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� CHECb' OFF LIST FOR ISSUA.�'�TCE OF PERtifITS <br /> FOR OFFICE USE ONI.Y . ' . <br /> ADDRESS OR LEGAL: Z�t O S C ✓�5 c-� Po i�vT ��� <br /> PID: <br /> DESCRIPTION OF�YORK: (��c„� ✓3 cc�55 s'r-✓�� � <br /> ZOti'L1'G REY�ti�BY: , D�TE APPROVED: G • Z� -�'� <br /> BUILDI�'G REV1�E�BY: � . D�TE APPROY�D: � -i.c,�� _o� <br /> FEES TO BE C�i4RGED: Niisc. Fees Caiculated By: <br /> pEgM[T Yes �- No �� <br /> PLAN REVIEW Yes � No SE�TER CONNECTION <br /> STATE SURCHARGE Yes �/� No ��T�C�N���� <br /> �,'VESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECITON <br /> Number of SAC�Units OTHER (specify) <br /> ZOti�G' C�CK LIST zonin�Districc: itro Gtt.�r�..0 _ . <br /> e artm nt: Post Oftice• Sc`col District: • � ' <br /> Fire D p � • • <br /> Lot Area: Sq.ft. Acres � Width Depth <br /> Surve;� Sub�itted: Yes No Date of Se::ey: <br /> Propased Setbacks: <br /> Front(La.�Ce): Ri;ht Side: ' <br /> � �v.�+ 0 2 <br /> Rear (Screet): L.eft Side: <br /> c��<< <br /> Adjacen[Structures: �Vetland: • <br /> guildin� Hei�ht: Def. H�t. Peak H�t. <br /> Lot Covera�e: <br /> Gradin�: S�afi Approval Date: gy: Council Approval Date: <br /> Septic: Staff Approval Dace: By: <br /> Zoning File: R Resolution: � Resolutio�Date: � <br /> Shoreland District: _T y J��Ca�•e��e: <br /> Av�. Setback: Blufi Secback: � <br /> Existin� Proposed <br /> Hardcover: 0-7�' ----- <br /> 7�-250' - <br /> ti0-500' -- <br /> 500-1000' -- <br /> Hardcover Variance Required: Yes No Date of Council Aoproval: _____ <br /> gEI�IAR�;S (in house): <br /> 7 <br />