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� , . _ .� � <br /> CHECb' OFF LIST FOR ISSU��iCE OF PERI`ZTI'S <br /> FOR OFFICE USE ONLY <br /> ?,DDRESS OR LEG�,I.: T � (��2-�w N �2�1 5 � - <br /> PID: <br /> DESCRIP'T'ION OF WORK: ��J� i-n o�S -I�o ��a4��� <br /> ZON�1G REVLEW BY: DATE APPROVID: S` -"�-0C� <br /> BLZLDING RE'VLE�V BY: DATE APPROVID: 5--- �- �� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER'v1IT Yes ✓ No <br /> P�N ��p� Yes f No SEVJER COi�NECTION <br /> STATE SL�RCHARGE Yes � No WA'I�R COi�TNECITON <br /> INVESTIGATION FEE Yes No � PA� FEE <br /> SAC Yes No � SITE INSPECITON <br /> Number of SAC Units OTHER (specify) <br /> ZO�I'�iG CHECK LIST Zonin�District: 422 -\� Shoreland District : /UC� <br /> Fire Department: (�o rv (� <br /> Post O�ce: u� �School District: p(L2`�/st� <br /> Loc?.rea: Sq.ft.�lU C.� G H�d�sGQ <br /> Acres Width Depth <br /> No Date of Survey: ckC�17o-� <br /> Survey Submitted: 1'eS � � S�,� �� r�,,,� ���,,,,,,,,a�- y i,3 <br /> Proposed Setbacks: � -�. <br /> Front (Lake): /��/4- Ri?ht Side: I.S�U <br /> Rear (Street): (�o ' � Left Side: 2- � 5 � �— <br /> Adjacent Struccures: ( 4� � � Wedand: N//�} <br /> Buildin� Height: Def. Hgt. 0 �{�- Peak H�t. /J�� <br /> Av�. Setback: Bluff Setbac . L,ot Co er e: <br /> Ezistin� Pro sed <br /> Hardcover: �-� ' <br /> 75 _50' <br /> 25 -500' <br /> 5 -1000' <br /> Hardcover Varian e Reouired. Yes No Date f Council Approv : __ <br /> g Council �pproval a[e: <br /> Grading: Staff . pproval Date Y� <br /> Sepcic: Scaff proval Da[e: BY� <br /> Zoni.n� File: esolution: � Resolutioa Date: <br /> (in house): <br />