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i� <br /> CHECK OFF LIST FOR ISSUAIVCE OF PERttiIITS <br /> FOR OFFICE USE ONL Y <br /> ADDRESS OR LEGAL: �5 Z �o c,l �� �✓� � <br /> PID: ' <br /> DESCRIPTION OF YliO.RK: N�w �7�c�S <br /> ------------------------------------ ------ - -------------------------------------------- <br /> ZO�vI�VGREVIEtVBY: D.�.TEAPPROVED: �- � -os� <br /> BUILDING REYI.EW BY: DATEAPPROG'ED: � -20 -os <br /> --------------------------- <br /> FEES TO BE CHA,RGED: �Iisc. Fees Calcc�fated By: <br /> PERNIIT Yes ✓ No <br /> PLAtV REVIEGV Yes � �Vo SEYVER CO�VNEGTION <br /> STATE SURCH.4RGE Yes ..�— tVo tiVATER COtVtUECTIO�V <br /> I�VVESTIG,4TIOtV FEE Yes [Vo � PARK FEE <br /> S:�C Y"es ✓ !Vo SITENSPECTIOtV <br /> Nun26er of SAC U��its _�_ OTHER (specify) " <br /> ------------------------------------------------------------------------------------------------------------- - --- <br /> 2'O�vI1VG CHEC.Fi'LIST zo�a,�g o�sc,�tcc: <br /> Fire Deparhrierrt: Post Office: Scltool Dish•tct: __.. <br /> Lot.�(ren: Sq ft. Acres YVicid� Depth <br /> Siuvey Subruitted: Yes�C _ No Date af Scuvey: � - �3-C)S <br /> Proposed Set6acks: <br /> Fronr(L-rrkcr• 6 Right Side: e� <br /> Rear(Sf�aet): � Left Side: � <br /> Adjacent Struct�u•es: � G�etland: o •1c <br /> Building Keiglit: Def. Ngt. C`� •� Peak Kgt. <br /> Got Coverage: � /�I A <br /> Grading: Staff App��ovctl Date: � •�� �'� �f By: �� Council Approva! Date: <br /> Septic: Stnjf,�lpp�•o1�a!Date: /V(/9 By: <br /> Zonirzg File: # — Resolutiai: # Resolt�tion Dnte: <br /> Shoreland Dish•ict: Q�l v <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Exisiing Pra p osed <br /> Hardcove�•: 0-7.5' <br /> 75-2�0' <br /> Z50-500' ' <br /> 500-l000' <br /> Harcicover Var•iance Rec�ieir�ed: Yes No Date of Cowicil�lpproval: <br /> RE1I�IARXS(irt Itouse): <br /> �1 31 <br /> ��i• ; �,�'� ,. � <br /> ;i �t: <br /> - �� � . . � ��� . . ... . �� ���SI 41iY �� i�,�Iir .r i I��(��Il !'��� ��".,� �,"I�„ � d�i ' I� i i <br /> i� i�N�k� I �k i��,9 A �'� � ���' <br /> :� .�. <br />