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CHECK OFF LTST FOR ISSUANCE OF PER�I�iITS <br /> � FOR OFFICE USE ONLY <br /> ' ADDRESS OR LEGAL: l� �5 �-!L R�T rac,C. �v�+�` ' . <br /> PID: <br /> DES CRIPTION OF WORb: ,�r�,� ,,�o„� � <br /> ZO�TiYG REVIEti'V BY: � (��_ � � DAT'E APPROVED: � Z- � -`1� `- <br /> BUII..DliYG REYI.Eti'Y BY:. � . DATE APPROVED: �L-fh-.9� <br /> �'EES TO BE CHARGED: - � � Misc. Fees Calculated By: <br /> P�cRMIT _Yes �/`' No . <br /> PLAN REV�� Yes ,/� No SEWER COVNECTiON <br /> STATE SUR`H�RG�, Yes r/ No ti�ATER CONNECTION <br /> TivVESTIGAZZON-FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPEC�ION <br /> Number of SAC Units ��OTHER (specify) <br /> �ONI3�'G CFiECK LIST zoning Districc: L2- l 1� � ~ <br /> Fire Department: (;o,�� L.A�1c.G Post Office: �..� U�tc.e School District: _�Ror.�o � <br /> Lot Area: Sq.ft. �{2�337.� Acres .9� �Vidth 1�$1.e� h,t�. Depth _�3 Z.:'�`� �4 ve � <br /> Survey Submitted: Yes p� No Date of Survey: S-l o-�(o <br /> Proposed Setbacks: <br /> _ Froat (�'ce7: . (35 _..__Rigfi2 Side: �1 ' t. . _ _� _ ' <br /> Rear (S�tettj: sS� Left Side: �(,v t <br /> Adjacent Structures: (�r���.��-,r� tiVetland: �s r <br /> Buildino Heioht: Def. Hgt. 4 k. Pea.k Hgt. O•1�. <br /> Lot Coveraoe: �i�lo <br /> GradinJ: Stafi Approval Date: ^ . By: — Council Approval Date: -' <br /> Septic: Staff Approval Dace: -- gy; -- . <br /> Zoaing File: � � -- Resolution: � '— Resolution Date:� — • <br /> Shoreland Dis�-ict: ' /Uv <br /> Avg. Secbac?c: Bluff Setback: LotCove�age: � _ <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 Approval: <br /> � <br /> RE1�L?�RKS ('in house): <br /> ? � _ . - . <br /> . ' ��:� � .26 • <br />