032-539-29-3302-LUP-1999-483Application for Land Use Permit — Page 2
Describe Construction: List dimensions of each structure, story, addition, or alteration.
91. #2. !scr #3. #4.
Size_ ft. wide / a. ft. wide ft. wide ft. wide
A 63_ ft. long ft. long ft. long ft. long
Floor area _Ssq. ft. sn ft Ln ft
x from e to eak rear lot line o
p i
Stones 1
# 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:
53a
L.ai' '
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.
Issue Date August 26, 1999
Office Comments:
C-L �4
3 2 LY �
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TGkV'co `Y<- Grheel
Expire Date Augsut 26, 2000
Signature of Zoning Administrator