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, � � CHECI� O�F LIST FOR ISSUA.�'�TCE OF PER1tiJTTS <br /> FOR OFFICE USE Oi�L.Y ' . <br /> A.DDRESS ORLEGAL: ( �� QI b S.St/4r�1✓J A D 3�8Z� <br /> PID: <br /> DESCRIP'I'IONOF�ORK: l�GU� ��o�- �'�cAZC"f.3a <br /> . <br /> Z Or�G REVIEti�BY: D�TE APPROVED: S_2� -U i <br /> BUII,DTs�'G REVIE�BY: D�.TE APPROYFr..D: �,�-'-Z c �o i <br /> FEES TO BE CTiARGED: Niisc. Fees Calculated By: <br /> pEgMI'I' Yes i/' No -� <br /> PLAN R.EVIEW Yes �/' No SES�IER COiV�1EC'I'ION <br /> STATE SURCHARGE Yes _� No `�ATERCONNECTION <br /> Ii�,'VESTTGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECITON <br /> Number of SAC�Units OTHER (specify) <br /> ZONLti G CH�CK `,IST zoning Dis�icc: fZ S' . <br /> Fire Department: C�t-t� Post Ofuce: /J ( /�r School Distcict: - /��✓� � <br /> I.ot�,rea: Sq.ft. /v'd C[�+4r�Acres — � Widch — Depth <br /> Surve;� Sub�itted: Yes_�C No Date of Survey: o�r tt <br /> Proposed Setbacks: <br /> Fron[(Lz'_�e): I SS � RiQht Side: 25' % <br /> . � � + <br /> Reas (Screet): 7 '?� ^' L.eft Side: <br /> �0' . <br /> Adjaceat S�ructures: �.��� �Vetland: /`�<� • <br /> guildin� Hzi�ht: Def. H�t. o .G�- Pea��H�t. D(< <br /> Lot Covera�e: .��i� <br /> Gradi.n�: Stafi Approval Date: "— By: --' Council Approval Da[e: <br /> Septic: Scaff Approval Dace: "— By: <br /> ZQni�� File: n '"'" Resolution: � Resolutioa Date: . <br /> Shoreland District: V-C 5 <br /> Av�. Setback: c,.�.(L Blufi Setback: �^-���" LotCocera�e: <br /> E���j proposed <br /> Ha.rdcover: 0-7�' <br /> 7�-250' -- ���• <br /> Z�0-500' <br /> 500-1dQ0' <br /> Hardcover Variance Required: Yes No�_ Dat� of Council Aoproval: <br /> REl�L4R.�iS (in house}: <br /> 7 <br />