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e6,,k .- 0 f . Applicatio for a Permit to Build No. 73 7
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-0UPON FINAL APPROVAL /�/� MAP )9L5_ LOT 'tI to
FEE MUST ACCOMPANY THIS APPLICATION. DATE /a/. 19 go , ;:1
The undersigned hereby applies for a permit to build / /'?t%
acco�ing to the following specifications _
Name of property owner TVL, hi/P: JV 13,-64-7SIC � -I Tel.360'-3"/9
Address (2'04A/1/5 dog Se Toad
2.Name of Architect(if any) Tel.
3. Name of builder Jr-3.1 2J Address
4. License No. Tel.
5. Name of Mason Address
6. License� No. Tel.
t7:6: nstructionaddress be' RAMS kFna3-e 6&cC elt aft
Flopd District
8. Date of subdivision Approval plain zone Zone
9. Private dwelling 0 Estimated CostDO NOT WRITE IN THIS SPACE
10. Multi family 0 Lia,a 4 7 Type of room No.
11. Commercial 0 � ' Kitchen
12. Other 0 ' --c0-- Dining Rm.
13. No. of stories Living Rm.
Bed Rm.
14. Foundation — Full 0 Half 0 Crawl 0 Slab 0 Bath
15. Materials — Wood 0 Cement 0 Other 0 Deck
16.Type of heat — Oil 0 Gas 0 Electric 0 Other 0 Closed porch
17. Garage — 1 0 2 0 Family Rm.
Sun room
18. Swimming pool - Size Garage
19. Storage shed — Size Shed
20. Stove — Wood 0 Coal 0 1 Alterations
21. Size of lot: No. of feet front No. of feet rear No. of feet deep
22. Size of building: No. of feet front No. of feet side No. of feet rear
23. Distance from nearest building: Front Ft. side Ft. side Rear
24. Distance back from line or street From rear lot line Side line
LOT RELEASED BY Signatu v _ . .
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PLANNING BOARD Address Cid r )-ttaa-
Date r'iD.t h eed. m4. 607621---