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i w CHECK OFF LIST FOR ISSUAlvCE OF PER�tiIITS <br /> FOR OFFICE USE ONLY <br /> �DDRESSORLEG:�L: �oib so"'�2s�� �a"'e PID: <br /> DESCRIPTIO\ OF «'OR�i: P�d <br /> ZO`'�i G RE`'��V B�': O ��I��- _ DATE APPROVED: r z-�-y s' <br /> � BY�� DATE APPROVED: <br /> EUII.DL�G REVIE`V <br /> FEES TO BE C�L�RGED: vq�,o ,g�r. Niisc. Fees Calculated By: <br /> PERti1IT YzS � �o <br /> PL:��1 REVIE��I Yes No ✓ SEWER COI�NECTION <br /> STATE SliRCH�RGE Yes No J WATER COi�NECTION <br /> INVESTIG�TION FEE Yes No PARK FEE <br /> SAC Yes No SITE INSPECTION <br /> Number of S�C Unics OTHER (specify) <br /> ZONl� <br /> G CHECK LIST Zoning District:M �R"i3 Shoreland Discrict . Ne <br /> P t School Dis�rict: <br /> Fire Depar[men[: ���jf <br /> Lot Area: Sq.fr. <br /> Acr 7`/ idth Depth <br /> Survey Submitted: Yes �C_ No Date of Survey: �d'zY-4S <br /> Proposed Secbacks: <br /> Front lL�e)� Ri�ht Side: <br /> Rear (Screec): Left Side: <br /> Adjacen[ Structures: Wetland: <br /> Building Height: Def. Hgt. Peak H;t. <br /> Avg. Setbacic: <br /> Bluff Secback: Lot Covenge: <br /> N�P Exiscing Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-�00' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No <br /> Dace of Council Approval: <br /> v roval Date: I L-(-`�S By:d��• Council :�pproval Date: <br /> Gradin�: Staif APP <br /> Septic: Staff �+pproval Date: Nr� BY� <br /> o File: n ?.o�ti Resolution: � Resolution Date: S� �� � <br /> Zoni.n, � <br /> REI�IARK.S (in house): <br /> 26 <br />