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CHECK OFF LIST FOR ISSUANCE OF PE.R�vIITS <br /> FOR OFFICE USE ONL Y <br /> ADDRESS OR LEGAL: �2� I?� '`� �t <br /> PID: <br /> DESCRIPTIO:V OF y�"O.KK: ' <br /> - - -------------------- <br /> -------------------------------------- -- -- <br /> ----------------------------------- ------- -------- <br /> ZONINGREVIEtVBY: � � � � ��� : ' � ' DATEAPPROVED: ��5-oC. �0- <br /> BUILDI�VG.REVIEW BY: DATEAPPROVED: �i � - s'-oc. <br /> FEES TO BE CHARGED: Nlisc. Fees Calculated By: <br /> PERrtiIIT Yes ✓� No <br /> PLAN REVIEyV Yes f �Vo SEWER CON�VECTION <br /> STATE SURCH.4RGE Yes ✓ No � �VATER COiWt ECTIOtV <br /> INVESTIGATION FEE Yes �Vo �/' PARK FEE <br /> SAC Yes No� SITE NSPECTIO�V <br /> Nzc�zzber of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONIIVG CHECK LIST Zar�i�:,�Distr�ict: G��� <br /> Fire Deparhnerit: Past Offcce: Sc/cool District: __,. <br /> � _ ' i <br /> Lor.�lrea; Sq.f't. �(p`'I �J�7 ,�cres � � 6l�idtlt � U Deptli j�'�� <br /> � <br /> Scc�vey Sc�6ruitted. Yes Na � Date of Survey: <br /> Pr•oposed Setbacics: <br /> Fror:t(Lalce): �O d� � Right Side� L S� t <br /> Rear(Street): �t7 d� 'f Left Side: �U6� �" <br /> Ad�acent Struct�u•es: I�O� �" G�etland: N �� <br /> Building Height: Def. Hgt. �1�� Peak Hgt. � <br /> Lo�Coverage: 0•��-- <br /> Grading: StaffApprovrtl Date: — By: Coccncil Appr'oval Dctte: <br /> �Septic: Staff,�(pproval Date: �� BY� �� <br /> Zoi�iit,�File: # �- Resofution: # Resolu[fo�i Dnte: <br /> � <br /> Shoreland Dish-ict: ��b — �U U � <br /> Avg. Setback: Bliiff Setoack: Lot Coverage: <br /> Etiistino Proposed <br /> Hardcover: 0-7�' (�. ,��.�"t� � <br /> r�, �� 1 75->j0' <br /> �l'1���� � � 250-500' <br /> 500-1000' <br /> Kardcover I/ariance Reqccired: Yes No Date of Co�uicil�pproval: <br /> REttifARKS(in house): <br /> „ <br /> �� <br />