002-940-13-5508-LUP-2000-094Application for Land Use Permit — Page 2
Describe Construction: List dimensions of each structure, story, addition, or alteration.
# 1. R-a&r'. #2.
43.
Sized ft. wide
ft. wide
ft. wide
g ft. long
ft. long
ft. long
Floor area q 5 b sq. ft.c'�
sq. ft.
sq. ft.
Hgt. from grade a D' to peak
ft. hgt.
ft. hgt.
Stories 2
stories
stories
# of bedrooms 1
l`*cLHbasS��aNr a
rear lot line
or waterline of G��Np ST�Na
O'A4'A
In the box sketch in:
Location and size of all
¢ a
existing and proposed strictures.
Location of septic system.
Indicate distance to:
Waterline/Wetlands
Road
Lot lines
Septic system/privy
Well
Distance between structures.
Indicate North.
Fire Number:
W0% op vv�
Signature of Owner
The above certifies that the listed
information and intentions are true and
correct. The above persons/ hereby
give permission for access to the
property for onsite inspection.
IssueDate April 12, 2000
Office Comments:
i
------- centerline of w v oo L
9
a
MA
Expire Date April 12, 2001
c�
Signature of ❑Wing Administrator
ft. wide
ft. long
sq. ft.
ft. hgt.
stories
lake/river
road-------