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� CHECK OFF LIST FOR ISSUANCE OF PER�IITS <br /> FOR OFFICE USE ONLY • <br /> ADDRESS OR LEGAL: 1�1 S (3�w r.s tLo A'� S� <br /> PID: <br /> DESCRIP"rION OF WORK: � G�,�s ��� <br /> _--__ ------------- <br /> ZO:�Tti'G REV��V BY: DATE APPROVED: /I - 3���i`�' <br /> BUILDLVG REVIEW BY: DATE APPROVED; I � - 3� -�g <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes </' No <br /> pLAI�1 REVIEW Yes v� No SE`VEK C0�1NECI�ION <br /> STATE SURCHARGE Yes � No tiVATERCOiVNECTION <br /> INVESTIGATION FEE Yes No v� PARK FEE <br /> SAC Yes No � STTELVSPECITON <br /> Number of SAC�Units OTHER (specify) <br /> ZO`Z�G C�3E.CK LIST Zoning Districr. 2(L- � � <br /> Fire Department: +�.� lh-�c� Post Office: 1.���c.� School District: ��Y"`-� <br /> Lot Area: Sq.ft. t 6 .aA� vo Acres 2,y g 7 Width Zc�� Depth S�l`'� <br /> Survey Submitted: Yes pc No Date of Survey: '�-43 •�+9 <br /> Proposed Setbacks: � <br /> Front(�aice�: 3S$ � Right Side: S� <br /> Rear (S�rcec): S�?' } Left Side: �0 <br /> Adjacent Structures: N /A `Vetland: "Z l'o� <br /> Buildin; Height: Def. Hgt. O� I�- Peal:Hgt. <br /> Lot Covera�e: N (�- ' <br /> Gradin�: Staff Approval Date: m��. By: �• Council Approval Date: <br /> Septic: S[aff Approval Da[e: ( 1• 30 �(°I By: � <br /> Zoning File: # --- Resolution: # Resolution Date: <br /> Shoreland District: �O <br /> Avg. Setback: Bluff Setback: Lot Co��era�e: <br /> Ezisting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> RE�LARKS (in house): <br /> 7 <br />