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j ,. <br /> CHECK OFF LIST FOR ISSUANCE OF PERIVIITS <br /> FOR OFFICE USE ONLY <br /> ' ADDRFSS OR LEGAL: 3 y-1 Z L 1 V 1 N fo�Tp N A-u�P <br /> PID: <br /> DESCRIPTION OF WORK: ����� r S �,� �,N�. i(J o o/� <br /> __----------------- --------------____o,_� <br /> ZO.vI�Ti G REV�W BY: c,� DATE APPROVED: � •►� ' <br /> BUII.DI�i TG REVIEW BY: DATE APPROVED; � -�2.-o � <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes ✓� No <br /> PLAi�t REVIEW Yes c� No SEWER CONNECTION <br /> STATE SURCHARGE Yes � No WATER CONNECTION <br /> INVESTIGATION FEE Yes No �- PARK FEE <br /> SAC Yes No � STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZO�TING CH�CK LIST Zoning District: [.2-� �- <br /> Fire Department: iM�o u nr✓� Post Office: t,�/�,�-vl-6�'a School District: W P�S rjO��' <br /> Lot Area: Sq.ft. I 3, �a Acres •3 Width (Oo Depth �3a <br /> Survey Submitted: Yes_ C� No Date of Survey: 7-/4-�l�' <br /> Proposed Setbacks: <br /> Front(�: 1(0� Right Side: [d� _ <br /> Reu(S�rcet): 3�8� Left Side: ��� <br /> Adjacent Structures: 10� i'' ��Wetland: /� (A <br /> Building Height: Def. Hgt. N � ih Peal:Hgt. — <br /> Lot Coverage: l Z•b <br /> Grading: Staff Approval Date: � By: Council Approval Date: <br /> Septic: Staff Approval Date: -- By: <br /> Zoning File: # '— Resolution: # Resolution Date: <br /> Shoreland District: IU�c7 <br /> Avg. Setback: Bluff Setback: L.ot Coverage: l Z•fo <br /> Eusting Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): _ <br /> � f <br /> � <br />