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CHECK OFF LIST FOR ISSUANCE OF PERVIITS <br /> . � FOR OFFICE USE OivL,Y • <br /> ADDRESS OR LEGAL: 343ZS C 4+�2� qV� - <br /> PID: <br /> DESCRLPTION OF WORK: ��� <br /> ZO�'Iti"G REVIEtiV BY: --------- DATE APPRO��ED: �- Z,m=o 0 <br /> BL'ILDL�tG REVIE`V BY: DATE APPROV�D: 1 -Z�•� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes ✓ No <br /> pLAN REV�W Yes No SEtiVER CO�fiTECfiION <br /> STATE SURCHARGE Yes No tiVATF�tCOi�I�+�ECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEItii TSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZO�Zti G CH�CK LIST zoning Districc: G R- !C- . <br /> Fire Department: �urn/� Post Office: /M.���v� School DsSict: t�rf'S�nrl,ci4 <br /> I.ot Area: Sq.ft. 31+ �1�7 Acres . 73 � Width j 2R�"� ��`� Depch <br /> Survey Submitted: Yes�c_ No Date of Survey: l2—17-�t rb <br /> Proposed Setbacks: � <br /> Front (La.ke): N/Ia Ri�ht Side: �� <br /> Rear (Street): N,�" Left Side: ?� ' <br /> Adjaceat Structures: /�llrA �Vetland: <br /> Buildin� Hei;ht: Def. Hgt. Peal:H?t. <br /> Lot Covera�e: ' <br /> Gradin�: Staff Approval Date: By: Council Appro�-z1 Date: <br /> Septic: Scaff Approval Date: By: <br /> Zonin�File: # Resolution: # Resolution Date: <br /> �A <br /> Shoreland District: <br /> Av�. Setback: Bluff Setback: I-°�C°�=r�;e' <br /> Ezisting Progosed <br /> Hardcover: 0-7�' <br /> 75-2�0' <br /> 2�0-Sd0' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date o`Council Approval: _ <br /> REI�LAR�iS ('in house): <br /> 7 <br />