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. CHECK OFF LIST FOR ISSUAI\'CE OF PER1�iITS <br /> FOR OFFICE USE ONLY <br /> :�DDRESS OR LEG:�L: %�/4o Ch�� pLA�' pID' <br /> DESCRIPTIO\ OF «�OR�i' �/1G� <br /> ------------------------------ -- <br /> ---------�------------------ <br /> ZO�I\G RE`'IE�V BY: DATE APPROVED: � - �'7 -S S <br /> BL�.DL1G REVIE`V BI': DATE APPROVED: �- 5-�S <br /> ----------------------------- <br /> FEES TO BE CH.�RGED: �iisc. Fees Calculated By: <br /> PER�IIT Yes � �o <br /> PLAN REVIEW Yes r/ No SEWER CONNECTION <br /> STATE StiRCHARGE Yes �/ No WATER COIVivEC'ITON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> --------------------------------_---_ <br /> ZOi\L`G CHECIi LIST Zoning District: G�'l�- Shoreland District : ��5 <br /> Fire Department: rIn�.,�•c� Posc Office: ��,.,►•+n.� Schooi Distric�: WQ,al-�� <br /> � <br /> Lot Area: Sq.ft. I 1,�(�`/ Acres • 't-�► �'iath �� 14Y�'- Depth 2�y �� � `�� <br /> Survey Submitted: Yes �_ No Date of Survey: �— S' 13 <br /> Proposed Setbacks: , ��;� <br /> F�eerrt �Lal:e): l� �� Right Side: 1 S �./ <br /> .Rear (Street): 1'�� = Left Side: �d� � <br /> Adjacent Structures: ��IAGI�� Wetland: N �- <br /> Building Height: Def. Hgt. /u/A Peak H�� ,. �{�,.yt.� <br /> '! �„�, <br /> Avg. Setback: /�/1�4 <br /> Bluff Setback: _ i�f`� � �; �� ��• U <br /> ��` � ` <br /> ExistinQ �`' r' " � '� <br /> Hardcover: �-��' V i.�� '+/{'�• ��� <br /> 75-250' �•2 ��' n,�,�j���' <br /> 250-�00' ��'�� �' - <br /> �00-1000' f�•�" 1,` <br /> Hardcover �Jariance Required: Yes D� No Date of Council Approval: �J-Z�'�s <br /> Gradin�: Staff Approval Date: —" By: Council Approval Date: <br /> Sep[ic: Scaff ?.pproval Date: — By: <br /> Zonina File: ; ?�3`'� Resoiucion: # Resolution Date: '7-2'�'� S <br /> ��i�tKS (in house): <br /> 26 <br />