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CHECK OFF LIST FOR ISSUA��'CE OF PER.I�IITS <br /> _ FOR OFFICE USE ONLY . � . <br /> ADDRESSORLEGAL: ZSOQ SI�kM�4Wt�O�J �� <br /> PID: <br /> DESCRLPTION OF WORK: 1'Lt: O�D tsL U4�3 <br /> . <br /> ZO.�i'G REVIEti�BY: DATE APPROVED: //-Z�i -� <br /> BU]TrDING REVIE�BY: . D4TE APPROYID; 1�• ZQi�-'oo <br /> F'EES TO BE CHARGED: Misc. Fees Calculated By: <br /> pg�tMlT Yes �'' No :• <br /> pI,AN REVIEW Yes �' No SEW�CO�iNECTION _ <br /> STATE SURCHARGE Yes � No WATERCONNECTION <br /> INVESTIGATION FEE Yes No p�RK FEE <br /> SAC Yes No . SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZO\1,iG CH�Cg LIST zoning Districc: Nv G f�4�/JC' � _ . <br /> Fire Department: Post Office: School District: • � � <br /> Lot Area: Sq.ft. Acres � Width Depth <br /> Surve;Suba:itted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Fron[(La.ke): Riaht Side: � <br /> Reaz(Street): Left Side: <br /> Adjacent Scructures: W tland: • <br /> Buildin�Height: Def. H�t. Pe •Hgt. <br /> I,ot Coverage: <br /> Grading: Staff Approval Date: y: Council Approval Date: <br /> Septic: Staff Approval Dace: y: <br /> Zoaing File: # Resqlution: � Resolution Date: _ . <br /> Shoreland Disuict: <br /> Avg. Setback: Blufi Setbac : I.otCoven�e: _ <br /> E���o Propos�d <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' - <br /> 500-1000' - <br /> Hardcover Variance R�quire : Yes No Date of Council Approval: <br /> REI�IARKS (in house): <br /> 7 <br />