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� <br /> CHECK OFF LIST FOR ISSUANCE OF PER1ti17TS <br /> FOR OFFICE USE ONLY ,,,� ^ <br /> ADDRESSORLEGAL: Z�roS �'��"� �� +�"`�� ' <br /> PID: <br /> DESCRIPTIONOF yvORK: �D!`7''l4�`�1.-S '�' �'t�"��`��`�-'��' <br /> ----------------------------------------- ---------------------- - - --------------------------------------- <br /> ZO�VING RE VIE G�B Y: �°°� r <br /> D.A TE APPRO VED: � - � �l`8� <br /> B UIL DItYG RE Y.IB W B Y: DA TE APPR O 6'ED: 6 -/�, -a ` <br /> ---- -------- ----------------------- ---------------------------------------------y--�----------- ------------ <br /> FEES TO BE CHARGED: [1�Iisc. Fees Calct�lated B �: ,. }`.,;�•�"'�."'� y <br /> PERNIIT Yes ✓ 1Vo <br /> PLAN REVIELV Yes�— �Vo SEWER CONNECTION � <br /> STATE SURCH.4RGE Yes�_ !Vo tiVATER CON.�IECTIOtV '--- <br /> I�VVESTIG.4TIO�V FEE Yes [Vo � PARK FEE �--�� <br /> SA C Y'es Na� SITE tNSPECTIO�V <br /> Nacnzber of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZO�YING CHECK LIST Zor�ing Disd•ict: 1•—l2 ' C <br /> Fu•e Depar•hner:t: N �/A�� Post Off ce: Ti SclGool District: !_... <br /> � � �J�� � <br /> Lot.=lrea: Sq.f't. J"� �0 Rcres i .3� Gt�i�lth �DQ /JD►^�l� Depth <br /> Scvvey Sc�bruitted: Yes � No Date of Scuvey: 7�� <br /> P��oposed Setbac%s: /�� �� <br /> CN� lo ,� ' <br /> Frorrt(Lake): ��J C��.J6�' Rig/zt Side: ,�G� C-����.)� <br /> r ' N,� ,� ��� <br /> Rear(Sh•eet): 5'� �` Left Side: 5 �� <br /> N n C t�w tr�' � ^ <br /> Ar(jnce�zt St��ucaires: �� '� GGetic�nd: �.,1�[ <br /> / �. <br /> Buildirrg Heigl:t: Def. Xgt. �I�J C' G't-�F+�-)�=` Pec�k Kgt. 2� — N� �'-,'��� <br /> Lot Coverage: / ��S � t✓'�C7S'T►i��a (Nv C�CYr.-``� <br /> Gracfing: Staff,4pp��ova1 Date: � /`t By: — Coccncil App�-oval Date: `—" <br /> Septic: Staff,4pproval Date: BY� � <br /> Zo�tirzg File: # ~` Resolcction: � ^— Resol��tio�a Date: <br /> Shoreland Disd•ict: �� .-�� � ��'�" /� �' � <br /> /t1 �,j °y.:> <br /> Avg. Setback:� �iL- - B1c�ffSetoack: N LotCoverroe: � � <br /> Etisting Praposed ����,y�.���,-IQ•D6 ��. <br /> Har•dcover: 0-7�' ���- ���� ��� <br /> 75-?�0' /�� I /��. -- <br /> 150-500' /�*! � C.�,� � �.�- �.��`7 � <br /> 500-1000' �"�C� � e�.�' ���' ' <br /> Karcfcover Variance Required: Yes No� Date of Co�uicil�lpproval: �30 <br /> RE�tiIARKS(i�i lzouse)�/U��-'�� ,4� `- ,-�'Z %�",��"t`�' � CavF�r2 w� �,C' . <br /> � ✓�C,.Q�t-��•.� � `�'� �„ i9/�'°��,�r;'� �.� <br /> -,, <br /> �1 <br />