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CHECK OFF LIST FOR ISSUANCE OF PEY2MITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 12.3 c� A�2f3 02 5'r' � <br /> PID: � <br /> DESCRIPTION OF WORB: p CC=(c <br /> Z0.�1I�Ti G REVIEW BY: DATE APPROVED: S-6-03 <br /> BUII.DING REV�W BY: DATE A]PPROVED; .S=6= 93 � <br /> FEFS TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes _� No <br /> PLAN REVIEW Yes_/ No SEWER CONNECl'iON <br /> STATE SURCHARGE Yes ,/ No WAT�ZCONNECTiON <br /> INVESTIGATION FEE � Yes No PARK F]EE � <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CHE.CK LIST Zoning District: <br /> Fire Department: � Post Office: School District: • <br /> Lot Area: Sq.ft. Acres •`11 ' Width Depth <br /> Survey Submitted: Yes�c_ No Date of Survey: 3-2-5 -93 <br /> Progosed Setbacks: � ' � <br /> Front(�Slce): �I6 Right Side: �{y� <br /> Reaz(S�ree�: �ti 0` � Left Side: 33' <br /> Adjacent Structures: A.r�c�� �Vedand: iv//�I. . <br /> Building Height: Def. Hgt. — Peal:Hgt. <br /> Lot Coverage: -- � <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resoludon: # Resolution Date: <br /> Shoreland District: �., <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No Dace of Council Approval: <br /> REMARKS(in house): _ <br /> 7 <br />