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�CHECK OFF i,IST FOR ISSU.ANCE �F PERMITS <br /> FOR OFFICE USE ONL�.'' . <br /> ADDRESS OR LEGAL: Zb�3 51-►�q✓� w o 'z-o�� <br /> PID: <br /> DESCR]PTTO�i OF WORK: �?�v►n,�d�t/ i4�J�0 iT'��� <br /> ------------ -------- -------- <br /> -----------------------------------------�_______-- -- <br /> ZOYNG RE'��V BY: � r DATE EiPPROVED: -Z. -o� <br /> BUII�DING REV.��V BY: D A T E A PPROVED; 1 6 -z3-o�� <br /> FEES TO BE CHAI2GED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW � Yes _,G No SEWER CONNECTION <br /> STATE SURCHARGE Yes _� No WATERCONNECTTON <br /> INVESTIGATION FEE Yes No _/ PE1.RK FEE <br /> SAC Yes No ✓ STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONIIIG CH�CK LIST Zoaing District: , <br /> Firc Department: Post O�ce: School District: � � <br /> Lot Area: Sq.ft. y2.0�(o Acres .�V � Widch Z!g� Depth i g K � J4V�T <br /> Survey Submitted: Yes�_ I�10 Date of Survey: 6-('8- O 2, �o•.� 1���� <br /> Proposed Setbacks: oa.c � '`N�a`� �c r °� . . <br /> Froat(ba�e): Z' R.i;ht Side: 3 <br /> Rear(s,sL��): 3�3 Left Side: 1 tp'3 <br /> Adjacent Structures: A-�Cfk� Wetland: N /A� <br /> Builclin,Hei�t: Def. Hgt. p.I� _ Peal:Hgt. <br /> Lot Coveraae• D •K <br /> Gradino: Staff Approval Date: �v//� By: '! Council Approval Date: ' <br /> Sepcic: Staff Approval Date: �1 � ,A- BY� i <br /> Zonin; File: t# oJ(�- Resolution: # — Resolution Date:— <br /> Shoreland District: �,..p� ____ <br /> Av;. Setbac� �/�/� Bluff Setback: i.1 //�' I.ot Coverage: d.l� <br /> Eusting Proposed <br /> �Hardcover: 0-75' <br /> 75-250' Z�aTc� v e7o <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No y Dacz of Council Approval: <br /> RE1��L4RKS (in house).� P.�w��se�9 �-r��ti ��,00r o��e�. t�csn••�c, P«v T o — r�o(1.c,�. <br /> v�. �s T �1 c:c,f� <br />