The City of Lorimor, Iowa
Zoning Clearance Permit Application
Date: ___________________ Permit No.:____________
Name of Owner/Applicant _________________________ Home Phone _____________
Address _______________________________________ Work Phone ______________
Name of Builder(if applicable)________________________________
Address _________________________________________________
Location of the Improvement:
Lot __________ Block __________________ Addition ______________________
Street Address ____________________________________
Type of Improvement _______________________________
Present Use of Property ______________________________
Use District __________ Intended Use ____________________ Size of Lot _____________
Dimensions of Building: Width ____________ Depth _____________ No. of Stories _________
Complete all that apply: Basement __________________sq. ft.
First Floor __________________sq. ft.
Second Floor ______________ _sq. ft.
Garage ____________________ sq. ft.
Accessory Bldgs _____________ sq. ft.
Other (specify) ______________ sq.ft.
Number of Rooms:_______________ Bedrooms ______________ Bathrooms _______________
Material: Exterior Wall ____________________ Interior Wall ____________________________
Foundation _____________________ Roof ____________________ Floor __________________
The structure will set back: ____________ feet from front property line,
____________ feet and ____________ feet from side property lines,
____________ feet from the rear property line.
Date construction is to begin: _______________________
Date Construction is to be completed: _____________________
ATTACH A DIMENSIONAL PLAN OF THE LOT SHOWING THE PROPOSED WORK AND EXISTING STRUCTURES WITH THE SETBACKS AND DIMENSIONS OF THE STRUCTURE.
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THE CITY OF LORIMOR, IOWA
