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CHECK OFF LIST FOR ISSUA1vCE OF PER1ti.tITS <br /> FOR OFFICE USE ONL Y <br /> ADDRESS OR LEGAL: Z7 o U Go�,.f� Si� �� �' <br /> PID: <br /> DESCRIPTION OF Y(�ORFC: o�� <br /> -- - ----------------------------------- <br /> ------------------------------------------- <br /> ZONItYGREVIE�I�BY: � DATEAPP�ZOVED: �/- � -05 � <br /> BUILDI�YG REVXEW BY: DATEAP,PR06`ED: �- K -6s <br /> ----------------------------------- <br /> FEES TO BE C.HARGED: hlisc. Fees Cc�lcccfated By: <br /> PERNIIT Yes ✓ No <br /> PLAN REUIEGV Yes __� tVo SEYYER GOtVNEGTIO�V <br /> STATE SURCH.4RGE Yes __� �Vo LVATER CONNECTIOIV <br /> ItVVESTIG.4TION FEE Yes tVo �/' PARK FEE <br /> SAC .Y�es No // SITE tNSPECTION <br /> tV�u��ber of SAC U�iits OTHER (specify) <br /> --------------------------------------------------------------- -- <br /> ZO�VING CHECh'LIST zo+�i,i�Discr�tcc: <br /> Fire Deparhner�t: Post Office: ScJzool DisA•ict: _.. <br /> Lot.,�{rea: S t. Acres �Yidth Depth <br /> 9•� <br /> S�c�vey Subr�iitted: Yes�_ No Dafe of Scuvey: ON ��� <br /> Propased Setbacks: <br /> Froru(Lake): I'-►5� f Right Side: N I f� <br /> Renr(Sn•eet): y� + Left Side: ct� � <br /> AdjacentStruct�u•es: �a G[/efland: <br /> Buildirtg Height: Def. Ngt. — Penk Kgt. <br /> Got Coverage: � <br /> Grnding: Stnff.4pprovcc!Date: --' By: Council rlpproval Date: <br /> Septic: Staff.�{pp�•oval Date: — BY� <br /> Zoniizg File: # ^ Resolutio�t: # Resol��tion Dnte: <br /> Shoreland Dist�•ict: N� <br /> flvg. Setbnck: Blceff Setbac�:: Lat Coverage: <br /> Esisting Proposect <br /> Har•dco�er: 0-75' <br /> 75-250' <br /> 250-500' � <br /> 500-1000' <br /> Hardcover Vnr•iarice Reqeiireci: Yes No Date of Cot�itcif�pproval: _ <br /> .RE�I�lARKS(irr.liouse): ' <br /> ,, 31 : ' <br /> � ; : <br /> t 47, ry'' �% <br />