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CHECK OFF LIST FOR ISS UANCE OF PERMITS <br /> FOR OFFICE USE ONL Y <br /> ADDRESS OR LEGAL: ��5 3 �Q?tll�C�'�L �le • <br /> PID: '' — j "� —Z� 7 <br /> DESCRIPTIONOFWORK: /�;`�l.i-S G����'�' � <br /> --------------------------------,�----- --------------------------------------------------------�--z---- ------- <br /> ZONING REi�IEW BY.• ' DATEAPPRDTjED: l G� <br /> BUILDING REVIEW BY: DATEAPPROVED:«. Lz o� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes f No <br /> PLAN REVIEW Yes� No SEWER CONNECTION <br /> STATE SURCHARGE Yes � No WATER CONNECTION <br /> INVESTIGATION FEE Yes No �/ PARK FEE <br /> SAC Yes_�' No SITEINSPECTION <br /> Number of SAC Urrits � � OTHER (spec�) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST Zoning Distr•ict: � ��-� <br /> Fire Depar•tment: Post Office: �i� Schoo!District: ����� <br /> Lot.4rea: Sg.ft. ��p S� .4cres��� �,3� Yi�idth �2 � v� Depth ���� <br /> Su�vev Sarbr�iittecl: Yes� No Date of Stn•vey: �r 3 � ��p <br /> Pr•oposed Setbacks: t <br /> Fwont(�rkej: � Rrght Side: � ��� �� �� �����,� <br /> , � � i <br /> Rear(Street): _ Z= � �� Left Side: �. <br /> i � <br /> Adjacent Structa�r•es: .��— Y6'etland: �2 <br /> � �- 31 � � <br /> Bzrilding fleight: Def Hgt. "�i� Pect/c Kgt. _ <br /> Lot Coverage: ��, ��V�,L�IY.,�-�;� <br /> . /��7 <br /> I �,�t/—�J� �'js <br /> tY �� �j,�,pJ� ✓. <br /> Gradi��g Staff Approval Dale: P�v"'� By '/��'�1 Coz�ncil�Approval Date <br /> Septic: Staffflpproval Date: ��/`� By: � <br /> 7_vnirtg File: # Resoh�tion: # Resoltrtion Date: <br /> Shoreland District: � NICGi�D Permit: '�— <br /> .Atig. Selback: �'� BliffSetbnc%: � LotCover�«ge: �— _ <br /> 6xistii�g Pi•oposed <br /> Hardcover: (J-7.i' <br /> 7.i-?.i 0' <br /> 250-.i 00' <br /> .i 00-1000' <br /> l�fardcove�� !%ar•iance Re��c�i��ed. }es ��'o� Date of Coarncil Approval. � <br /> RE1l�IARKS(in hocrse): �E��S �re� `TD DUTS��.£ pr /!f, �,,,��-�, p�.� QG.,A.l�!� A r..�'7' <br /> �j .� /,^.�S � � ;�^.� S u o�v�""3r. r�'c�A�tS' w r i-t.. w o Rk ��e �a2. 1 F D E c.fc s <br /> �,�:.�. "� -1"},F� �u`T"S10[` . �4"'x'L. �'�,{��'a �G/-1/t..3:' i � i <br /> T <br /> �� <br />