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CHECK OFF LIST FOR ISSUANCE OF PERIVIITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS ORLEGAL: `�S'� �S"cJssc:x GA-�vt: <br /> PID: <br /> DESCRIPTION OF WORK: �1 �w /2E-5. <br /> ZOrZ\G REVIEW BY: DATE APPROVED: 1 - 't-� -�� <br /> BUII�DING REVIE`V BY: DATE APPROVED; 7 • � ��� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes � No ; <br /> PLAN REVIEW Yes � No SEWER CONNECTION <br /> STATE SURCHARGE Yes � No WATER CONNECITON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZO�G CH�CK LIST Zoni.ng District: RR-1b <br /> Fire Department: (Anr tt.c; Post Office: � School District: �f2-O�ta <br /> Lot Area: Sq.ft. Acres 2 i- Width �M..�3�vc.HZ Depth <br /> Survey Submitted: Yes�_ No Date of Survey: � • Z-L ~�� <br /> Proposed Setbacks: <br /> Front(L,a�e): Q(� � � Right Side: 1l0' '�' <br /> Rear(SL�est): �,k� � Left Side: Z ti0� t <br /> Adjacent Structures: /l�lA- Wetland: N�� <br /> Building Height: Def. Hg[. �g 2�.�- Peal:Hgt. ?�.�' <br /> Lot Covera�e: /�lJ�/�" <br /> Grading: Staff Approval Date: �7�?-v—t�u By: /�U� Council Approval Date: '�- <br /> Septic: Staff Approval Date: '7 -?� • �� By: G-P• <br /> Zoning File: # � Resolution: # � Resolution Date: � <br /> Shoreland District: <br /> Avo. Setback: Bluff Setback: L.ot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REi�iARKS (in house). I-�bv�,,�ov T (/�L c.�� r�-�w► � T �� . �H�T— <br /> 7 <br />