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CHECK OFF LIST FOR ISSUAI�TCE OF PERII�IITS <br /> _ FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: g Z� �(�w,�v 1�10 tA� sQ - - <br /> PID: <br /> DESCRIP7'ION OF WORK• q� rnnti.�- ���.s�s�-� <br /> ZO�i'G REVIE`V BY: DATE APPROVED: ! -/�t � � <br /> BUII.DPi tG REVIE`� BY: DATE APPROVID: � -��1 -� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes _� No :. <br /> PLAN REVIEW Yes c/� No SERrER CONNECTION <br /> STATE SURCHARGE Yes �/ No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZO�G CH�CK LIST Zoning District: /Vt� C h�.P <br /> Fire Department: Post Office: School District: � <br /> L.ot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Fron[(La.ke): Right Side: <br /> Rear (Street): I.eft Side: <br /> Adjacen[Structures: Wetl d: . <br /> Buildin; Heigh[: Def. H;t. Peak gt. <br /> Lot Covera�e: <br /> Grading: Scaff Approval Date: B : Council Approval Date: <br /> Septic: Staff Approval Dace: By <br /> Zonin; File: # Resolution: !# Resolution Date: <br /> Shoreland District: <br /> Av�. Setback: Bluff Setback: L,ot Covera�e: <br /> Existin� Proposed <br /> a <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Da[e of Council Approval: <br /> RE�iARKS (in house): l t rv tsl�-�ni l� (3 i=lSP� ('"`� �2 ' 6"^'� ��— <br /> w ��'t-F o n�-e l�� �"�o N - c��•}e Q-e D�IL�o�f3-c. W^' <br /> c�i t t cs.z c.-> � t t-F...�v �-�s e� I'�r� s i �r-L. �v�..r `�-v �"'� �+-r/ <br /> 7 <br />