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CHECK OFF LIST FOR ISSUANCE OF PER�'IITS <br /> FOR OFFICE USE OivL.Y - <br /> ADDRESS OR LEGAL: Z S�v C�Ov N T�2 s�a�e.. �R. <br /> PID: <br /> DESCRIPTION OF WORK: p��n o n} i2�.rvw �Z <br /> ZO��'G RE`'IE`V BY: — ---- DATE APPRO�,�D:` Z-z= o 0 <br /> BL�DLVG REVIE`� BY: DATE APPROYID; z- i-o � <br /> �____:____-- --- ----- _____ -- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER�tiLIT Yes ✓' No <br /> PLAN REV��1 Yes � No SEWER COivi�'ECITON <br /> STATE SURCHARGE Yes // No tiVAT�CON�'EG"ITON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEI�i TSPEG"TION <br /> Number of SAC�Units OTHER (specify) <br /> ZO`Z�G CH�CK LIST Zoning Districr. l2�Z-13 �. <br /> Fire Deparcment: (Pnr6 (A�c.c Post O�ce: L.t>�v� L4�ws School D:sLLict: �9�^�a <br /> Loc Area: Sq.ft.nt o G�qnr6�. Acres � Width Depth <br /> Survey Submitted: Yes � No Date of Survey: J I•Z.�-°�`� <br /> Proposed Setbacks: <br /> Front(bake�: q� •3 Ri;ht Side: `8`�•�1_ <br /> Rear (Street): I{.3•5 Left Side: �`1•3 <br /> Adjacent Struccures: A���au�—YJ tiVetland: y�1�� <br /> Building Height: Def. Hgt. C�.1�. Pea�:H�t. �' <br /> Lot Covera�e: � «" ' <br /> Gradin�: Staff Approval Date: 2- Z- oO By: �0 . Council�ppro�zl Date: <br /> Septic: Scaff Approval Date: Z-2-- �'� gy; � 140AtT7oN 0�= ons� ��=��Oi" <br /> y Ex �snN� 6c,o2oo�. �- �•wP��s�6�,�J/ <br /> s ys n..n�. r s � <br /> Zonin�File: # Resolution: # Resolution Date: t�,� � a��o� <br /> Shoreland District: <br /> Av�. Setback: Bluff Setback: LotCo�-�ra�e: <br /> Ezistmo Progosed <br /> Hardcover: 0-7�' <br /> (�'� . 75-2�0' <br /> �� 2�0-SQO' <br /> 500-1Od0' <br /> Hardcover Variance R:quired: Yes No Date o`Counci? Approval: _ <br /> RE�L4R�S (in house): <br /> 7 <br />