APPLICATOIN FOR BUILDING PERMIT
BARODA TOWNSHIP, BERRIEN COUNTY, MICHIGAN
Section          Tax Code          
Owner                
Address                
Address of new or moved building            
Type of Building                                                 Alteration          Addition    
Cost of Project   $    No. Rooms   No. Baths:       Full Half  
Proposed Building Size   X            Height    No. Stories  
Basement: ____________________ ____  Size    X No. Fireplaces    
Exterior Fin.       Type of Heat     No. Chimneys  
Water Supply: Twp.         Well              Depth    
Sewerage System:     Septic   Other (Explain)      
                       Size   Tile Field         Sq. Ft.    
Distance from well to:             Septic Tank     Sewer Pipe    
Septic Tank Capacity       No. Bedrooms    
Lot Dimensions:       X Set Back:    Front Sides Rear
Contractor's State I.D.#            
General Contractor              Address      
Plumbing Contractor              Address      
Heating Contractor              Address      
Electrical Contractor              Address      
In Consideration of the granting of this certificate of approval, I/we certify that I/we shall comply with
provisions of the Zoning Ordinances and with all other applicable ordinances of the Township of Baroda,
Berien County, Michigan and the Township of Baroda shall not be liable for any damages resulting
therefrom.
Signature of Owner(s) or Agent            
           
Approval Date       This permit expires in one year.
By              
Building Inspector
Attach print or pen sketch (2) to scale showing: Lot dimensions, present and proposed Building, Well, 
Sewerage System, and profile of the Exterior Footings and Walls shown in marginal drawing.