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� '� CHECK OFF LIST FOR ISSUANCE OF PER1ti1ITS <br /> _ FOR OFFICE USE ONL.Y � . <br /> ADDRESS ORLEGAL: �Z,C� � �(Z�e�iC_�{ C12.t_Z.K 1��✓� <br /> PID: <br /> DESCRIPTION OF�ORK: �},pr� � r� o�I <br /> . - <br /> ZO��I:ti'G REY�ti� BY: DATE APPROVED: /O - <br /> BUII,DING REVIE� BY: DATE APPROVED: � <br /> FEES TO BE CH.4RGED: Niisc. Fees Calculated By: <br /> pERMIT Yes o( No � <br /> pL,AN REVIEW Yes � No SEWFR CONNECTION <br /> STATE SURCHARGE Yes o� No WATERCONYECIION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPEC ITON <br /> I�'umber of SAC�Units OTHER (specify) <br /> ZO�+�L�IG CH�CK LIST Zonin; Districc: <br /> N`' . . . <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Surve;� Sub�itted: Yes o� No Date of Survey: �•2�t• °11 <br /> lrt ST R'�'yU� SVo� lu-�1 • 00 . <br /> Propcsed Setbacks: <br /> Front (La.ke): �y� '� Ri;ht Side: SS' } <br /> � + <br /> Rear (Screet): 51� � Left Side: �b – <br /> Adjacent Structures: q��r,c�W..P�.4 �Vetland: � (A • <br /> Bui?din� Hei�hc: Def. H�t. (� , �L Pea'_�H�t. (�� 1� <br /> Loc Covera�e: � <br /> Gradin�: Staff Approval Date: — By: Council Approvai Date: <br /> Sep�ic: Staff Approval Date: — By: <br /> Zonin�File: # — '�',-" �� Resolution: N — Resolution Date: — <br /> Shoreland District: ��� <br /> Av�. Setbac : Blufi Setback: /�(d�' I.otCo��era�e: <br /> E���� Proposed <br /> Hardcover: 0-7�' <br /> 75-250' <br /> ti0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Dat� of Council Approval: <br /> REI�IA.RhS (in house): c. p2n D�= C�/1�tn,«T s5`'P� ti 5 r' <br /> - S�-P n c l�f-,�✓� �-o (3-P Vt^'o � lp.-z- `{"��� �< r r�I Ss�� _ <br /> 7 <br />