Date of Application __________________________________________________________________

Owner's Name ______________________________________________________________________

Phone:_______________________ Mailing Address:____________________________________

Physical Address of Activity:________________________________________________________

Contractors Name:_____________________________Phone: ____________________________

Brief description (indicate type of structure and the proposed activity i.e."remodel kitchen or single family home" or replace roof of a duplex").

_____________________________________________________________________________________________

_____________________________________________________________________________________________

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USE:........... RESIDENTIAL ........COMMERCIAL...... INDUSTRIAL...... OTHER

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MOBILE HOME SERIAL#_______________________MAKE/MODEL/YEAR__________________________

FOUNDATION:....POURED CEMENT...........CEMENT BLOCK..........CEMENT PAD.....OTHER........

DIMENSIONS:________X________ STORIES:______ OTHER: _________________________

APPROXIMATE TOTAL COST OF LABOR & MATERIALS: $__________________________

SQUARE FOOTAGE TO RECEIVE STRUCTURAL IMPROVEMENTS: __________S.F.

LOT SIZE - TOTAL ACREAGE: __________

LOT DIMENSIONS: FRONT______RIGHT_______BACK______ LEFT______

FRONT SETBACK: ______ REAR SETBACK: ______

RIGHT SIDE SETBACK: ______ LEFT SIDE SETBACK:_______

WILL ANY WIRING BE DONE:............ YES_____ NO _____

WILL ANY PLUMBING BE DONE: ... ..YES_____ NO _____

WILL ANY FILL BE REQUIRED: ........YES______NO______

SIGNATURE OF APPLICANT:_____________________________ DATE: _________________

Please attach a sketch of property and locations of all existing, or proposed structures. NOTE: Any measurement

more than 50' in excess of what is required for your district can be estimated. The information on this plan was supplied by the applicant. Property lines and set-backs shall be verified by the Property Owner/Contractor prior to construction. Any discrepancy from that shown, shall be immediately brought to the attention of the CEO of Turner.

EXAMPLE:

<-------------------------[ House]------------------------------>

ROAD NAME:____________________________________________________

IS IT A PUBLIC ROAD ______ YES ______NO___________

SECTION II: (OFFICE USE ONLY TO BE COMPLETED BY TOWN STAFF)

OWNERS NAME: _____________________________________________________________________________

ASSESSORS' MAP _________ BLOCK _________ LOT _________ SUB _________

ZONE: _________________________________

PHYSICAL LOCATION:_______________________________________________________________________

WITHIN 250' OF RIVER/POND? ______YES ______NO

FLOODPLAIN:..............YES______ NO______

SIGNATURE OF CEO: ________________________________ DATE: __________________

REASON: _____________________________________________________________________________________

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