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CHECB OFFLIS7'FOR ISSUANCE OFPERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: i r j 3 C�5 e C� � ,� �-- <br /> PID: <br /> DESCRIPTION OF WORK: � p,/,,V �,���J <br /> ZONING REVIEW BY.• DATEAPPROi�ED: <br /> BUILDING REf�IEW BY.• DATEAPPROT�ED: <br /> 6 y-09 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes No <br /> P�N��E� Y�S� N� SEWER CO <br /> STATE SURCHARGE YeS �' NNECTION <br /> WVESTIGATION FEE YeS NO u'ATER CONNECTION <br /> No ./ PARK FEE -- <br /> SAC Yes No ,/ SITEINSPECTION <br /> IJumber of SAC Units Pp��-g z i a �. bY OTHER (spec�) <br /> ZONING CHECg LIST Zoning District: %i/�/L, <br /> .�ire Department: Post Dffice: <br /> School District.• <br /> Lot Area: Sq.ft..���'"�T y�' l� ,qcres��G�f Width <br /> ' i`Wt.vG�� -- 37C�G� � � �,y� --------- Depth <br /> Survey Submitted: Yes� No � Date of Survey: � i�/ <br /> Proposed Setb� ��� Ri t�}. <br /> Front ake ^ gh S'ide: � �, � <br /> Rear treet : �� (y Le�de: � �j� � �W� �5�� <br /> /'_ Dd�� <br /> Adjacent Structures:l�(;"' Z[� _ ,L� Wetland: ^//�' C%�� � � <br /> —��— n � � � � <br /> Building Height.• Def. Hgt•_ '�G�,�j Peak Hgt, '`,�2 � �-�'R'� <br /> Lot Coverage: �, �G'��O_ LG��LL pj� <br /> r y, <br /> Grading: Staff,4pproval Date: By: CouncilApprc,,,ui Uate: <br /> Septic: Staf�"Approval Date: By. �� <br /> Zoning File:= # 1"�-'� Resolution: # r'��� <br /> Resoluiion Date: <br /> Shoreland District.• <br /> MCWD Permit: <br /> Avg. Setbacb.• BZuffSetback: <br /> Lot Coverage: <br /> Ez isting Proposed . <br /> Hardcover: 0-75' ZZ� , 3' �OIV <br /> 75-250' <br /> zso-soo- `��� � 2�°1� <br /> soo-r000� —�'Z� �2I, r�v ` <br /> Hardcover i�ariance Required.• Yes No <br /> Date of Council.4pproval: <br /> REMARKS(in house): <br /> 33 <br />