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, . , <br /> CHECK OFF LIST FOR ISSUAtVCE OF PEK1tiIITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: $Zs S d�W r' ��O� <br /> PID: <br /> DESCRIPTIONOF yf�O,Rh': AO��T�uN <br /> ------------------------------------- <br /> - --- ---------------------------------------------------------------------------- <br /> Z0��7[VGREVIEGVBY: � D.ATEAPPROYED: l- �—os <br /> B UILDII�'G RE VIE W B Y. � DA TE APPR D�'ED: �- �-oS <br /> -------------------------------- <br /> FEES TO BE CHARGED: [L'Iisc. Fees Calci�lated By: <br /> PERrtiIIT Yes .� No <br /> PLA1V RE I/IE tiV Y'es ✓ �vo SEYVER COlVIVECTIOlV <br /> STATE SURCH.4RGE Yes � 1Vo tiVATER COtWECTI01b' <br /> Irti�VESTIGATION FEE Yes tVo ✓ PARK FEE <br /> SAC Yes tVo—�- SITE NSPECTIO�V <br /> Ncu�zber• of SAC U�tits OTHER (specify) <br /> -------------------------------------------------------------------------------------------------- <br /> ZONING CHECK LIST Zor�irtg District: <br /> Fire Departrnerrt: Post Ofjcce: Sclrool District: ___. <br /> Lot,�lrea: Sq.ft. Aa•es GYidth Depth <br /> Siu-vey Subniitted: Yes�C_ No Date af Scutiel�: 12•z�- °N <br /> P�•oposed Setbacks: <br /> Fronr(Lake): 4�1�' t Right Side: Ibt�� '- <br /> Rear (Sn•eei): 69 B ; Left Side: 's�� j <br /> Adjacerzt Sti•��ctu�•es: – GVetland: �03�� <br /> Building Heiglit: Def. Hgt. D.lL Pectk Hgt. <br /> Lot Coverage: � N�✓� <br /> Grnding: Sraff,4pproval Date: — By: Cotu2ci!Ap�roval DRte: <br /> , CHEU< An+� A4N6LA'w�+ /�SuGVPt� '�"� <br /> Septic: Stnff,�(ppro��al Date: � —�3 - C�S By: �_ oo sp.�o*�� Won�� �., sPQwS <br /> Zorti,tg File: # — ResolL�tio�t: # Resol��tion Date: <br /> Shoreland Dish•ict: /.1 e <br /> Avg. Setback: Blc�ff Setbnck: Lot Coverage: <br /> Etisting Proposed <br /> HRrdcover: 0-7�' <br /> 7.5-?S 0' <br /> 250-500' <br /> 500-1000' <br /> Karcicover Var•iance Reqccired: Yes No Date of Co�uacil Approval: <br /> RENIARKS(in house): <br /> 31 <br />