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� CHEC� OFF LIST FOR ISSUAI�CE OF PERtiIITS <br /> FOR OFFICE USE ONL.Y . � . <br /> ADDRESS ORLEG.�,L: 2� 6 5 c�-�-4q� ,q„P — <br /> PID:� <br /> DESCRIPTION OF�'ORK: �(l.o��� Qn�c✓�.e �r� �a��l�� <br /> ZOr'Lti G REY�ti�B�: DATE APPROVED: �• Lv�- 01 <br /> BU]I,D�'G REVIE�i BY: � DATE APPROVID: 6 •io =a) <br /> FEES TO BE C�i4RGED: Niisc. Fees Calcula[ed By: <br /> pEgNfIT Yes r/' No :� <br /> pL,AI�t REVIE�I Yes t/' No SE�TER COY�ECTION <br /> STATE SURCHARGE Yes �/ No `�IATERCONNEC'TION <br /> .J'`i,'VESTIGATION FEE Yes No �/' PARK FEE <br /> SAC Yes No _ j SITEINSPECTION <br /> Number of SAC�ULts OTHER (specify) <br /> ZO\�L�IG CH�CK LIST zonin�Distzicc: �,/1 -� L _ . <br /> Fire Departm�nt: �p�r.r� _ Post Ofuce: W (a�4r'M Schcol District: �,�A�-t-oNi�Q � - <br /> Lo[Area: Sq.fr.T,4b Z Acres . I'1 � Width `-�5•7� Depth l y 5•�l�_— <br /> Surve;� Subritted: Yes r�� No Date of Survey: �-I 3 -�� <br /> Propased SetbacF<s: � � <br /> Front (Izke): �,5. I Ri�h.t Side: �(,O <br /> � � �� <br /> Rear (Sc.zeet): ZS LeftSide: �3 <br /> Adjace�c Struc,^�:es: /U ( (L �Vetlznd: � • <br /> Buildin� Hzi�hr. Def. :i��. V. l� Pea.�:H�t. <br /> I,ot Covera�e: <br /> Gradin�: Scaffr Approv�� Date: /U (,/L By: Council Approval Date: <br /> Septic: Staff Approv� Date: /V � /4 By: <br /> , <br /> Zoain� File: r Ut-'u�7� Resolution: n `/�'S S Resolution Date: �� � i � <� � . <br /> Shoreland Discrict: 4-e f ��� <br /> Av�. S�tback: /v� /�- Blufi Secback: /�!�/�" LotCorera�e: <br /> E���? Proposed <br /> H2.:dcover: 0-7�' -- �,C <br /> 7�-250' - <br /> 2�0-SQO' <br /> 500-1000' - <br /> Hardcover ti'`-iance Required: Yes No�,_ Da�e of Council Aoproval: <br /> gEI�IARb'.S (in house): <br /> . �t._ ' t. -a-C•� �,�1 i �_ ")Le( � ��_ e'—' /�-..��:� � <br /> j— — <br /> � ' �. <br /> 7 <br />