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CHECK OFF LIST FOR ISSUA.��'CE OF PERI�IITS <br /> FOR OFFICE USE 0�1I.Y • <br /> ADDRESS OR LEGAL: 3l t 1 �..�v t N�sT o� , . <br /> PID• <br /> DES CRIPTI4�I OF�ORg: �,c w rz.�.5 <br /> ZOV�G REY�tiv BY: DATE APPROti�D: 3-ZS •oo <br /> �� BL7I,DLYG REYIE�V BY: � � � DATE APPROYE'D; 3-24-O° � <br /> FEES TO BE CHARGED: � Misc. Fees Calculated By: <br /> PER��IIT Yes �/ No . <br /> pLp,Tt REVIEW � Yes ✓ No SEWER CO�TECTION <br /> STATE SURCHARGE Yes ,,/ No � �VATFFtCON�v�CTION �3�G.uiJ <br /> INVESTIGATION FEE Yes No ✓ PARK FEE <br /> SAC Yes � No � � STTEI�i TSPECTION <br /> Number of SAC•Units � OTHER(specify) <br /> ZO\Zti G CHECB LIST Zaning District: �R -�c - I__ <br /> Fire Deparcmeat: /vW�nn� Post Office: w�,�–�4 School DsLLict: �,.�Psr��4 � � <br /> Lot Area: Sq.ft. 1�5�5.�2 Acres , O�-t 5' Width 3 V,"l Depth �o�(.�3 <br /> Survey Submitted: Yes X No Date of Survey: Z 'Z �g'da <br /> Proposed Setbacks: � � <br /> � <br /> Froat(L.a-ke): � Ri;ht Side: ' C� - � . <br /> Rear (Street): 8 I.eft Side: O <br /> Adjacent Structures: �-r-T,�e„c.�tr,t�o b� Wedaad: �l r4 <br /> Building Hai�t: Def. Hat. �-I�C- Pea.'�Hgt. <br /> Lot Covera;e: N�� ' <br /> Grad.in;: Sca�i Approval Date: o.l� By: ��- Council approrzl Date: <br /> Septic: Staf;Agproval Date: �(l l�' gy; <br /> Zoain;File: � � Resolution: � R:soluaon Date: _ '. <br /> Shoreland District: � <br /> Avg. Setback: Bluff Setback: LotCot�ra�e: <br /> � Exis�mg Prop�o5�d • . <br /> n/� Hardcover: 0-7�' __ . <br /> 75-?SO' _— <br /> tiasao� <br /> 500-1000' <br /> Ha.*dcovec Variance R�quired: Yes No Date of Counci?Approval: <br /> REI�LA.RPS ('in house): lV U 5 l T�. �� ��ry����" � <br /> -r�C: IZ "� 3�UZ LI v crs�SN� chr� <br /> 7 <br />