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. , �CHE��K OFF i�TST FOR ISSUANCE O�' PE�'VIIT5 <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �`t'C7� ��'�rU� h�I ���2�'� <br /> PiDi: <br /> DESCR.IPTIO�i OF W4RK: <br /> ---------------------- <br /> __ ----------- -------------------- _ <br /> ZOV1�G RE�'�V BY: DATE APPROVED: �%L�t/U � <br /> BU�LDING REVIE�V BY: DATE APPROVED: ��2`t� �'1 � . <br /> FEES TO BE CHARGED: Misc. Fees Calculated By; <br /> pEg�T Yes � No <br /> PLAN REVIEtiV Yes � No SEtiVER CONNECTION <br /> STATE SURCHARGE Yes � No `VATFJRCONNECTION <br /> INVESTIGATION FEE Yes No �' P�RK FEE <br /> SAC Yes No � SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> -------------------------- <br /> ---------------------------------- 1 C� <br /> ZO��G CKE.CK LTST zaning Distric�: (_„� - . <br /> Fire Departmeat: Post Office: School District: � <br /> L,ot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes _� No Date of Survey: �J Z�� Q <br /> Proposed Setbacks: +_ ��s�- <br /> Front f��ee-}: , 1vt� V t�'`� �Side: ���{� <br /> (�y+ , <br /> Rear (�aa�: 2 , 2, - � � Side: — 7 <br /> Adjacea[ Structures: �Vetland: V1 - <br /> Buil�lin� Heioht: Def. Hgt, Pealc Hgt. _ <br /> Lot Coverage: <br /> �„��s�-`� <br /> Gradino: Staff Apgroval Date: 5�Z1��_. BY� �1��""` Council Approval Date: ' <br /> Septic: Scaff Approval Date: N /�1 By: �� y�+c,'-c�l <br /> SrL1'�lA�'�' 11 <br /> Zoain� File: R (�7' �Z55� Resolutioa: n Resolution Date: Z`� O _ 4rc-nn`�slY�� <br /> Shoreland District: <br /> Bluff Setback: L.o[Coverage: <br /> Av�. Setback: rt �1 Proposed <br /> ELis�ino <br /> Hardcaver: 0-75' <br /> 7�-2�0' s��=-���a �/� �� % <br /> 2�0-500' <br /> 5C0-lUCO' <br /> _ �, o`„ y _� �; Da;e ci Ce�c�! AP�_ova_i: Z`� <br /> cia:dco'�e� �a;i�ce .�uire�+: es o <br /> •�",�/'.Z t S <� <br /> / <br /> F.E�L�RI�S (in house): 1—►�G4z��hlCl2o���' �� ���"�''�'''��' �'�►�c,+e.2.�►-�`1 <br /> I✓i �Irr' - - <br />