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^ CHECb OFF LIST FOR LSSUAI`rCE OF PERtiIITS <br /> FOR OFFICE USE ONLY <br /> ,- G', �/� -� � �_3 c�a j � <br /> �DDRESS OR LEG:�L: � 7 �" 5 �t �'� p� '�� PID: � � i <br /> DESCRIPTIO\ OF `�"OR�: /(�� -�'�-�'- --�n''Z-S'`"'" �r�u.� <br /> ZO\ZtiG REti'�V BY: N�� DATE APPROVED: / -/�- `�6 <br /> BL�II.DL\G REVIEtiV BY�„ � �►� � DATE �PPROVED: i -�4� fib <br /> , vlisc. Fees Calculated By: <br /> FEES TO BE CK�RGED: �, <br /> PER:ti1IT Yz5 '�o <br /> PL.�;t RE�%ZE�V Yes � tiro SE�VE.R CON`NECITON <br /> ST�TE SliRCH.-�RGE Yes � No tiVATF�R COi�ECTION <br /> ItiVESTIG:�TIOv FEE Yes `j0 P� �E <br /> Sr1C Yes No SITE INSPECI'ION <br /> Number of S�C Uni�s _ OTHER (specify) <br /> -------------------------- <br /> ZO\Z\G CHEC�i LIST Zonin� Discrict: Shoreland Districc : <br /> Fire Depart '� nc: <br /> Posc ff.ce: + $cho 1 Discrict: <br /> Lot Area: S . <br /> Acres Width '� Depch <br /> i <br /> Survey Suo [te - Yes No Date o�Survey: <br /> ! <br /> Proposed Sec acks: � <br /> F:on �Lal:e : Risht Si�ie: ;" <br /> i af <br /> Re:r (Streec): Lert Sid�: <br /> � <br /> E � <br /> Adja ent Struc res: 'Wetland: <br /> Buildin� Hei t: Def. H �. Peak H;t. <br /> Avg. Secbacic Blu Setbacic: � Lot Coverag : <br /> � <br /> B <br /> � Exis in� i opose <br /> Hardcover: `0�-�5' ��� <br /> 75-Z50' � i� <br /> 250-�00' °� � <br /> 500-1000' 'y, ; <br /> \ � <br /> Hardcovez V �aence Required: 1'�s No� Dace oi Council r�ppr.oval: <br /> Grading: Sc "" Approval Da�e: ` By: Council :�pproval Da : <br /> � <br /> Sz�[ic: Sca� �pproval Dace: 1` By: <br /> Zonin� File ,�___ �sn ution: j_ Resoiucion Date: <br /> f � <br /> RE:I-IAR�S (in hOuse): <br /> 26 <br />