> - 0 3 " Z. 3. Yellow Applicant ~ ~ LEGAL DESCRIPTION (office use only) LOT A~ BLOCK I. 1 ' ()(J . ADDITION ~ PID' 5-38;t-o~3 OWNER (Name) ZONING (office use) I (Phone) ~;). - 'I ~b - ?.3 4 3 (Address) BillLDER h ~ ~ (:::~Name) - :;1f- ,;':;~ (Address) l ~ J -.. .s -#' ().L)O (Phone) (Phone) '1Sa ~9SS '-Iyg> X' I O~ TYPE OF WORK ODeck o Porch ORe-Roofing OLower Level Finish o Fireplace OAddition OAlteration o Misc. PROJECT COST IV ALUE (excluding land) $ I hereby certifY that I have furnished information on this application which is to the best of my knowledge true and correct. I also certifY that I am the owner or authorized agent for the above-mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building official n revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed in ection. ( ~ I x # # Signatur ~ 't? Contractor's License No. Permit Valuation Permit Fee Park Support Fee SAC # # $ $ $ $ $ $ $ $ TOTALDUE ~.J Plan Check Fee Water Meter Size 5/8", ' Pressure Reducer State Surcharge Penalty Plumbing Permit Fee Mechanical Permit Fee Sewer/Water Connection Fee Water Tower Fee Builder's Deposit Other 00.00 /00.00 6'.$0 o .CO Sewer & Water Permit Fee Gas Fireplace Permit Fee ORe-Siding OUtility Connection ....3 J /LRIl)~ Date $ $ $ $ $ $ $ $ $ if- 5 -o~ Date This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be i~-+--r-1~ -t/lL-tez- ~ ~ r~ ~Ianning Director t Date Special Conditions, ifany 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 The ('enfef flf 'he l..k~ Counlr)' White - Building Canary - Engineering Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT c W~ iJ~ APPLICATION RECEIVED L/, ;L-6d---.- The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity whicAroP~s~d at: !!)3 t,~ ~aL ~ Accepted Accepted With Corrections X. Denied Reviewed B(;2Q ~ Date: -1-s-o~ Comments: J~ (ill a.-\klo"Q ~~mJs "The issuance or granting of a permit or approval of plans, specifications and computations shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of this code or of any other ordinance of the jurisdiction. Permits presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid." White - Building Canary - Engineering Pink - Planning The- Crnlt"r or Ihr t.kr Counlr1' BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED L/ / ,./ '-. The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: ,Lj Accepted ~ Accepted With Corrections Denied ~~~ Date: y/l2-/02- ~ Reviewed By: "The issuance or granting of a permit or approval of plans, specifications and computations shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of this code or of any other ordinance of the jurisdiction. Permits presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid." White - Building Canary - Engineering Pink - Planning, Tht Cf'nln of Ihr I.akr ('ounlry BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT \ bJ bYJdu.-cod i0~ APPLICATION RE;;CEIVED L/... ;L-6d--- The Building, Engineering, and Planning Departments have reviewed the building permit application for canstr~ctian activity which i;;yropased at: /1'J _0 .I 6 ,::S to (0 ao1.~ o:e' ~ Accepted Denied x Accepted With Corrections Reviewed By: ;V~f3 Date: 4 -'I-o~ Comments: See Reverse Side for Additional Information! ~ee Attachments: 1) Grading Plan, 2) Erosion Control Measures 3) Erosion Control Plan "The issuance or granting of a permit or approval of plans, specifications and computations shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of this code or of any other ordinance of the jurisdiction. Permits presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid." \ \ Date Rec'd CITY OF PRIOR LAKE SEWER AND WATER PERMIT ~~~:w ~ii~~. I PERMIT NO. /)....,~ /J?J P- Gold Applicant U t7\ (/ V(O ZONING (office use) .f.1lG {lOBC-. T .LLI I LEGAL DESCRIPTION (office use only) LOT ~ LOCK {ADDITION ~'/ ?D ~ PID ;25'--3 ~;{-O:7L3 OWNER (Name) W I,.Jt:r1..v () 00 J{ 0 ME (' (Phone) (Address) (Address) (City) (Zip Code) APPLICANT (Name) () fl f.fH' t/L f ~ C (Address) --1 L,. II ~ ToP L ~ vJ It 'I (Address) (Phone) f q 1.2) ,f 91- (., ~ (" t (Contact Person) L A-I(. t (,It: U_~ (City) (Phone) DATE SSo'l<-j (Zip Code) APPLICANT SIGNATURE APPLICANT PLEASE COMPLETE BELOW Size of water service ~ inches. Location of any couplings from structure -=-- feet. Type of sewer pipe. D ABC ~ PVC D Cast Iron Estimated length of sewer line ~ feet. Clean out (if required) located at -=- feet from structure. Residential sewer and water line connection $35.50 Sewer connection only $17.50 (> (,: Estimated Cost $ 900 . FEE SCHEDULE Industrial, Com'l & Multi-family Water connection only 1% of job cost with a $39.50 minimum $17.50 Building Permit # .50 {j ttJ d P1 tJ' SEWER AND WATER PERMIT FEE STATE SURCHARGE TOTAL PERMIT FEE $ $ $ This Application Becomes Your Building Permit When Approved Paid (Office Use Only) Building Official Date Date Ljr;< '1-0 d- By 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 P.l Date Rec'd <) r 11 - (/2- 1.'1~asL! !)'pc Qr Jlriiit and sIgn at bottom) AI:,H?RESS . J ~- ~ b ~ {J. & \, <. "" (,I r tk J. rln~ 2, 000'" 1. '"(.JID'''' foil. rrE~J.T NO. -... Cil Y ( .... Appl;..nl I ...... ~ - 0 ':1 '0 . 1 -,I '" ii:; "n;" "" .-' LaOt\L DESCRIPTION (ofilce Us~ Qnly) LO'r ~BLOCK \ ^DDITION~ ~ \ a.~ ~ O\4..~ PID o W1':J ER (Njirt)c) ~ 0\..1.. r", ~ (Phone) C\ ~ :l~ ~ ~\ ~ -~ S S ).() l,J __~ (Aild{ess I .{.. ~ t " \\t APPpCANT i'I. I ~. (~aqle) \<\ '3-.. ~ f"'"\:) \ "q - -L ...., l., (A~d~'CSS) \ ~ 'i ~ \J "1,\ L u ~ Pt, V \.... ~ (Address) (Cc.,mplc[ Person) N L\ V\ C-\J S c..-~ ~ ~ \ \.. Afl,PI..ICANT SIGNATURE ~~ ~ 1......~l..J~ (Phone) C, S :)," "-\ \\ l- '?; \ :), ~ 'tV., ~)- lll\~ 0~v s ~ ~.-' -d. ((,:ily) (Zip C~Jdc) (l'l1ono) 9";":>'. \,\ '-\ '0 '" I: '-\ DATE ~ NEW CONSTRUCTION 0 REPLACEMEN1' FU~~ACE MA.KE AND MODEL C "'.......' t- i'"\ V l' - , QC) FLlJEl SIZE '" 'l L RETURN OPENINGS ~ TIPE OF SYSTEM APPLICANT PLEASE COMI)LETE BELOW INPUT I ~~ J G~ HEATING OR POWER PLANT o ALTEHATIONS rVEL l\)tLt- OUTPUT ~ OGO , . QWarm Air PlnnlS OOI'Dvity o Met:hlllliclll , DAir Conditioning jijVcnl. System o StCDrll o Hol Waler o Radilltion o Spccial Devices o Olhet Dc;vices PLEASE NUTE: Air Conditiolll.:r Units Cannot Encroach int" Required Side Yard Sethack.5 FI~EI:L^CE MAKE AND MODEL FEE SCHEDULE IndIISlllll.l. Commc:rcilll &. MullH;'amiJy 1% ofjub cost Rcsidclllial. Oo:! fireplace $.I9.S\l $39.50 minimum RC~ld~rtiaL Hl;llting &. NC (New ConslnlClion) $99.50 Residenliill, Additions & AllcrllLiuns J,'J9.$O Rc~idflrlil\J, Healing Only (New c.::onslruelion) S64.50 Residcmial, AC Only $J9.50 Estimated Cost.$ , () J 0 O~ ~ Buildillg Permil # () Z/ /0 ? ~, ~ (Ollict l15c Only) Tht~ ApplicatiDn Becomes YQur Building Pernllt WheJl Approve/J Paid HEA TlNG PERMIT FEE $ STATE SURCHARGE $ TOTAL PERMIT FEE S IJlltf oSO;;PAIDWrm--- BUILDING p"" c' .-:.. . t;. '.11I" Ii - ---_.- Receipt N DuUdln!: omclnl By 24 bour notice fot 1111 inspecliuns ('52) 447-9850, {liS (952) 4474245 MATTHEW DANIELS, INC. 423 3017 P.01 Date Rec'd CITY OF PRIOR LAKE PLUl\iIBING PER.J.\IIT ~~:: ~~~ I PER.\nT NO.. J _ ~ 0-.1 1 1 Y' ~ltow :\P9h":int . ~ '-- ~ J IPle:l3e type or print .u1I1 SIgn lt borroml I, ADDRESS Ir~:3J ~ .L. J._..J.. I ~(p(D v.JUJ ILa..lJ ~ 'i...)}: ZONING (or'fic= :J$e) i LEGAL DESCRIPTION (offiC:~ use only) \ LOT~.3 BLOCK I ADDITION' ~JJ;) vt~-l-rU I OWNER . . "\ \. . J '\ I ~a.me) J'l J" HI! .I .i~ ~ JJtU : (Addr~s) I.Jc3JI j..Jd..J'~~ ()~~L. ~. APPUCA~3.J _ ' . ~ (~am~) 1"{rl-!1J71 j~l1J1jA!JJ .~J.(l. (Address) J~!JJ'Jn {J.;/JJ.A.J1Jtl d J ~Jh . (AdJress) fJ PID (Phone) 95~. Jlqg - 8.!I4i' ~'~''''';.J.,7;).~. ~3M j (Phon~) bS'}. ~;L?). qAJIJ J ri .of..l , ./ r. \...t.J.. ;) (Ci~y) ...3 7. ~ (') ~06~ (Zip Code) APPUCA:-.-r SIG~ATURE (Phone)" bS"l. ~J,;3 3'/.30 DATE .5/OJ-9h:J- (Contact Person) APPLICA~T PLEASE COMPLETE BELO\V QU:lntity Type of Fixture Quantity I Type of Fixture I Bath Tub <,.vith or without shower . Rough-ins I \ Dishwasher Water Heater f D I I I loor ral.!1 I J .10: i Water Softner i I 4 Lavatory (Bathroom Sink) : I I Stand Pipe (Washing Machine) I :Laundry Tray (lor 2 compartment sink i i Sewage Ejector I Shower Stall , i Backflow Assembly : I I >Sinks I I Backflow Assembly Test I :Bar Sink I I Lawn Sprinkler I ~-3 !Water Closet (Toiler) ! Other FEE SCHEDULE Industrial, Commercial &. :\-luIU.family 1% of job cost with 11 539.:50 minimum Residential, New One & Two-Family 599.50 Residential, Additions & Alterations 539.50 Estimated Cost S Building Penn it # fII. ~ .50 ,." /tJ4~ IJIJ t::.lr, '-tlj".. . r'\ . PLUMBING PERMIT FEE I 51 A TE SURCHARGE TOTAL PERMIT FEE S $ $ i t J (om~e Use Ortly) This Application Becomes \' our Building Permit When Approved Paid Receipt No. ...~ .~uildlng Official '" Date H ~~. 1 5 By Dare ~ hour notice for .11 inspection$ (951) 447-9850. fax (951) 447-4245 , FAX 7635530887 GUYERS BUILDERS SUPPLY ~002 HEATING/AIR CONDITIONING/FIREPLACE PERMIT I, Pid~ Z. Gwn J. ,...._ r;iCUl' I PERMIT NO. *' ~&Vl I ZONING lolfu:cuse) I ~~::~.;:~:~ C, \.-l'~l e LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID I ~~R w~V\Jwood (Address) (phone) APPLICANT" (Name) l-=, U"te. ~~ (Address) 13 ~ () 5 \00 t: (- C' c:. ~ l CLC e :-r ~ fJ 1:5 ue..r)ve (Adcltess) (Phone) 7' ~ - ~~y- yJ,k ~ P / Y hi 0 U + h 5"5 Y<i { (Ci~) (Zip Cod<:) (Contact Per.;on) (phone) DATE ~ /ri. J /0"). . APPLICANT SIGNATURE APPLICANT PLEASE COMPLETE BELOW t$lNEW CONSTRUCTION o REPLACEMENT o AL TERA TIONS FURNACE MAKE AND MODEL FUEL FLUE SIZE RETURN OPENINGS INPUT OTJTf'UT TYPE OF SYSTEM HEATING OR POWER PLANT OWann Air Plants o Steam PLEASE NOTE: OGravity o Hot Water Air Conditioner Units o Mechanical o Radiation Cannot Encroach into DAir Conditioning o Sp~..1 Devices Required Side Yard .. aVent. System o Othclr Dc::...iccs Semacks FIREPLACE MAKE AND MODEL S y," et' ~ 0,," bTIQOo ~ Industrial. Commcrcial & Multi-FlUTlily FEE SCHEDULE I % of job cost Residentia1, Gas Fireplace $39.50 minimum $99.50 Residential, Additions '& Alteration$ S64.50 Residential, AC Only $39.50 Rc:sidcntial. Heating & Ale (New Constl1lction) Residcnlial. Hc:ming Only (Nc:w Construction) $39,50 $39.50 Es[ima[ed Cost $ Building Permit # HEATING PERMIT FEE STATE SURCHARGE TOTAL PERMIT FEE $ $ $ .50 Ollie Receipt No. (Omee lIse Only) Thi!l Application Becomes Your Building Permit When Approved Building Official By 24 houl" notir:e for:aU inspections (952) 447-9850, fax (952) 447424$ PRIOR LAKE INSPECTION RECORD DEPARTMENT OF BUILDING AND INSPECTION SITE ADDRESS 153~ 5;,100d C!.t'r-. NATURE OF WORK -Alew USE OF BUILDING 3~ D PERMIT NO. tJ2-03ft?2- DATE ISSUED -=1-s~o'"2.. CONTRACTOR Wt\w1u~ ~" PHONE ~52- a9~--8<fC/8 NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE DOCUMENT FOOTING 13 FOUNDATION (Prior to Backfill) 1> ~ S- PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ROUGH - INS SEWER I WATER I SEPTIC L FRAMING INSULATION ELECTRICAL PLUMBING HEATING (if required) FIREPLACE GAS LINE AIR TEST t7 COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED I I FINALS DATE GRADING (Prior to Sodding) BUILDING . Q.rJ. I rl d2,l ELECTRICAL PLUMBING HEATING DO NOT ~ "'05 "J 102..-- OCCUpy UNTIL ABOVE HAS BEEN SIGNED NOTICE This card must be posted near an electrical service cabinet prior to rough-in inspections and maintained until all inspections have been ap~roved. On buildings and additions where no service cabinet is available, card shall be placed near main entrance. Call between 8:00 and 9:00 A.M. for all inspections FOR ALL INSPECTIONS (952) 447-9850 crTY OF PRIOR LAKE '" . Impervious Surface Calculations" - - .. _ .. f'I:o, be :Submitt~ ~ith !3~ilding Penni~ AppliCltion)'. .. . . For All Propc:~es.Loc:ite,~ in the Shoreland District (SD). . The Maximum Impervious Surface Coverag~'Peniiitted m30 Percent /53/;6 Lot Area 22- 331 Sq. Feet x 30% ='........~.~... ~ 7tJ/r 7 ' *****~****************************************~******~****************** hO~CYJ.7 U/.2ct.€ " Jlk! I Property Address LENGTH WIDTH , SQ.FEET x - HOUSE . x x I ,-. . ATIACHED GARA.GE = Z'Z2;o TOTAL PRINCIPLE STRUCTURE.._....___... . QETACHED BLDGS (Garage/Shed) X:.. X TOTAL DETACHED BUILDINGS..............._...... p/f ~VEW ~.A VED 'AREAS . (Driveway-paved or not) , .' CSId~arking A~2S)' , G6:H X z,q) - ~ = 6gf, 6 /fL ... " , x' = ,> X 4- = p(~~~~~;~ boards. with a pervious surface below, are not considcn:d'to be. i~pcr:i~~~. ~ /? t, TOT.AL P A YED AREAS..............................._........ X. = U9 x. = X = . . .. 7 A"JO T OT _~ DE CKs...............;._........_..._..................-.. ~ ( . .. .. OTHER X = X = TOTAL OTHER.._.._.__..._.....___.._................. J/ It , . TOTAL IlVIPERVIOUS SURFACE 6m~VER. .. . Prepared By. ~ ~ Company I~L i;~-M~ ~_. I ~Z~b '1 I '5446./ I Date 3-22 -tJZ- Phone # 4~7.. - S OoD