032-539-27-4404-LUP-2000-142Application for Land Use Permit — Page 2
Describe Construction: List dimensions of each structure, story, addition, or alteration.
41. #2. #3.
Size ft. wide ft. wide ft. wide
C �d ft. long ft. long ft. long
Floor area — sq. ft. sq. ft. sq. ft.
Hgt. from grade to peak ft. hgt. ft. hgt.
Stories I stories stories
# of bedrooms —C)—
rear lot 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
Well
Distance between structures.
Indicate North.
Fire Number: //
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Signature of Owner
The above certifies that the listed
information and intentions are true and
correct. The above person.'s.1 hereby
give permission for access to the
property for onsite inspection.
Issue Date 5 / 1 / 00
Expires 5/1/2001
Office Comments: ��
#4.
ft. wide
ft. long
sq. ft.
ft. hgt.
stories
lake/river