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� ChTECK OFF LIST FOR fSSUANCE OF PER�ti.fITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 1 �5 Svv� �-�' 1� 'K�v i= <br /> PID: <br /> DESCRIPTIO:Y OF yvO,RK: IU r.�-« �- �A-z�/3� <br /> -------------------------------------- -------- ----------------------------------------------- <br /> ZOtYINGREVIEtVBY: DATEAPPROVED: /o-/y- �"Y <br /> BUILDIlYGREVIEWBY: DATEAPPROVED: �o -_ �y-y <br /> ------------------------------------- <br /> FEES TO BE CHARGED: �%Iisc. Fees Ccticzclatecf By: <br /> PERI�IIT Yes � No <br /> PLAN RE vIE GV Yes � �Vo SEYVER GO�VNEGTION <br /> STATE SURCHARGE Yes � tVo tiVATER GOtViVECTIOtV <br /> I��IVESTIG.4TIOtV FEE Yes No PARK FEE <br /> SAC Yes 1Vo SITE tNSPECTIO�V <br /> Nacmber of SAC U�zits OTHER (specify) <br /> -------------------------------------------------------------------------------------------- <br /> ZOrVI[VG CHECh'LIST zoriirig Disd•icr: <br /> Fire Departmer:t: Post Offtce: School District: �_.. <br /> Lot.�trea: Sq.ft. � b45 o O '� _Acres 6Yidth Depth <br /> Scvvey Subniftted: Yes�_ No Date of Su�vey: I 0-� 'ci 3 <br /> Pr•oposecf Setbacks: <br /> Front(LRhe): 11 a Right Side: Zo•� <br /> Rear(Sd•eet): 7,c� Left Side: Z S <br /> Adjc�cent Str-uctures: ► t� WetlRnd: <br /> B«ilding Heiglit.• Def. Hgt. C�.1� Pectk Kgt. — <br /> Lot Coverage: � �y�� <br /> GrRdirlg: Staff�tpproval Date: "' By: Coz�ncil Approval Date: <br /> Septic: Stnff Approval Dnte: — BY� <br /> Zo�ti�:g File: # � Resolution: # Resol�ition Dc�te: <br /> Shoreland Dish•ict: N � <br /> Avg.Set6ack: Bluff Setbc�ck: Lot Coverage: <br /> E�isting Proposecf <br /> Ha�•dcover: 0-7.5' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover 1/artance Reqllij•ed: Yes No Date of Co��ncil Approval: <br /> RE1I�IARKS(in house): <br /> 31 <br />