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CHECK O�'F LTST FOR ISSUANCE OF PER�I�i�TS <br /> � FOR OFFICE USE ONLY <br /> AUDRESS ORLEGAL: J 5/SS C�r-�eh %retS ' . <br /> PTD: � � . <br /> DES CR�ION OF ti'YORB: %re_e_ a.c�e � <br /> ZO�TiYG REVIE'�'y BY: � DATE APPROVED: 5 l� n z `- <br /> BU]ZD .T�i IG 1:2.EVTEti� BY: � � . . DATE APP�tOVED: � � <br /> �'EES TO BE CHARGED: • � � � Misc. Fees Calculated By: � � <br /> PERMIT �� �Yes ' No - � <br /> PLAN REVIEW � Yes No SEWF...R COVNECTION <br /> STATE SUR�H�RCr� Yes No �VATER CO�INECIZON <br /> IIVYESTIGA'IZON-FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECITON <br /> Number of SAC Units ���OT��R (specify) <br /> ZONI.I�'G C�CK LIST � 2onina District: .� <br /> Fire Departrnent: Post Office: School District: ' � � <br /> Lot Area: Sq.ft. � � Acres tiVidth Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: � <br /> ---=---------_ -- _- -- <br /> Front (La.'ce): -:--. - Right Side:= _: . __ - ' .__ - - <br /> Rear (Streec): � Left Side: <br /> . Adjacent Structures: SVetland: <br /> Building Heioht: Def. Hgt. Pea.k Hgt. <br /> Lot Coverage• <br /> Gradin�: Stafi Approval Date: � By: Council Approval Date: <br /> . Septic: Staff Approval Date: By: ' � . <br /> � Zoain� File: � � � . Resolution: � Resolution Date:� ' . <br /> Shoreland Dis[.-ict: � <br /> Avg. Secba=:t: Bluff Setback: I.�ot Coverage: . <br /> • • Existin� Proposed � <br /> Hardcover: 0-75' , <br /> 75-250' - • � <br /> 250-500' � � ' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approvas: <br /> REI�LARKS ('m house): � K �'o �r� ��a.c� � ��c k�-f�o v�v� a� 6 �.�Ls� <br /> " a� <br /> o--�'� (,,..�e� � �I�., y z 5 M a,�< pe � a��-A�1� �. � l <br /> � _ . . <br /> . ' ��. .26 ' <br />