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�CHEC]K pFF �IST FOR ISSUANCE O�' �E�'�'nTS <br /> FOR OFFICE USE ONLY � � t�C i :Q <br /> �DDRESS OR LEGAL: <br /> � /-1 SC� <br /> PXD: ,p�c— <br /> �E5 CRIy'I.'���1' OF W ORK: p i�rt� �' �'''W <br /> -----______------ ----��G��—���----------------pATE APPROVED: �^� '��<i J t <br /> ZO�'1�G REVIE�V 13Y: <br /> gULLDING REVIEtiV BY: <br /> � D�,.T'E APPROVED: � • 2.6 •o� . <br /> �`EES TO EE C�IAJ�GEA:r Misc. Fees Calculated By: <br /> PERl�'LIT Yes � No <br /> PLAN REVIEtiV � Yes �/ No SE�VER CO�INECTION <br /> � No tiVATER CONNECTION <br /> STATE SURCHAR.GE YeS �o _� p�I{ FEE <br /> INVESTIGATION FEE Yes No �/ STTEINSPECTION <br /> S AC Yes <br /> OTHER (specify) <br /> Number of SAC�Uruts __________ ___________ <br /> ----------------------- <br /> --------------------------------- <br /> �p� � G CH�CK LIST Zoaing Districr. L�"� � � <br /> Post Office: Schaol District: � <br /> Fite Dep3rtmen�: . <br /> Lot Area; Sq,ft. <br /> 7i� �jl� � Acres � ��C� Width Dep�h <br /> Survey Submitted; Yes� �Q <br /> Date of Survey: �� 2�J� � � <br /> Proposed Secbac . • V � l' <br /> Froat'(Lake) � � � R�ht Side; � G � V <br /> � � I / <br /> Rear (Screet): �7�� � � L�ide: �____ <br /> �YPC���� �.� .1 <br /> ���a�P�t Crn1r71rz=; --- <br /> � /A �f / <br /> auililin� Hei�t: DeF. Hgt. Peal`Ho�' �� <br /> f� � <br /> Lot Coverage: � � ' � ��'I <br /> n g Council Approval Dace: <br /> Gradi.ng; Scaff Approval Date: Yenro�,�vc, y; . <br /> Szpcic: Scaf� Aporov� Date: <br /> �l" By: W � <br /> � • � ��(l' Resolutioa Da:e: <br /> Zoa+n� File: �� �`'��-� Resolut;oa. R _ <br /> J �_��� <br /> Shoreland Dlstric�: ��� � �� � 1-� i��'� <br /> A�g� �e������^='� <br /> �i�g�,��F,'S�tbzck; � I.o�Coverage; � <br /> E�st�s� P;oposed <br /> � <br /> �, l° <br /> H2�cover; G-7�' �--- (t I o <br /> � ------ <br /> 7�-2�C __-- _��o <br /> 2��-���:; __ � <br /> ���U-i'��.,'.'' <br /> -� ��,-G��.:2� ;2� /�� �';� �_... �:: �v'�„=_� , -_-.. �'. <br /> ���C���';zC ��z�.� _ti . <br /> t;^,�L��a.�� r i _ 't1 p�.i5`1 <br /> �._. <br />