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� CHEC�i OFF LIST FOR ISSUAi�TCE OF PER11�nTS <br /> •_ ' FOR OFFICE USE ONI.Y . ' . <br /> ADDRESS OR LEGAL: 2 g�l� c..� c�'r o RC t-c AR�J W v�., <br /> PID: <br /> D�CRIpZ'ION OF�ORK: o ol <br /> , <br /> ZOr'�L1 G REVIEti�BY: DATE APPROV�D: y-s'-�l <br /> BUILDING REY��BY: . D�TE APPROVE�D: y-�-vt ' . <br /> FEES TO BE C$4RGED: Niisc. Fees Calculated By: � <br /> PERMIT Yes / No :� <br /> PLAN REVIEW Yes _� No SE�ER CO�INECTION <br /> STATE SURCHARGE Yes � No �ATF�CONNECTION <br /> I�,'VESTIGATION FEE Yes No PARK FEE <br /> SAC � Yes No SITEINSPECTION <br /> Number of SAC•Units OTHER (specify) <br /> ZO��LIIG CS�CK LIST zonin�Dis�ict: GR -I/� . <br /> Fire Deparcment: t Post Office: a School District: ,!2(�u/Ju' • <br /> L,ot Area: Sq.ft. iv� C M�rvG/�►cres — ' Widch — DeP� � <br /> Surve;Subritted: Yes_ C� No Date of Survey: ,�nr f"► (`Q � �� �� <br /> Pro osed Setb2cks: , � <br /> P F,�aet(La.ke): 125 +±' ��}�,t Side: ' ?0 � '}' � <br /> Screet I�0 � ± !R S� "�' <br /> F�ear ( ): Lefr Side: <br /> � • <br /> Adjacent Structures: Z4 Wetlxnd: N 1 A • <br /> Buildin�Hei�ht: Def. H�t. /J I� Pea.�:Hgt. N/� <br /> Lot Coverage: N �� � <br /> Gcadin;: Srafi Approval Date: —' By: Council Approval Date: <br /> Septic: Staff Approval Date: —' By: _ <br /> Zoain�File: R — Resolucion:: Resolution Date: • <br /> Shoreland District: y,C3 ��Ca�em�e: O•l� <br /> Av�. Setback: O-��- Bluf[Setback: D •�L • <br /> E���a PropoSed <br /> Hardcover: 0-75' <br /> 75-250' Zy'a <br /> — ti0-500' <br /> 500-1000' _ <br /> Hazdcover Variance Required: Yes No�_ Date of Council Aoproval: <br /> gEl�1AR�;S(in house): <br /> 7 <br />