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CHECK OFF LIST FOR ISSUANCE Ok'PER1ti.fXTS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z(7 S 5 H��IL�� �(�- <br /> PID: <br /> DESCRIPTION OF yf�ORK: � ���^' f <br /> ------------ ------------------- ----------- <br /> ZOIVINGREVIEtVBY: DATEAPPROVED: �—S-6S � <br /> BUILDIIVGREVTEWB : D�TEAPPR06'ED: 3-S -6S <br /> -------------------------------------- - <br /> ,FEES TO.BE CH'ARGED: �l%tisc. Fees Cnlcctlated B}�: <br /> PERNlIT Yes �� No <br /> PLAtV RLT�IEYV �es � �Vo SEtiVER CONi�IECTIOrV <br /> STATE SURCHARGE Yes � tVo yVATER COtVtVECTIO�V <br /> . It�IVESTIGATlON FEE Yes �Vo PARK FEE <br /> SAG .Yes tVo SITE NSPECTION <br /> Number of SAC U�:its OTHER (specify) <br /> ------------------------------ ('. <br /> ZO�YIIYG CHEC,£i'LIST Zor�ing Disd•icc: o C o 2 (t� <br /> Fire Depnrhnerrt: Post Office: Sdiool Dish•ict: _.. <br /> Lot.�Irea: Sq.ft. �lcres �Yidtl► Depth <br /> Su�-vey Subrriitted: Yes No Date of Seuvey: <br /> Proposeci Setbncks: <br /> Froru(Lal.e): R lit Side: <br /> Renr•(Str•eet): Geft <br /> Adjacent Structures: I�e nd: <br /> Buildilig Height: Def. Hgt. Peak K . <br /> Lot Coverage: � _ _ <br /> G�•aciing: Staf}'.4pp►'ava!Dccte: _ Bv: Counci!Approval Date: <br /> Septic: StnffApprovRl Dnte: BY <br /> Zonirig File: # Resalutian: # Resolution Dnte: <br /> Shoreland Disd•ict: <br /> Avg.Setback: : BI Setback: Lot Coverage: <br /> �nng � Proposed <br /> Hardcove�•: 0-75' <br /> 75-250' <br /> 250-500' � <br /> 500-1000' � <br /> Hardcover Variance Required: Yes No' Di�te of Cvunci[�ipproval: <br /> REMA.RXCS(in ltouse): <br /> 3 <br /> �, � <br /> . . . . . .. � . . . . . � . .. �' ���� .. - <br />