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' CHECK OFF LIST FOR ISSUAlvCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Sb-7 F ERN vJ A L�. ,�,�+,A N <br /> PID: <br /> DESCRIPT'ION OF WORK: �L vJ R,`.-� <br /> ZOVPtG RE'VIEW BY: DATE APPROVED: /�- 9 -0 5 <br /> BUII�DI'�i �'G REV��V BY: DATE APPROVED: �J . q- a s <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes .� No <br /> PLAN REVIEW Yes � No SEWER C0�INECTION <br /> STATE SURCHARGE Yes � No WATERCONNECITON <br /> INVESTIGATION FEE Yes No �/ PARK FEE <br /> SAC Yes No �/ SITEINSPECTION <br /> Number of SAC Units ,-�` OTHER (specify) <br /> --------------------------------------------------------------------------------------------------------------------- <br /> ZO�Ti tG CH�CK LIST Zoning Districr. <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sc.ft. $S, Zo`I•`1K Acres I.�is Width �Rlus���9-/L- Depch <br /> Survey Submitted: Yes �_ No Date of Survey: I o -Z5 -O � <br /> Proposed Setbacks`. <br /> Front (L-sic�: � 3�� � Right Side: 3Y�S <br /> Rear (Sz�eet): S3 .I Left Side: ( �y� <br /> Adjacent Structures: nl I A Wetland: Z.S/D� � <br /> Buiiding riei�ht: De�. Iioi• 3� reai:iioc• 3 g <br /> Lot Coverage: � .S "jo <br /> Grading: Staff Approval Date: I I-S '�`� By: �. r[Sv Council Approval Date: — <br /> Septic: Staff Approval Date: �1- 4 -o S By: (,v•�. <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: ?`�S C� <br /> Av�. Se[back: Bluff Setback: L.ot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 7�-250' <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> R�I�LA�tKS (in house): <br /> � <br />