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� , CHEC�i OFF LIST FOR ISSUA.1�►rCE OF PERitiIITS <br /> ' FOR OFFICE USE ONLY ' . <br /> ADDRESS OR LEGAL: I 3 7 S 2.��T �O rn�r �f <br /> PID: <br /> DFSCR�'J.'ION OF�ORK: (La i�� 1�.�;�� c_t,�..�2 <br /> . <br /> ZO�'L�G REY�ti'y BY: �( /� DATE APPROVED: <br /> BUILD�'G REYIE�BY: � . DATE APPROYID: Z-z� =c�t <br /> FEES TO BE CH.4RGED: bSisc. Fees Calcuiated By: <br /> pERNLIIT Yes � No :• <br /> pI,ATt REVIEW Yes No�- SEWER CONNECTION <br /> STATE SURCHARGE Yes� No WATERCONNECTION <br /> INVESTIGATION FEE Yes No pARK FEE <br /> SAC Yes No STTEINSPECrION <br /> Number of SAC•Units OTHER (specify) <br /> ZO\"L�IG CA�CK LIST Zonin�Districc: /�� C/�yh^�C� _ . <br /> Fire Department: Post Office: School District: • ' � <br /> Lot Area: Sq.ft. Acres � Width Depth <br /> Surve;Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: � <br /> Front(La.ke): Right Side: ' D` /C <br /> 1 <br /> Rear(Screet): Lefr Side: <br /> Adjacent Structures: �Vetland: • <br /> Buile�in,Hei�ht: Def. Hgt. Pea�:Hgt. <br /> Lot Covera;e: <br /> Grading: Scaff Approval Date: gy; Couacil Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zonin,File: � Resolution: : Resolutioa Date: . <br /> Shoreland District: <br /> Av;. Setback: Blufi Setback: LAtCocera�e: <br /> E���� Proposed <br /> Hardcover: 0 75' <br /> 75-250' <br /> 230-500' <br /> 500-1000' <br /> Hardcover Variance R�quired: Yes No__ Dat�of Couacil Aoproval: <br /> gEI�IARb'S (in house): <br /> 7 <br />