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� CHECK OFF LIST FOR ISSUANCE OF PERI�IITS <br /> FOR OFFICE USE O�tLY • <br /> ADDRESS OR LEGAL: ;'1`�s`� -�'1� ►"� /� v l.� /�r� . <br /> PID: ,;�� i I� I ' �� ,1- :i i � L�,=;��� _ <br /> DESCRIPTION OF WORK: � _ `;��`���'i���- � <br /> ZO�fi'G REY��Y BY: �t ���t�t ���� ,�. �..����,.�j� DATEAPPROV�D: ;:- -i --�����'; <br /> BLZLDLYG REti�� BY: ' � �.,,.;_���, ,� DATE APPROVED; C�� �--��t�,�� <br /> �� � . � <br /> ,� ____�;- . <br /> F'EES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER�tiIIT Yes 'n No <br /> pLAN REVIEtiV Yes _� No SEWER CO��C'I'ION <br /> STATE SURC�L4RGE Yes No �VATERCON�'ECIION <br /> INVESTIGATIO?t FEE Yes No PARK FEE <br /> SAC Yes No SITEI�i TSPECTION <br /> Number of SAGUnits OTHER (specify) <br /> ZO`Z�G CHECg LIST zoning Districr. �l��C�= <br /> Fire Department: �L'l t` �.�. 4��` Post Office• � , � '1 School DSSict: _���-C�L�4'�'�f (:�J I�'YC��; <br /> � ., <br /> Lot Area: Sq.fr. Acres � Width Depth <br /> Survey Submitted: Yes i`< No Date of Survey: �� �`�� % �+� <br /> � <br /> Proposed Setback�: <br /> Front(Iz<e): RiQh.t Side: � � � . <br /> Rear (Stre�t): _`� � I.eft Side: <br /> Adjacent Struccures: �Vetland: <br /> Building Heio�:: Def. H�t. Pea.�Hgt. _ <br /> Lot Co�•era�e: ' <br /> Gradin�: Staf�y?proval Date: By: Council�ppro�-zI Date: <br /> Septic: Staff Arrroval Date: By: <br /> Zonin�File: � =�`� `� � . Resolution: � `�'�ZZ Resolution Date: <br /> Shoreland Distric:: <br /> Av�. Se��ack: Bluff Setback: LotCo��ra�e: <br /> � Ezistm� Progos�d <br /> Hazdcove:: 0-?�' <br /> -. 75-2�0' <br /> 250-500' <br /> 500-1000' <br /> Hardcc�:er Variance R�quired: Yes No <br /> Date of Coucci? Approval: � <br /> RE`LAR�iS ('in house): <br /> 7 <br />