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� ' CHECg OFFLIST FOR ISSUANCE OFPERMITS <br /> FOR OFFICE i1SE ONLY <br /> ADDRESS OR LEGAL: �-- ��.� � <br /> PID: <br /> DESCRIPTIpN OF WORg:_M�s n� /3,4rh+ <br /> 2�iwc,o� <br /> ZONING REVIEW BY.• _� DATEAPPROVED: <br /> BUILDING REi�IEW BY.• DATEAPPROT�ED: <br /> 7-I- o� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER.MIT Yes � No <br /> P���E� YeS—� NO_ SEWER CONNECTION <br /> STATE SURCHARGE Yes �/ No <br /> INVESTIGATION FEE YeS — R'ATER CONNECTION <br /> �qC No �/ PARK FEE -- <br /> Yes No � SITEINSPECTION <br /> l�umber of SAC Units OTHER s eci <br /> — (P .f') <br /> Z4?VIlVG CHEC%LIST Zoning District: p <br /> Fire Deperrt�nent: Post O�ce: <br /> Schooll3istrict: <br /> Lot Area: Sq.ft • Acres Width <br /> - Depth <br /> Survey Submitted.• Yes No <br /> ate of Sra-vey.• <br /> Proposed Setbacks; � <br /> _. .. .. <br /> Front(La1re}: Right Side: <br /> Rear(Street): Left Side: •-• . _ <br /> Adjacent SYructures: Wetland,• _ <br /> Building Height: Def.Hgt. Pe�H� � <br /> Lot Coverage.• .. <br /> Grading: Sta,fJ'flpproval Da1e: <br /> B3'� Council Appruvcrl Date: <br /> � Septic: Stufj'Approval Date: By, r, r�� <br /> 1 A�/�/ <br /> Zoning File: # Resolution: # Resolution Date: - <br /> Shoreland I}zstrict: <br /> .4vg. Setback: C�Permit: <br /> Blzr„�"Seibacl�• LotCaveruge: <br /> Fxisting Proposed <br /> Hardcover: 0_7j� <br /> 75-250' <br /> • 250-500' <br /> 500-1000' ` <br /> Hardcover Yariance Reguired.• Yes No <br /> Date of Council Approval: <br /> REMARKS(irc house): <br /> 33 <br /> � <br />