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CHECK OFF LIST FOR ISSUA1�tCE OF PER1vSITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �S F'c:.(Z� �D A�: C-����'� <br /> PID: <br /> DESCRIP'TION OF WORK: �p o, -,-,, �.�S <br /> ZO�tIti'G REV�`V BY: M� N DATE APPROVED: .�j .( _�`� <br /> BUII.DING REVIEW BY: DATE APPROVED: � -1 --�J <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes ✓ No � <br /> pLAN REVIEW Yes �i No SEWER CONNEC'I'ION <br /> STATE SURCHARGE Yes ✓ No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONI:�tG CH�CK LIST Zoning Disuict: �• /� <br /> Fire Department: (,�/ayZ�A�-r�4 Post Office: �,✓Ayz4T+'Q School Disuict: ��--7�>� <br /> Lot Area: Sq.ft. �Ig.95 1 Acres 2•Z�► Width !2+��cA� Depth -- <br /> Survey Submitted: Yes� No Date of Survey: l�15- o� <br /> Proposed Setbacks: � � <br /> Fron[(L-$icc): 35 Right Side: 30 <br /> Rear (SEteet): 3 Z.v� Left Side: �c�' <br /> Adjacent Structures: /1�c�1�-�� Wetland: � / w � <br /> � , <br /> Building Height: Def. Hgt. �{o Peal:Hgt. ,3s <br /> I,ot Covera?e: �•��- <br /> Grading: Staff Approval Date: �—" By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: /# -- Resolution: # Resolution Date: <br /> Shoreland District: N � <br /> Avg. Setback: Bluff Setback: L.ot Covera?e: <br /> Ezisting Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> RE�Z,ARKS (in house): <br /> 7 <br />