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CHECK OFF LIST FOR ISSUANCE OF PER�1�tITS <br /> � , � FOR OFFTCE USE ONLY <br /> ADDRESS OR LEGAL: _ �y 4� Q��I S 1��.. . �r�� . <br /> PID: <br /> DESCRIPTION OF WORK: __ ��p,p �t � 0�1 � <br /> ZOYPi 1G REVIEti� BI': w . _ DATE A.PPROVED: _1 n- S- 9�',`- <br /> BUII,DI�TG REVIEti� BY• � DATE APPROVED: �o. . �. .� � <br /> FEES TO BE CHA.RGED: � � � Misc. Fees Calculated By: ~ <br /> PERMIT _ Yes ✓ No ' <br /> PLAN REV�W Yes �/ No SEWER CONNEC'ITON <br /> STATE SUR`H�RG� yes � No ti�ATER CO�i�TECTION <br /> INVESTIGATION-FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> -------------------------------- ----- _� <br /> ZONI�tG CHECK LIST zoni.ng Districc: C�2�/�� � <br /> Fire Department: �, �,r Post Office: �� � School District: _ (�(lsp nr� � <br /> Lot Area: Sq.ft._ D G/fA•v�L2 Acres — �Vidth — `-- <br /> —� Depth <br /> Survey Submitted: Yes_� No Date of Survey: I-I� �� <br /> Proposed Setbacks: , <br /> Froat (�}: . �� i' Right Side: 3�' . <br /> Rear(�): ti�1�� �' Left Side: �c�� i= <br /> Adjacent Struc[ures: /.�T-rx���� tiVetland; n/ (,9- <br /> Building Heioht: Def. Hgt• [�, (�-- Pea.k Hot. — <br /> a <br /> Lot Coverage• Q�� <br /> Gradin�: Staff Approval Date: --- By; — Council Approval Date: — <br /> Septic: Staff Approval Date: -- gy; � . <br /> Zonino File: # � — Resolution: # — Resolution Date:� � <br /> Shoreland Dis�-ict: _ �-/�C S � <br /> Avg. Setback: N(/�� B(uff Setback: /f (/-� I.ot Coveraae: /J%� <br /> � ' E���� Proposed <br /> Hardcover: 0-75' <br /> 75-250' . . - • <br /> 250-500' . . ��� <br /> SOQ-1000' <br /> Hardcover Vaziance Required: Yes No_� Date of Council Approval: <br /> . � <br /> RE1l�ZA�RKS ('in house): � <br /> z � - � ' � <br /> : ��� � 26 <br /> , �t:�.. . . <br />