Permit No._______________

Copy sent to applicant______

BUILDING PERMIT APPLICATION

CITY OF WILLIAMSBURG

WILLIAMSBURG, IOWA

CITY OF WILLIAMSBURG

BUILDING PERMIT APPLICATION

DATE_____________

Owner_______________________ Applicant____________________

Address______________________ Address_____________________

___________________________ __________________________

Telephone___________________ Telephone__________________

Legal Description Lot______ Block_______ Addition_____________

________________________________________________________

________________________________________________________

________________________________________________________

Street address_____________________ Zoned_____________

Is this in flood plain? Yes____ No____

Lot Dimensions Depth_____ Width_____ Square feet______

Setback required Front_____ Side______ Rear_______

(See page 4)

Setback furnished Front____ Side______ Rear_______

Variance needed Yes____ No____ Dated Granted_______

Condition____________________________________________

________________________________________________________

Number of Buildings Now on Lot(s)_______Number proposed______

Class of Work New__ Addition__ Move-in___ Alteration__

Demolition____

Use of existing structure None___ Commercial____

Residential_____ Other_____________________

Proposed use of new structure______________________

Construction cost (if commercial)____________________

New building Dimensions:Length_____ Width____ Square feet_____

Sewage disposal: Public (City)_____ Individual (Septic)______

Water supply: Public (City)_____ Individual (Well)_______

__________________________________________________

Contractor___________________ Address____________________

Lot plan submitted: Yes____ No____ Completion date:_________

Permit fees: Residential New Residence---------------$100.00

Alteration or Addition---------------------$ 50.00

Storage Building (Maximum 150 sq.ft) $ 25.00

Commercial 0.1% of Construction Cost

Minimum $100.00

WATER HOOK-UP SCHEDULE (Meter Only in Newer Subdivision)

WATER HOOK-UP FEES:

New Home Service 1” Service Line 11/2” Service Line 2” Service Line

1” Tap--- $275.00 Tap---$275.00 Tap---$400.00 Tap---$515.00

Meter---- $ 80.00 Meter-$145.00 Meter-$355.00 Meter-$475.00

Total----- $355.00 Total--$420.00 Total--$755.00 Total--$990.00

Lots in new subdivisions are charged only for meter if subdivider provided service line to lot.

Sewer hook-up schedule (No charge in newer subdivision with services extended to lot)

Sewer hook-up fee (Saddle supplied by City) - $100.00

NOTE: A saddle provided by the City shall be installed by your

contractor on the sewer main. Installation must be inspected

by City personnel prior to burial.

_______________________________________________________________________

I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of any other state or local law regulating construction or the performance of construction. It is expressly understood that the Zoning Regulations of the City are to be followed.

Signature of Applicant_______________________________ Date___________

Approved by Inspector_____________________________ Date___________

Council Member_______________________ Date___________

Footing Tile Statement

All footing tiles must be inspected by City personnel prior to backfilling foundations. Footing tiles shall be drained to sump pit or yard area. Sump pumps must discharge to yard, street, or storm sewer.

Inspected by______________________________________ Date___________

ZONING	FRONT YARD	REAR YARD	SIDE YARD
AG	50	50	15
RS8	25	30**	7
RS40	50	50	20
C-1	35	15	10

* If lot is adjacent to differently zoned district, check zoning ordinance

** Storage buildings and unattached garages need to be at least 5 feet from the house and at least 5 feet from the rear yard (unless there is an alley)