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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> , . FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z.� -3 S C �2-u�.�rv L <br /> PID: - - - -- <br /> � DESCRIPTION OF WORK: A T-r,,,c,� 6,4�t,4 6� <br /> ' �- ----------------------- _---__ --_-- <br /> Z�:�1G REVIE`V BY: � DATE APPROVED: �-2�c� 0 3 <br /> BUILDI�i 1G REV�W BY: DATE APPROVED: -��z�i-�3 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER11ifIT Yes ,/� No <br /> pLA1�1 REVIEW Yes ✓ No SEWER CONNECITOiV <br /> STATE SURCHARGE Yes ✓ No WATERCO�TNECI'ION <br /> INVESTIGATION FEE � Yes No PARK FEE <br /> SAC Yes No STTEINSPECI'ION <br /> Number of SAC�Units OTHER (specify) <br /> ZOi�1PiG CHE.CK LIST Zoning District: . <br /> Fire Department: Post Office: School District: � <br /> Lo[Area: Sq.ft. 11,i 6 9 Acres . 3�f � Width 1/�l-� 2- Depth /`�9• y <br /> Survey Submitted: Yes�_ No Date of Survey: y• z.`1-97 <br /> Proposed Setbacks: � <br /> Front(L-�e): 3�1� Right Side: ��( <br /> Rear(S�rect): °I 0 � Left Side: � �� <br /> Adjacent Structures: i¢�+c�`� �Vetland: N �✓� <br /> Building Hei�ht: Def. Hgt. (�.k Peak Hgt. — <br /> Lot Covera�e: /$��� <br /> Grading: Staff Approval Date: '— By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning FIle: # -- Resolution: # Resolution Dace: <br /> Shoreland Disuict: y�5 <br /> Avg. Setback: N/fi- Bluff Setback: �(//� L.oc Covera�e: �S°]o <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' � <br /> 500-1000' 3��70 <br /> Hardcover Variance Required: Yes No OC Date of Council App:oval: <br /> REI�LARKS (in house): <br /> 7 <br />