BRULE COUNTY
BUILDING PERMIT APPLICATION
Brule County Building Permit No.______________________
Zoning Administrator Date Issued____________________________
300 S. Courtland St. Ste.101 Receipt No.____________________________
Chamberlain, SD 57325 Check_____________ Cash______________
(605) 234-4432 Fee Paid $____________________________
Legal Description:______________________________________________________________________
___________________________________________________________________________________
Owner:_____________________________________________________________________________
Address:___________________________________________________________________________
Phone:(605)__________________________
Builder/Contractor:___________________________________________________________________
Address:___________________________________________________________________________
Phone:______________________________
Please attach a list of the names, addresses, and telephone numbers of all other contractors and subcontractors on a seperate sheet of paper.
Total Cost___________________________
Class of Work: _____New _____Demolish
_____Alteration _____Repair
______Addition _____Move
Size:__________________ Height:___________________
No. of Stories:__________ Size of Lot:_______________
Zoning:________________ Existing Use:_____________
Signs, If permitted Proposed Use of Structure:
Size:________________ Primary:_________________
Type of Construction:(e.g. wood, brick, etc.) No. Off-Street Parking
______________________ Spaces:_________________
Attach to this application a scale drawing of the shape and dimensions of the location of streets and alleys: all existing and proposed buildings and distances from buildings to lot lines; an proposed and existing off street parking.
Note: This application is not acceptable unless all required information is furnished and accurate. Every permit issued by the Zoning Official under the provisions of this code shall expire by limitation and become null and void if the building or work authorized by such permit is not commend within 90 days from the date of such permit, or if the building or work authorized by such permit is not completed within one year from issuance of permit.
Approval of this building permit should not and shall not be construed as an approval of the endorsement or ability of the contractors involved, the suitability for the proposed use of the plans submitted, the fitness of the proposed location of the construction, the ownership of the land shown, a right to change water drainage in any manner or to grant any other right to authority except as is authorized by the Brule County Zoning Ordinance.
The above information is, to the best if my knowledge, true and accurate. It is understood and agreed that any error, misstatement of misrepresentation of fact, either with or without intention on my part such as might, if known, cause a refusal of the application, or any alteration or change in plans made without the sufficient grounds for the renovation of such permit.
Approved:_______________ Signature:_________________________________
(Owner or Contractor)
Disapproved:____________ Signature:_________________________________
(Zoning Administrator)
