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CHECK OFF LTST FOR ZSSU 'CE OF PER�YIITS <br /> � FOR OFFICE USE ONLY <br /> ADDRFSS OR LEGAL: y'��� ;�„�w s;v`I`.. � . <br /> � PID: <br /> DESCRIPZTON OF WORK: ��4L..� t'.-�:� - <br /> �, — ------------- __ ___ <br /> ZO\TNG REVIE'�'V BY: � C�-�,�,,,��,.._ � DATE A.PPROVED: r -e: �,�`: <br /> BU]ZD .�,i'G REVIE�'Y BY: • �_--� ` i' . � DA1E APPROVED: i - � `j 1� <br /> �EES TO BE CHA.RGED: - � Misc. Fee Calculated By: F�M � <br /> PERMIT -Yes � No . <br /> PLAN REV�W Yes �/ No SBW�C0�IECTTON <br /> STATE SUR`H�.RG� Yes � No ��ATER CO�TNECITON <br /> I7VYESTIGAZTON-FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units �`OTHER (specify) <br /> ZONING CHECK LIST zoning District: ��- t�4 �2 -t�I`�-i r'!----N----- �r- � -~- <br /> Fire Depa.rcment: �n�y�i.L pv�c�: post Oft"ice: vWt,�;v�.'� School District: �..; c'_sT-c=�•v:c;� <br /> Lot Area: Sq.fr. Z�o',� f{c,tES Acres Z��� SVid � f�,��L„h � Depth — <br /> Survey Submitted: Yes�_ No Da e of Survey: � Z_��;, +,�, <br /> Proposed Setbacks: <br /> –__ -• - - _--.___ <br /> Froat (La.�Ce): . � 8�� _ - Right Side: 1(�'`i _ _ _. <br /> Rear (St�eet): �?t� Left Side: Z3c:1 <br /> Adjacent Structures: il�� �� tiVetland: J�v %f� <br /> Buildina Heiaht: Def. Hgt• "�6 Pe�.k Hgt. �, 3• .S` <br /> Lot Covera�e• !�' /e7- <br /> GradinJ: Stafi Approval Date: � -�� -`� '� By: ��� Council Approval Date: '' <br /> Septic: St�°f Approval Dace: ►'- � `�``� gy; �': ` . � . . <br /> Zoaing File: � — Resolution: � Re olution Date:� — • <br /> Shoreland Dis[.-ict: '°���`j � <br /> Avg. Setbzck: v I� Bluff Setback: i�� I.ot Coveraoe; /�.� ;,,� <br /> ' � Existin� Proposed <br /> Hardcover: 0-75' <br /> 75-250' . � ' <br /> 250-504' �"i • �l 3-f <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> � <br /> RE1I�SAR]�S ('in house): � <br /> � - _ . • . <br /> , • �Z� . .26 , <br />