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. � CHEC� OFF 3�IST FOR ISSUANCE O� PER�.�fIT5 <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �l 3 3 �A 5� G��� <br /> PID: <br /> DESCR�T'�ION OF WORK: ��c� �G�A�✓Z -f �� ��0� <br /> ZO�PtG REVIEtiV BY: `--- - - ___ DAT'E APPROVED: �Q,-2� -J� <br /> SLTII�DING REVIEtiV BY: DATE APPROVED: g•2�—o t <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIE`V � Yes /No � SE`�IER CONNECTION <br /> STATE SURCHARGE Yes v No `VATERCONNECTION <br /> INVESTIGATION FEE Yes Na PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC�Units OTHER (sgecify) <br /> ZON'!VG CHE.CK. LTST Zoning District: 1Vo �1`F�'�C� , <br /> u <br /> Fire Deparcment: Post Office: School Distr' . � <br /> L,ot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes No Date of Su ey: <br /> Proposed Setbacks: <br /> Fronc (Lake): Right Side: <br /> Rear (Street}: Left Side: <br /> Adjacent Structures: etland: <br /> Buil�lin� Height: Def, Hgt. Peal:Hgt. <br /> Lot Coveraje: <br /> Grading: Staff Approval Date: By: Council Approval Date: ' <br /> Sepcic: Staff Approval D . �Y� <br /> Zoaing File: �/ _ Resolutioa: # Resolution Date: <br /> Shoreland 'strict: <br /> Av�. Setback: $luff Setback: I.ot Coverage: <br /> E�istin� Proposed <br /> 0 <br /> Hardcover: 0-75' <br /> 75-250' �` <br /> 2�0-50a' � <br /> 500-1000' \ <br /> Ila:dcover Va:iance Required: Yes No Da�e F Council Approva!: <br /> RE�L4RKS (in house): <br />