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CITRCK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> • PID: <br /> ADDRESS OR LEGAL: /1 ZS W�L-L x ) O/Z N <br /> DESCRIPTION OF WORK: 14) .‹....K. -------- --------------' <br /> --------------------- ` DATE APPROVED: � -I -�iS <br /> ZONING REVIEW BY: <br /> APPROVED: B -1 -co:: <br /> BUILDING REVIEW BY: ( _ DATE AP <br /> __________ <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes o <br /> PLAN REVIEW Yes_eff::: SEWER CONNECTION <br /> NoWATER CONNECTION <br /> STATE SURCHARGE Yes No PARK FEE <br /> INVESTIGATION FEE YesNo <br /> INSPECTION <br /> SAC Yes No <br /> Number of SAC Units <br /> OTHER ( specify) <br /> ZONING C:iu cx LIST <br /> Zoning District: R 2' 13 <br /> Post Office: 4...A.- School District: OR-(DNo <br /> Fire Department: LL Post <br /> Lot Area: <br /> NO 0,4A--A/ ..e' Width: Depth: <br /> Survey Submitted: Yes jc No <br /> Date of Survey: -1:15_± 111 <br /> Proposed Setbacks: s � Right Side: N�11 N <br /> Front ( ) : 6 Z g <br /> Rear (Stret) : 3GS <br /> -1_ Left Side: �O �9 <br /> Adjacent Structures: 4rTlhcH-50 <br /> Wetland: X <br /> HeighI <br /> Building : Def. Hgt._ Pe-k Hgt. <br /> Lot Cove <br /> age: <br /> Avg. Setback: <br /> Existing propo-ed <br /> 1 <br /> Hardcover: 0-75 ' 1 / <br /> 75-250 ' <br /> 250-500 ' ' <br /> 500-10x0 ' <br /> \ Date of Cou�icil Approval:__.. <br /> Hardcover Variance Required: ; Ye- N. <br /> Grading• Staff Approval' Date By: <br /> Council Approval Date: <br /> Septic: Staf Approval D te: By <br /> Zoning File: <br /> R olu■ion #: Resoluti n Date: <br /> REMARKS (in house) : <br />