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� � CHECK OFF LIST FOR ISSUANCE OF PERI�IITS <br /> FOR OFFICE USE ONLY • . <br /> ADDRESS OR LEGAL: Zv�bo SPATCS K1v E <br /> PID: <br /> DESCRIPTION OF WORK: �-1-onq�� s�-� <br /> Z0�1I�'G REY�W BY: DATE APPROVED: _�-�c,:ao <br /> �. BLZLDLIIG REV�`�BY: � � DATE APPROYED; 3-�6-o a � <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> pERMIT Yes ✓ No <br /> pI,AN REVIEW Yes �/ No SEWER COYi�rECTION <br /> STATE SURCHARGE Yes ✓ No tiVATERCONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEI�i TSPECTION <br /> Number of SAC•Units OTHER(specify) <br /> �__� <br /> ZO�Zti G CH�CB LIST zoning Districc: 2 f�-1� . <br /> Fire Department: �v Post Office: W A�-vYr'�� School District: p�n � <br /> Lat Area: Sq.ft. s O,'i7 2 Acres t-�1. ' Width i 2��z v�-rt Depth �3 O <br /> Survey Submitted: Yes_� No Date of Survey: nn� �t t�;, <br /> Proposed Setbacks: � , <br /> Front(�eej: ! z.o� Right Side: � f S { � � . <br /> Rear(�eec): I S� � Left Side: �y o� t <br /> Adjacent Structures: �"t� = Wetland: N 1/> <br /> Buildin�Height: Def. Hgt. �.(rL Peal:Hat. l�•S� <br /> Lot Coveraae: �•� ' <br /> Gradin�: Staff Approval Date: nJ/�4 By: Council Appro�-�1 Date: <br /> Sepdc: Staff Agproval Date: — By: <br /> Zoning File: # �' � Resolution: # — Resolution Date: <br /> Shoreland District: .Q <br /> Avg. Setbac : N�/d' Bluff Setback: � i� Lot Co�tra�e: 9•B <br /> � Existme Progosed <br /> Hardcover: 0-75' ----- . <br /> . 75-250' ---- <br /> 250-500' --- <br /> 500-1000' J.-y � � <br /> Hardcover Variance Required: Yes No� Date of Council Approval: <br /> REi�1ARKS('m house): <br /> 7 <br />