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� • <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESSORLEGAL: SZS �v,vrcrz l�AsS <br /> PID: <br /> DESCRIPTION OF WORK: �o x��a s�rv►c�,= s,y-�� <br /> ZO�TIG REY�tiY BY: DATE APPROYED: Q!- �Z -�`� <br /> BUII.�DT1G REV�tiV B • DA'I'E APPROVED; �8 -�2-�`� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER�v1IT Yes �/ No <br /> PLAI�t REVIEW Yes r/ No SEWER CONNECTION <br /> STATE SURCHARGE Yes �/ No WATERCONNECTTON <br /> INVESTIGATION FEE � Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC-Units OTHER (specify) <br /> ZONING CHE.CK LIST Zonina Districc: <br /> Fire Department: Post O�ce: School District: � <br /> Lot Area: Sq.ft. Acres � Width Depth <br /> Survey Submitted: Yes_ � No Date of Survey: on+ �=�� <br /> Progosed Setbacks: <br /> Front(Ls�ee): Z°I� � Right Side: �'�Z- <br /> Reaz(S�rcbt): 2"1 Z� Left Side: 30� <br /> Adjacent Structures: i L` t �Vetland: l ZA <br /> Building Hei�ht: Def. Hgt. Peal:Hgt. <br /> Lot Coveraae: �/A <br /> Grading: Staff Approval Date: ,✓(A By: Council Approval Date: <br /> Septic: Staff Approval Date: ,.��� By: <br /> Zoning File: #� Resotution: # Resolution Date: � <br /> Shoreland District: /U� � <br /> Avg. Setback: Bluff Setback: I.otCoverage: <br /> Eusting Proposed <br /> Hardcover: 0-75' <br /> 75-Z50' <br /> 250-500' <br /> 500-1000' <br /> Hazdcover Variaace Required: Yes No Date of Councit Approval: <br /> REMARKS (in house): <br /> 7 <br />