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� CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> � ADDRESS OR LEGAL: g ZS (3(2.t�w� ��J _ <br /> PID: /��- // y,'- �3 - .�/ - x x x� <br /> DESCRIPTION OF WORK: ��� (2�ts S <br /> ZOrT�G REV�W BY: „_ DATE APPROVED: '�-i Y - S� <br /> BLTILDPIG REV�W BY: DATE APPROVED: � -1�( -�r� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓� No <br /> PLAN REVIEW . Yes ✓ No SEWER CONNECTION <br /> STATE SURCHARGE Yes � No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTTON <br /> Number of SAC-Units OTHER (specify) <br /> ZONING CH�CK LIST Zoning District: 2�"4� <br /> Fire Department: r,u�i G4� Post Office: ��t� School District: pR-��1J0 <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes_ Cp_ No Date of Survey: '� • "z' 9 9 <br /> Proposed Setbacks: <br /> Front(i..aice): K�-S� '� ��:t S:de: // Z <br /> Rear (Sueet): �`1�� � Left Side: � ,'7 � <br /> Adjacent Structures: , N �✓+ Wetland: i��3 � <br /> Building Height: Def. Hgt. Z"� � Peal:Hgt. 31 ` <br /> Lot Coverage: /✓�/¢ <br /> Grading: Staff Approval Date: 7- ►`l ` ?'Qt By: o�'�• Council Approval Date: <br /> Septic: Staff Approval Date: '�-� `/ ` �"� By: ot�� <br /> Zoning File: # � Resolution: # '� Resolution Date: <br /> Shoreland District: NV <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Existing 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 /> REMARKS (in house): <br /> 7 <br />