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� CHECK OFF LIST FOR ISSU�iCE OF PERl�iITS <br /> FOR OFFICE USE ONLY <br /> �DDRESS OR LEGAL: 12 lo`� ��-�c.::,��L,�v c�=- �-�+= <br /> PID: <br /> DESCRIPTTION OF WORK: �j�'+'�'��+�v L <br /> ------------- -------- ., <br /> ZO�tPi tG REVIEW BY: -�. � C.��-��--� DATE APPROVED: +� . ; � `-�� <br /> BUII.DING REVIEW BY-� N �rt-- DATE APPROVID: <br /> ----------------------------- <br /> FEES TO BE CHARGED: �.,�":���'�"5 Misc. Fees Calculated By: <br /> PERrv1IT Yes ✓ No <br /> PL�.N REVIE`�I Yes No --�'� SEWER CONNECTION <br /> STATE SLRCHARGE Yes No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ----------------------------- <br /> ZO��PtG CHECK LIST Zoning District: �('� ' i e� Shoreland District : ti�r`� <br /> Fire Depar[ment: �j ' ' Po Off/ce , r � School Distnct: <br /> �' � d,_� r <. <br /> �, / <br /> Lot�rea: Sq.ft. Acres Width Depth <br /> Survev Submitted: Yes No tx Date of Survey: ;��-�-�" ;�}::�r�� <br /> Proposed Se[backs: t ;-� ' <br /> F�eat (Lake): 7 '"' + Right Side: �- <br /> -}�ear (Street): Z-�=��`� �� Left Side: i�"1U�� <br /> 1 Wetland: � <br /> ?.dj 'c nt Structures: <br /> Building Hei t: Def. Hgt. Peak Hgt. <br /> Av;. Setback: Bluff Setback: Coverage: <br /> i <br /> Ezisting j Prop sed <br /> Hardcover: 0-75 <br /> 75-250' �_ <br /> 250-500' <br /> 500-1000' � <br /> �_ <br /> Hardcover Vari ce Required: es i No r Date of Council Ap oval: <br /> Gradin�: Staff A proval Date: ,l gy: Council Appr val Date: <br /> , 1 <br /> � <br /> oval Date: C �Y� <br /> Septic: Staff App � <br /> � <br /> Zoning File: ,�� <br /> Resol tiqn: f# � Resolution Date: <br /> � <br /> R:���l[ARKS (ui hOuse): <br />