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� CHECIi OFF LIST FOR ISSUAIVCE OF PERNfITS <br /> ' FOR OFFICF US� ONL�' <br /> ADDRESSORLEG_AL: S�fl M,q��,p� �� <br /> PID: <br /> DESCRIPTION OF i�''ORIi: __ Q�o� 0�1 rL �p e Uc <br /> ZONINGRET'IEYi��BF � � DATFAPPROI'ED; � Q - <br /> B UILDI.NG RE[�I£iN'B F: DA7'EAPPR 0T'ED: (�•3�• o�i <br /> FEES TO EE CK4RGED: Misc. Fees Calculated Bv: �____, <br /> PEPv1�IIT I es � No y <br /> PLAI��REVIENr Yes_/ No SEN�ER CO_NNEC7'ION <br /> STATE S�RCKARGE I'es �/ No NATER CONNECTIO.�- <br /> ,� INVESTIvATION FEE �es r/ No FARK FEE <br /> SA C I"es No �/ SIT£II�'SPECTION <br /> I�umber o{SAC linits OTYER �spec fi�J <br /> ZONING CHECRLIST ZoningDistrict: � � ��~ ~� <br /> rire Department: Pos1 Of�?ce� School Disu�icr: <br /> Lot Area: Sq.ft. � � Acres � <br /> YG�idth _ � O Depth <br /> Surve} Suomitted: I''es � Ido Date ofSu.�-vey� � b���r �"� <br /> Proposed Setbacicr: ��� �m¢' ����/�� <br /> � Fronl(�kr): - y(�_�,�1 Siae: ZZ� q�Af2• <br /> W� � <br /> Rear(Stre�lj: /��} ��eft Side: �Z <br /> � � Adjaceril Structures: �J/�- N'etland: ff/�- <br /> S/KyIG S� <br /> Bui[aing Heignt Def Hgt. p�ah Ho� G.K �. <br /> � Lol Coverage: 8 ��s, 3�� (� <br /> Graain�� Stcrf,l�Aporoval Dat�: {�/� Bi�: Council Approva!Date: <br /> Septic: Staff,4pprovcrl Dare: B�, <br /> Zo�7ingFile �' � ',?j �{6�I R�solutior.: ;� R�solucior�Daie: T�� �. <br /> Shoreland District �/:� MCND Permir <br /> Av�. Setoac�: Bii�Setoaci: � <br /> Lot Cavera��: <br /> Faisting Fi•oposed <br /> Ha�•dcove.�•: p-";' <br /> '�-��0' <br /> ��0-�00' <br /> .i00-1000' <br /> fi'ar-aco»�r I"ariarzce Reqztired: I'es <br /> Ivo Date o>�Cozu��il.4poroi�al: <br /> REM4IZIiS�iit house): "I's� (�.1ti.�t� �o r�1P w�o�T��.�,. . .— <br /> :� <br /> � �S GC uTiO / s �h[ �1� �w�7� — l`lv S �t �3 E S�� �v�Y� <br /> � l <br /> /,f 3 � ,� c�i`t I r � S I SSvE� , <br />