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' ' CHECb: OFF LIST FOR ISSUA���CE OF PERtiIITS <br /> _ FOR OFFICE USE OiVLY . <br /> A.DDRESS ORLEGAL: YS(,� ,QA-�.Si�J-C /�� <br /> PID: <br /> DESCRI�''IZON OF�ORK: =, — -�✓1� <br /> . <br /> ZONL�'G REVIEti� BY: DATE APPROV�D: r r - a- n� <br /> BUII,DING REYIE�BY: DATE APPROY�D: <br /> w � G� tJ, . �q y� f/"��l /�/5 L. 5 b c� `.al�� '�- <br /> FEES TO BE CHARGED: �'�"`,� N4�sc. Fees Calculated B : y��-'�S <br /> pEgMI"I' Yes � No -� <br /> pi.,?,N REVIEW Yes No SE��ER CO�v�1ECTION <br /> STATE SURCHARGE Yes No WAT�RCONNECITON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPEC"I'ION <br /> Number of SAC�Units OTHER (specify) <br /> ZO\`L�G CH�Cb LIST zonin�Dis�icr. F-U ,c�f'J4���Q _ <br /> Fire Department: Post Office: Schcol District: • � <br /> Lot Area: Sq.fr. Acres Width Depch <br /> Surve;� Sub�itted: Yes No Date of Survey: <br /> n 'V. ....v <br /> Proposed Setbacks: /� <br /> Fron[(La.ke): S� (�� Ri;ht Side: <br /> Rear (Screet): L.eft Side: <br /> Adjacent Struccures: `Vetland: • <br /> Buildin� Hei�ht: Def. H�t. Pea.�:H�t. <br /> Loc Covera�e: <br /> Gradin�: Staff Approval Date: gy: Council Approval Date: <br /> Septic: Staff Approval Da�e: By: <br /> Zoain,File: � Resolution: � Resolution Da�e: <br /> Shoreland District: <br /> Av�. Setback: Blufi Setback: I.otCorera�e: � <br /> Ezistin� Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 2�0-500' <br /> 500-1Q00' — <br /> Hardcover Variance Required: Yes No Dac� of Council Approval: <br /> REl�L4RKS (in house): <br /> 7 <br />