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� . r CHEC� OFF LIST FOR ISSUA,�CE OF PERVIITS <br /> FOR OFFICE USE ONLY <br /> :�DDRESS OR LEG:�L: l375 ��►c p/Z.�v� PID� <br /> DESCRIPTIO\ OF «'ORI�: fl0/J rnvN - ���c �-O� ���''— <br /> ZO\Zti G REV�jV BY: DATE APPROVED: I� -2 -95 <br /> - -�� , �_. DATE APPROVED: t,c� - Z-45 <br /> BUII,DL1 G RE�ZEtiV BY. <br /> -------------------------- ' <br /> FEES TO BE CH_�,RGED: �Iisc. Fees Calculated By: <br /> PER�IIT YzS � �o <br /> �,ra SEtiVER CONti"ECTION <br /> PL�N RE`ZE�V Yes �/� �ATER COiWECTION <br /> STATE StiRCH�RGE Z'zS �-�0 pp,� FEE <br /> I�i VESTIG:�TIO�i FEE Yes �o <br /> SaC Yes No SITE INSPECTION <br /> �iumber of S�C linics _ OTHER (specify) _� _� <br /> --------------- <br /> -------------- <br /> ZON�G CHECK LIST Zoning District: (�!L-I� Shoreland District : �.p5 <br /> Fire Departmen[: <br /> ry���.,� Posc Office: vvte.rr�c� School Discrict: ,�.�es�rr�svteA <br /> De [h <br /> Loc Area: Sq.it. Yz�`�� Acres •S$� Width P <br /> Survev Suomicted: Yes �C <br /> �,ro Da[e of Survey: 8-r� -� <br /> Proposed Secbac�cs: � ('� <br /> Ftorre (Lai:ej: l55 � Right Side: ?� ' <br /> R,ea� (Street): N ��4 Left Side: N�W �� <br /> Adjaeeac Scructures: AT%�'-w�� Wecland: �✓�A <br /> Buildiu� Heighc: Dei. Hgt• d •t� Peak H;t. O .l� <br /> Avg. Secbacfc: <br /> c� .K Bluff Setback: N�� Lac Coverage: �j•��.._�— <br /> Exiscing Proposed <br /> H:�rdcover: 0-75' z�•�y <br /> 75-250' Z`� <br /> 250-�00' <br /> �00-1000' <br /> Hardcover Variance Required: Yes No X Date oT Council Approval: <br /> Gradin�: Staif �oproval Dace: By: Council :�pproval Date: <br /> Se�tic: Starf .�pproval Da[e: By: - <br /> ZaninQ Fiie: � <br /> Re lucion: # esoiution Date: <br /> RE�tii.-�R�iS (in house): <br /> 26 <br />