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CHECh OFF LIST FOR ISSUANCE OF PERtiIITS <br /> FOR OFFICE USE ONLY <br /> �DDRESS ORLEG:�L: �2� I �32► w2 sT PID: <br /> DESCRIPTIO� OF «'ORIi: �-r C�A2A��= <br /> ----------------------------- <br /> DATE APPROVED: -z Z -�S <br /> ZO\T:\G RE�°�jV BY: =� C� DATE APPROVEI'i: �3 •zz.- �, 5 <br /> BUII.DL1 G RE«tiV BY: � � � <br /> ���--� ^ l��isc. Fees Calculated By: <br /> FEES TO BE CH_-�RGED: <br /> PERti1IT YzS ✓ �''o <br /> -- �r- SE`VER CONiti"ECTION <br /> r L ylv rc�v iL�� 1`'' � `'v WATER COi�NECTION <br /> ST:�TE SLRCH?�RGE Yes �—" vO <br /> Iv VESTIG�TIO� FEE Yes No PARK FEE <br /> S�C Yes ��� SITE I�i tSPECTION <br /> Number of S�C Ci nics OTHER (specify) �_ <br /> ---------------------------- <br /> ZO\l�G CHEC�i LIST Zoning Dist:ict: <br /> Shoreland District : <br /> � Pos ffice: ool D smct: <br /> Fire Department: � <br /> LotArea: Sq.ft. <br /> ?�cr i th ' Depth <br /> Survev Suomicted: Yes C �`o Date of Survey: (�� (1 -g7 <br /> Preposed Se:backs: � <br /> Fron< <�1= N �tA Rignt Side: ►�� <br /> Re:r (�e�H� Z6� Lefr Side: `1 v � <br /> .-�djacent Stn:c:ures: l b� Wetland: N�f4 <br /> Building Height: Def. H;t. �• )L Peak Hgt. <br /> .�vg. Setback: Bluff Setback: Lo C verage: <br /> / <br /> Existing rop ed <br /> Hardcover: �-��� <br /> 75-250' <br /> 250-�0 ' <br /> 500-I QO' <br /> Hardcover Variance equired: es _� No Date of Coun il Approval: __ <br /> r <br /> Grading: Staif �p , oval Dace: y: Coun il �pproval Da[e: <br /> Sep[ic: Staff .-�p�oval Date: By: <br /> / , <br /> Zonin� Fiie: ,j� e�olucion: Resol tion Date: <br /> , <br /> RE�l�1�RK,5 (in house): <br /> 26 <br />