014-941-04-5805-LUP-1999-656Application for Land Use Permit — Page 2
De.wribe Construction: List dimensions of each structure, story, addition, or alteration.
#1. #2. #3. #4.
Size o`C ft. wide ft. wide ft. wide
ro ft. long ft. long ft. long
Floor area (a11 sq. ft.
Hgt. from grade _ _L to peak
Stories
# of bedrooms
In the box sketch in:
Location and size of all
existing and proposed structures.
Location of septic system.
Indicate distance to:
Waterline/Wetlands
Road
Lot lines
Septic system/privy
Well
Distance between structures.
Indicate North.
Fire Number:
— I/ ILIA 4� �Iv-)I �Z_d
Signature of Owner
The above certifies that the listed
information and intentions are true and
correct. The above person/s/ hereby
give permission for access to the
property for onsite inspection.
sq. ft.
ft. hgt.
stories
rear lot line or waterline of
Issue Date November 2, 1999
Office Comments:
1
* t AK0 FRrNr --�
.3 f
sq. ft.
ft. hgt.
stories
ft. wide
ft. long
sq. ft.
ft. hgt.
stories
lake/river
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aj 1
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1
- centerline of cxc,t �.�jck —road -------
Expire Date November 2, 2000
xe� CM D41R:LZ
Signature of Zckiing Administrator