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� , CHEC�i OFF LIST FOR ISSUA.�TCE OF PERti1ITS <br /> , FOR OFFICE USE O�tLY _ � . <br /> AD]�RESSORLEGAL: 3UgS C �5�� Qd cN� ��� <br /> PID: <br /> DESCR�'TION OF�ORK: ��,L <br /> . <br /> ZOr'Lti G REVIEti�BY: o D�TE APPROV�D: �� 1�-1 - O ( <br /> BtT1I�D .7�TG REY��BY: . DA'I�E A.PPROYID: S- (`(- D1 <br /> F'EES TO BE CH.4RGED: Niisc. Fees Calculated By: <br /> pERMIIT Yes �/ No �• <br /> pL,AN REVIEW Yes� No SE�ER CO�tNECI'ION <br /> STATE SURCHARGE Yes � No ��TAZ�RCONNECTION <br /> I�i tVESTIGATION FEE Yes No PARK �E <br /> SAC Yes No SITEINSPECTTON <br /> Number of SAC�Units OTHER (specify) <br /> ZOti1-�G CH�CK LIST zoning Districc: C.jZ- ► L . <br /> Fire Degartment: �t��1 N � Post Ofuce: w���-t�4-ti�_ School District: �N G���1� <br /> L�ot Area: Sq.ft. /vo CN�rv�,.� Acres � Widch Depth <br /> Surve;� Sub.�.itted: Yes � No Date of Survey: <br /> Propased Sefoac?cs: � <br /> Front(La.ke): b�j� RiQhc Side: � �� � <br /> Re2s (Street): ► 2 5 Left Side: (2� �% <br /> Adjacenc Struccures: (�rTC14C.t--t�.Y.) �Vetland: f� ��' • <br /> Buile�in�Hei�ht: Def. H�t. /�!((q- Peak H�t. — <br /> Lo[ Covera��: O 11�- <br /> Gradi��: Staft Approval Date: /�! �./a- By: � Council Approval Da[e: — <br /> Septir. Staff Approval Dace: N (/� By: <br /> Zoa:��File: � � Resolution: n Resolution Date: � <br /> Shoreland District: y-G S <br /> Av�. Setback: N ( ✓1- Bluft Setback: �✓ (� ��Co�'em�e: <br /> E���� Proposed <br /> Hardcover: 0-7�' <br /> ��-Zso� o.)� <br /> ti0-500' <br /> 500-1OQ0' <br /> Hardcover Variance Required: Yes No�_ Date of CounciF Aoproval: �_ <br /> gEtiL�.R�;S (in house): <br /> 7 <br />