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, • CHECK OFF LIST FOR ISSUA��rCE OF PER1tiIITS <br /> _ FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: !-7 S C2�5 T�t- ��-P—� <br /> PID: <br /> DESCRIPri'ION OF WORK: �q-,�� , -�—i � N <br /> ZO�'G REVIE`�% BY: DATE APPROVED: S- �-�� <br /> BUILDI�i tG REY�ti� BY: DATE APPROVED: S - z-� -�o <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> pEg1VIIT Yes � No : <br /> pLAN REVIEW Yes � No SEWF�CONNECTION <br /> STATE SURCHARGE Yes v No WATERCONNECTION <br /> I'�1�VESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTTON <br /> Number of SAC�Units OTHER (specify) <br /> ZONI:�iG C�CK LIST zoning Districc: 0�� Gc-t-�w�, <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq.ft. Acres idth Depth <br /> Surve; Submitted: Yes � No Date of Survey: Oti <br /> Proposed Setbacks: <br /> Fron[ (La.ke): �D` = Ri�ht Side: ►y 0 <br /> Rear (Screet): 23'2-� �' Left Side: ln 3 <br /> Adjacent Structures: f4'rrr���-� tiVetland: N�✓� � <br /> Buildin� Hei�h[: Def. Hgt. (.?-1�-- Peaic Hot. d'1 <br /> Lot Covera�e: — <br /> Gradin�: S�aff Approval Date: � By: Council Approval Date: <br /> SeQtic: Staff Approval Dace: — By: <br /> Zoning File: � Resolution: n Resolution Date: <br /> Shoreland District: N � <br /> Av�. Secback: Blufi Setback: L.ot Covera�e: <br /> Eusting Proposed <br /> Hardcover: 0-7�' <br /> 75-250' <br /> ti0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> RE�LARKS (in house): <br /> 7 <br />