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� <br /> CHECK OFF LIST FOR ISSUA1vCE D.F PER.11%tITS <br /> FOR OFFICE USE ONL Y <br /> ADDRESSORLEGAL: Z3y5 63��AiNE A�C. <br /> PID: <br /> DES CRIPTION OF Yf�ORK: � A^�t�-�i" �S A��e`�- � `a'a�"`'�ri�°�"'e� <br /> - - - ---------- <br /> ---------------------------------------- <br /> -- --- ------ , <br /> ZONINGREVIEGVBY: G/!x6 6��/A �U . D.ATEAPPROVED: `/- Y-°� � <br /> BliILDX1VGREVXEWBY, /���/� DATEAPPR06`ED: <br /> -------------------------------------------------------------------- <br /> FEES TO BE CHARGED: hlisc. Fees Cafcccfated B}.�: <br /> PERII�IIT Yes ✓ No <br /> PL�4N REVIE6V Yes No � SEIVER GON�VECTIO�V <br /> STATE SURCH.4RGE Yes � tVo YVATER COtWECTIOIV <br /> I��IVESTIG,4TIO�V FEE Yes �Vo ✓ PARK FEE <br /> SAC .Yes tVo .� SITE NSPECTION <br /> Ncunber•of SAC U�tits OTHER (specify) <br /> -------------------------------------------------------------------- <br /> ZONING CHECh'LIST Zar�in�District: �v o G/-�� <br /> Fire Depnrhrien/: Post Off ce: Sdxool District: __.. <br /> Lot,�(rea: Sq.f'�. flcres 6Vidtli Depth <br /> S�c�-vey Subfriitted: Yes No Date of Su�vey: <br /> Proposed Set6ndcs: <br /> Frorit(Lal,e): Right Side: <br /> Renr(Sh•eet): Left Side: <br /> Adjncent Str•e�ctiu•es: Yf�edand: <br /> Buildi�Tg H�ight: Def. Ngt. \ Peak Kgt. <br /> � • <br /> Lot Coverage: � <br /> Grading: Staff.dpproval Date: By: Counci(rLpproval Date: <br /> Septic: Staff,�Lpp�•ova!Date: BY� <br /> Zonutg Fife: # Resolutia:: # Resoh�tiat Dnte: <br /> Shoreland Dish•ict: <br /> Avg.Setback: Bluff Setbnc/c: Lo[Coverage: <br /> Esistirc,; Proposed <br /> Hardcover: 0-T' <br /> 75-250' <br /> ?50-500' � <br /> � <br /> 500-1000' <br /> Harcicover Variatice Reqccired: Yes No Date of Coultcif Approval: <br /> .RE1I�IARKS(ifi house): <br /> PP2v�e� � 6�—� ��P -P`�, T it z,.o� <br /> 31 <br /> �{,; a �� :,� �, <br /> . �, �' <br />