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s <br /> CHECk OFr LIST FOR ISSUA�tiTCE OF PER1vIITS <br /> FOR OFFICE USE ONLY <br /> �DDRESS OR�EG:�L: `�S F�N O�KC G�'`}PID: <br /> DESCR�'I'IO\ OF «'ORh: F��L�— <br /> ----------------------------- <br /> _ --------------------- <br /> ZOtiItiG RE�1'E�V B�': DATE APPROVED: $ -2 �- 5S <br /> BtiII.DL\'G RE«W BY: N!/�" DATE APPROVED: <br /> - ------------------------ -- <br /> ----------- -------------------------------______ <br /> FEES TO BE CH_�iRGED: <br /> (oR�O`N isc. Fees Calculated By: <br /> PER�IIT Yes � �0 <br /> PL��1 REVIE«' Yes ' No SEWER C01�1�TECTION <br /> STATE StiRCH:�RGE Yes No WATER CON�]ECTION <br /> INVESTIG:�TION FEE Yes No PARK FEE <br /> SAC Yes No SITE INSPECTION <br /> Number of S�C Units OTHER (specify) <br /> ------------ <br /> --------------------__ <br /> ZONL\G CHEC� LIST Zoning District: Shoreland District : <br /> Fire Depanmen�: Post e: S�1 District: <br /> � <br /> Lot,area: Sq.ft. <br /> Acres Dep[h <br /> Survey Submicted: Yes x No Date of Survey: �N N��-C ��g�� <br /> Proposed Setbacks: � <br /> Front �Lakej: 3t� �' (� Right Side: Z7U 1 ru <br /> Rear (Street): `'�0 � �!- �Left Side: JO� = � <br /> Adjacent Structures: t Ff0( �' Wetland: N�V-� <br /> Building He� [: Def. Hgt. Pe� Hb <br /> Avg. Se[bac : Blu f Setba k: Lot Coverage: <br /> Exi tin� Proposed <br /> � <br /> Hardcover: 0- 5' <br /> 75- 50' <br /> 250- 00' <br /> �00-1 00' <br /> Hardcover V �ance Req 'red: Yes No Date of Co cil Approval: <br /> Grading: S[ � �'.oproval te: By: Coun il Approval Date: <br /> Septic: Sta� �pproval Date: By: <br /> Zonin� File: ; Res luc on: ,� Resolutio Date: <br /> g�ti (in house): <br /> 26 <br />