Dwelling Unit Number(s) ______, ______, ______, ______, ______, ______, ______, ______, ______, ______, ______,
______, ______, ______, ______, ______, ______, ______, ______, ______, ______, ______, ______, ______, ______
Total number of rooms in dwelling unit: ________ Number of Bedrooms ______
Living Room _______ft. by ________ ft. Bedroom #1 _________ft. by ________ft.
Dining Room _______ft. by ________ft. Bedroom #2 _________ft. by ________ft.
Kitchen ________ft. by ________ft. Bedroom #3 _________ft. by ________ft.
Other ________ ft. by ________ft. Bedroom #4 _________ft. by ________ft.
Occupancy Load for this Unit (to be completed by Village) __________
Dwelling Unit Number(s) ______, ______, ______, ______, ______, ______, ______, ______, ______, ______, ______,
______, ______, ______, ______, ______, ______, ______, ______, ______, ______, ______, ______, ______, ______
Total number of rooms in dwelling unit: ________ Number of Bedrooms ______
Living Room _______ft. by ________ ft. Bedroom #1 _________ft. by ________ft.
Dining Room _______ft. by ________ft. Bedroom #2 _________ft. by ________ft.
Kitchen ________ft. by ________ft. Bedroom #3 _________ft. by ________ft.
Other ________ ft. by ________ft. Bedroom #4 _________ft. by ________ft.
Occupancy Load for this Unit (to be completed by Village) __________
Dwelling Unit Number(s) ______, ______, ______, ______, ______, ______, ______, ______, ______, ______, ______,
______, ______, ______, ______, ______, ______, ______, ______, ______, ______, ______, ______, ______, ______
Total number of rooms in dwelling unit: ________ Number of Bedrooms ______
Living Room _______ft. by ________ ft. Bedroom #1 _________ft. by ________ft.
Dining Room _______ft. by ________ft. Bedroom #2 _________ft. by ________ft.
Kitchen ________ft. by ________ft. Bedroom #3 _________ft. by ________ft.
Other ________ ft. by ________ft. Bedroom #4 _________ft. by ________ft.
Occupancy Load for this Unit (to be completed by Village) __________
Dwelling Unit Number(s) ______, ______, ______, ______, ______, ______, ______, ______, ______, ______, ______,
______, ______, ______, ______, ______, ______, ______, ______, ______, ______, ______, ______, ______, ______
Total number of rooms in dwelling unit: ________ Number of Bedrooms ______
Living Room _______ft. by ________ ft. Bedroom #1 _________ft. by ________ft.
Dining Room _______ft. by ________ft. Bedroom #2 _________ft. by ________ft.
Kitchen ________ft. by ________ft. Bedroom #3 _________ft. by ________ft.
Other ________ ft. by ________ft. Bedroom #4 _________ft. by ________ft.
Occupancy Load for this Unit (to be completed by Village) __________
(Please make copies of this page as needed for additional units)
Fees: $100 (includes a unit) plus $50 for each additional unit.