002-203-00-0400-LUP-2000-535Application for Land Use Permit - Page 2
Describe Construction: List dimensions of each structure, story, addition, or alteration.
# I . RoM00— #) -lb- (� d d 6 d 03.
Size ft. wide C) ft. wide V_ 1 � + L� ft. wide
ft. long la` ft. long ft. long
Floor area sq. ft. 00 sq. ft. sq. ft.
Hat. from Bade to peak _ ft. hgt. ft. hat.
Stories _ stories�� +0 stories
# of bedrooms AW #Ito n g
C 19A? lV line or waterline of
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
`ti'ell
Distance between structures
Indicate Forth.
Fire Number:
Pignaturaf ► er
The above certifies that the listed
information and intentions are true and
correct. The above persoiti's/ hereby
ive permission for access to the
property for onsite inspection.
01
�L#A LAW)
/ CETriIV
a
------- centerline of
,S I
#4.
ft. wide
ft. long
sq. ft.
ft. hat.
stories
lake/river
ro aa-------
Issue Date September 25, 2000 Expire Date September 25, 2001
Office Comments:
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Ek0S1-( Kri 8'K 7t�Ik gctdi. ;0K
jaturc ofZ )nine Administrator
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