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' CHECg OFF LIST FOR ISSUANCE OF PERMITS <br /> � FOR OFFIC USE ONLY <br /> ADDRESS OR LEGAL: � �,� <br /> � PID: . <br /> DESCRIPTION OF Gi'ORK.• _ ��/ /-J�,Ur�_��,j��� �f c�./ <br /> ZONINGREifIEWBY.• DATEAPPROi�ED: '�� .3 G�' <br /> SUILDING REi�IER'BY.• � � DATEAPPROTtED: j� � <br /> —. 3 _�� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERIVIIT Yes :/� No <br /> PI'`���E� �'�s � No SEWER CONNECTION <br /> STATE SURCHARGE Yes l/ No WATER CONNECTION <br /> WVESTIGATION FEE Yes No �- PARK FEE <br /> SAC Yes No � SITEINSPECTION <br /> Number of SAC Units ��� ,�,-�y� OTHER (spec�) <br /> ZONING CHECK LIST Zoning District: _ –�� <br /> Fire Department: Post Office: <br /> School DistricT: <br /> Lot Area: Sq.ft. • Acres 2, Width <br /> Depth <br /> Survey Submitted.• Yes � No Date of Survey: �/ �S Q� <br /> Proposed Setbacks: z�� �.� r�.{� `j,�/� //(]� <br /> �i'tj�f;�d� ��roFro���; , RZght Side: ��� q _ <br /> �Gl'15/CG¢rQC� ' S� , �P�-�h�.�C� <br /> Rear(Street): -`�`�r 3 befE Side: 3 Q � �G�� <'(/GI Sty/�//?fj <br /> I/�'X�S�t�C� J � <br /> ��M����h Adjacent Structures: !�C� � <br /> Wetland: �� ft� t�cJ�ih�shf,h� <br /> � ��X�sh��y s i ,��yti�ic-� ��.nc�� %a�shc�-� <br /> ��,�-e BuildingHeight: Def. Hgt. ,?j � Se�ncK l.�v� �¢ <br /> ��,/Cc Sl Peak Hgt._'�2. � � <br /> /S � Lot Coverage:_ {� �- <br /> ����M <br /> � Grading: StaffApproval Date: By: Council Approval Date: <br /> ��� I�f��� Septic: StaffApproval Date: C `J " gy. ! _ �( �-- <br /> _i�L1� <br /> h�f�P Zoning File; # Resolution: # <br /> h �� Resolution Date: <br /> � �� �. � Shoreland District: MCWD Permit: <br /> ! tJ Av . Setback. <br /> g _ '� BluffSelback: %'1� LotCoverage: <br /> � Hardcover: 0_7S� O�5f Prop�ed <br /> 75-250' /� <br /> 250-500' ,?� S 3 % ,-�v% <br /> 500-1000' �p� �v"� <br /> "�f. 7:�`���'" ���-� <br /> Hardcover i�ariance Reguired.� 3'es No <br /> D te of Council,4pproval: <br /> KEMARKS(in house): <br /> GIYI S vrv�.� <br /> t-�,t��� l�t-� �sf �I��.�- U <br /> 33 � A��cc.��2 c� bY v��h U Z � <br /> T � �•P G� �/L�c°S��w�N(��� G� V►'�� ��/r <br /> � (.i.t n C�(.��.. /'c.+�f a�� r <br /> � 3 /L �� � ZS G - sUo Z �e <br /> J. 7 -- z x �- � �i�s�-�r��- <br /> -�- / Zr1 2 � <br />