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� CHECh: OFF LIST FOR ISSUA._'�TCE OF PER�tiIITS <br /> ' ~ FOR OFFICE USE Oi�LY . � . <br /> ADDRESS ORLEGAL: ��3� ('`cZr�( �l '� <br /> PID: <br /> DES CRD?TI4N OF�ORK• �..�r,-��.}�„t �,�zv��.-e`.. <br /> ZOti�G REY���% BY: D�TE APPROV�D: S�� '�� <br /> BUIZD�'G REVIEZY BY: DA'I'E APPROYED: S• 7-.� 1 <br /> F'EES TO BE C�iARGED: Niisc. Fees Calculated By: <br /> pEgM['r Yes _ ,/ No �� <br /> PLAN REVIEW Yes �' No SEWER COi�ECTION <br /> STATE SURCHARGE Yes � No ��ATERCONNECTION <br /> ��TESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC•Units OTHER (specify) <br /> ZO\Z:�IG CI-i�CK LIST zoning Districc: `t1c� G��� _ . <br /> Fire Department: Post Oftice: School District: - � ' <br /> Lot Area: Sq.fc. Acres � idth Depth <br /> Surve;� Subr�.itted: Yes No Date of Survey: <br /> Proposed Setbac!cs: <br /> Fron[(L�ke): Ri�ht Side: � <br /> Rear (Screet}: I.eft Side: <br /> Adjacenc Structures: ZV laad: lL.� <br /> Ci�Y,-` // <br /> guile�in� Hei�hc: Def. H�t. Pe L-H�t. � <br /> �/]�� L <br /> L,oc Covera�e: v"' ' ( �Q�- <br /> �� O <br /> Gradin�: Stafi Approval Date; gy: Council� � <br /> �' <br /> Septic: Staff Approval Date: By: <br /> Zoain�File: n Resolution: n Resolution Date: � <br /> Shoreland District: <br /> Av�. Setback: Blufi Setb�k: I,otCocera�e: <br /> E���? Proposed <br /> Hardcover: 0-7�' -- <br /> 7�-250' �', -- <br /> --� <br /> ti0-500' I <br /> --� <br /> S00-lOQO' <br /> Hardcover Variance Required: Yes Na Date of Council Aoproval: �_ <br /> REtiIAR�iS (in house): `�, <br /> 7 <br />