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� ' ' CHECb OFF LIST FOR ISSUAI�'CE OF PER1tiI1TS <br /> _ FOR OFFICE USE ONI.Y . ' . <br /> ADDRESS OR LEGAL: 2 3�� SIJ�A�(J�I t�uo o/J �7�� <br /> PID: <br /> DFS CRIP'IT4N OF�ORK: I?,c P tA c� �-�9,/�.5 - <br /> . <br /> ZOr�'G REVIEti�BY: D�iTE APPROYED: S• 2u -01 <br /> BUILD�'G REYIE�BY: � . D�TE APPROYID: � •�z y�-v� . <br /> FEES TO BE CS4RGED: biisc. Fees Calculated By: � <br /> pERMIT Yes f No :• <br /> PLAN REVIEW Yes _� No SEWER CONNECTION <br /> STATE SURCHARGE Yes �/ No �ATERCONNECTION _ <br /> Ir�'VESTIGATION FEE Yes No PARK FEE <br /> SAC Yes � No SITEINSPECZTON <br /> Number of SAC•Units OTHER (specify) <br /> ZOti�L1IG CHECK LIST zonin�Disaricc: /V'o G /-tnw�r? . <br /> Fire Department: Post Office: School District: • ' • <br /> Lot Arta: Sq.fc. Acies ' idth Depth <br /> Surve; SubL.i!ted: Yes No Date of Survey: <br /> Proposed Se:backs: � <br /> Front(La.�Ce): Right Side: � <br /> Rear(Street): Left Side: <br /> Adjacent Scructures: �Vetl d: • <br /> guil�in�Hei;�t: Def. H�t. Pea.k ot. <br /> I,o� Coverag�: � <br /> Gradin�: S.a:i Approval Date: _ By Council Approval Date: <br /> Septic: Stafi Approval Dace: By <br /> Zonin�File: R Resolution: � Resolution Date: _ . <br /> Shoreland District: <br /> Av;. Setback: B[ufi Setback: _ LotCocera�e: <br /> E���� Proposed <br /> H�dcover: 0-75' . <br /> 75-250' <br /> ti0-500' <br /> 500-1000' _ <br /> Ha:dcover Variance Required: Yes No Date of Couacil Approval: <br /> REI�iARbS (in house): <br /> 7 <br />