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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 2.‘6.0 w r4yLA-'rA- 13tAJO <br /> PID: _ Z� 0 /40 F ve[ /24 )4 a'? "I' <br /> DESCRIPTION OF WORK: s«� <br /> ZONING REVIEW BY: cam"."...__ DATE APPROVED: ii-2I-mss <br /> BUILDING REVIEW BY: ��Qy,.,,,._. DATE APPROVED: 11- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes No i/ SEWER CONNECTION <br /> STA 1'h SURCHARGE Yes '" No WATER CONNEUFION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No Sta. INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: 6-1 Shoreland District : <br /> Fire Department: 1.•L • Post Office: G•L_ School District: 0 a o N O <br /> Lot Area: Sq.ft. /Vd GK�� Acres <br /> Width Depth <br /> Survey Submitted: Yes No DG Date of Survey: <br /> Proposed Setbacks: <br /> Front (1=k-e): /V//- Right Side: 630� <br /> Rear ( et : 3 Left Side: /00 ` ± <br /> Adjacent Structures: p..). 3� Wetland: /U leg <br /> Building Height: Def. Hgt. O• - Peak Hgt. <br /> Avg. Setback: i Bluff -tback: •t Coverage: <br /> Exist'•g P oposed <br /> Hardcover: 1-7 ' <br /> 5-2 0' <br /> 250-9e' <br /> e' <br /> 500-1•Is' <br /> Hardcover V. 'mace Req ired: Yes o Date of Co Approval: <br /> Grading: St. Approval aate: By: Co 'cil •pproval Date: <br /> Septic: Staf Approval Dat : By: <br /> Zoning File # Resolutio : # Resolu ion Date: <br /> • DI • ' (in house): <br />