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V r.ai. V- <br />VIUA6I OF OKONO ■UILDING KRMIT 4 <br />puRPOsf or BuiLomo <br />owNUt Le^rret^ 'TTio^nri.p^^tn buuoer ^ ^ <br />AODRBSS ^ / ADDRBS ^ <br />f-t>^ mom MO. <br />PHUMT NS 2031 <br />S«c. No.Porcol No. Lot Block Addition or Subdivision <br />i <br />LAND DESCIUraON <br />Six# of Lot <br />Land Sq. Ft. <br />Elovotion <br />BUILDING LOCATION <br />Dit. From Rood <br />Dit. Sidos <br />Dit. Bock <br />Droinogo <br />CONSTRUCnON <br />Framo <br />Stucco <br />Stono <br />Brick, Solid <br />Brick Vonoor <br />Comont Block <br />FOOTINGS <br />Dopth i <br />Width -yC? <br />Loott Dopth <br />Bolow Grodo 'y <br />f> <br />FOUNDATION - Construction Pj Sizo <br />■ASHMINI <br />Ground Droinogo C) 'C. <br />Booring Posts jj Q^U ^ <br />Booms 'jK/d p.K,J <br />Floor <br />Sizo <br />Sizo <br />Spocing / i <br />Span ' <br />CHIMNBYS ^ <br />No. i\rUu i w <br />Foundation ^ , <br />HoightAbovoRoof <br />Smoko Pipo—Distonco From Joists I <br />NO. OF FIREPLACES _C1 <br />Typo <br />•1 <br />vlng <br />1C ^ <br />Ik" <br />-a <br />Id <br />Sizo^ v'-vw Span <br />Bridging V. 5 <br />STUDDINGS RAFTIRS CMINO JOISTS <br />Sizo '"I ^ Sizo Ck^ Sizo t' <br />Spacing Spacing ' Spacing <br />Plotos Span ' Longost Span <br />Bracing ^ <br />EXITS ^ <br />Basomont — No. ^ * Sizo <br />1st Floor — No. \'' Sizo <br />Stairway / <br />Stairwc <br />INSULATION <br />-'a, »zo / <br />VENTILATION AND LIGHT <br />Percentage of Floor Area Vent. <br />Percentage of Light to Floor Area (P. <br />UNms <br />Size <br />Location <br />Span <br />WEU TYPE <br />Construction <br />Location <br />SEPTIC TANKS OR MUNICIPAL HOOKUP □ <br />Size <br />Distance From Well <br />Construction <br />DRAINFIELD <br />Depth <br />Width <br />Length <br />Distance From Well <br />Distance From Lot Lines <br />PLUMBING FIXTURES <br />Garbage Disposal <br />Sinks <br />Laundry f <br />Bath Tub / <br />Dish Washer <br />Shower / <br />Toilet / y <br />Lavotory ^ ^ <br />ttiB A t 2. f/"s4 <br />6 ^i>r nr <br />'f <br />* / <br />(/ <br />Bldg. $'j^-0<>Pluinb. $. <br />InalSite Examination $. <br />Sewage $. <br />Wells.Total $. <br />PLUMROD WELL DRILLER- <br />ADDRESS.ADDRESS^/ <br />SEWER CONTRACTOR. <br />ADDRESS___________ <br />c <br />Approved.H JL 'A <br />OWMS os AUTHOSIZID AOIIir