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CHECK OFF LIST FOR ISS UANCE OF PERMITS <br /> FOR O FICE USE ONL Y <br /> ADDRESS OR LEGAL: 3SS � U�-'�N �l�k��-�= �2l Vk"`` <br /> PID: /��,=1� 7- Z ��''�/ �J <br /> DESCRIPTION OF WORK: 12�Pt,►,�C�/�t. a.._j�" ��" /V�/V G �iJ.A•t,l�S <br /> ------------------------------------ --------- ----------------------------------------------------------------------- <br /> ZONING REVIEW BY.• DATEAPPROTjED: ��f3 D Po <br /> BUILDING REVIEW BY.• - DATEAPPROVED: <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> FEES TO BE CHARGED: Misc. Fees Calczrlatecl By: <br /> PERMIT Yes `� No <br /> PLAN REVIEYV Yes No SEWER CONN TION <br /> STATE SURCHARGE Yes No WATER CONNEC ON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Y s No SITEINSPECTIO <br /> Numbe��of SAC Units OTHER (speci <br /> ------------------------------ ----------g----------------,---------------------------------------------------------- <br /> ZONING CHECK LIST zontn D�st,•tcr: ��--' � �-- <br /> Fire Depar�tment: Post Offrce: School District: <br /> Lot Ar�ea: Sq ft. ,4a�es G6'idth Depth <br /> Survey Subnlitted: Ye� No Date of Sin•vey: �/ ��"/ ' Q � <br /> Proposed Setbacks: <br /> Fr•ont(Lake): lZight Side: _ <br /> Rear(Street): Left Side: ,�� '�.-.�-1 c <br /> Adjacent Struetures: Wetland: �� � <br /> BtRilding Fleight: Def. Hgt. � Peak Hgt. �— <br /> Lot Cove��age: � " <br /> Grading: StaffApp��oval Date: S � �� By!I�%h� Cozrrrcil Approval Uate: U `— — �S� <br /> Septrc: StnffApproval Date: � � By: j <br /> 7_onirtg File: # 3r�� Resolidiorr: #�� Resolutiaz Date: c`7 2� � � <br /> Shoreland District: � rLICWD Pei�ntit: <br /> Avg. Selbnck: _ Bhrff Setbacic Lot Coverage: <br /> �xisting Proposed <br /> Harcicover: D-7.i' <br /> 7�-Z.i 0' �� t�''�..�` :C.) �._ .,"�� ,-, <br /> zsn-soo� <br /> soo-�000� <br /> Hardcover G'ariance Reyuired: }es � ��'o Date ofCouncil.lppi•oval.• � � � � <br /> REMARKS(in lzocrse): C 1 V/L �o�K�'2o'�S ['��,p u.� "�'a �/���t( ,�'a r� <br /> C t�l�t�oRii' �,,,�,�►f���� ���0'+a�"��-�' <br /> » <br />