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CHEC�i OFF LIST FOR ISSUANCE OF PER1ti1ITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �-7 Z C� C_�V I N(�S�pN �V L <br /> PID: <br /> DESCRIPTION OF WORh: N�W (ZC S <br /> ZO�G RE`�`V BY: DATE APPROVED: �-2� -v� <br /> BUII.DPiG REV�W BY: DATE APPROVED: -�-z� -�� <br /> FEES TO BE CHARGED: �fisc. Fees Calculated By: <br /> PERII�IIT Yes _�/' �o <br /> PLAlv REVIEW Yes �/' \o SEWER CONNECTTON <br /> STATE SURCHARGr, Yes � �o WATER CONNECTION 3�¢ <br /> INVESTIGATION FEE Yes �o PARK FEE <br /> SAC Yes � `o SITEI�i tSPECTION <br /> Number of SAC Units �.. OTHER (specify) <br /> ZO�Ti iG CHECK LIST Zoning District: L/1 -!�- � <br /> Fire Department: {Nt.a��n.0 Post Office: W�v.v� School District: W r5'fb�!lc.q, <br /> Lot Area: Sq.ft. ► �t?� Acres � d'Y�( �Vidth �(� Depth C� `( <br /> Survey Suomitted: Yes �C No Dare of Survey: '7�13-U� <br /> Proposed Setbacks: <br /> Fror.t (ba�c�e.): I S•`{`{ Right Si�e: � � <br /> Rear (Street): (� •5/Y Left Side: d <br /> Adj�cent Structures: �Q77-�Ci}f-�'7� �i'etland: Nl� <br /> Building Heioh(: Def. HgI. C9�(� P�ak HJ[. V� �� <br /> Lot Covera;e: —' <br /> Gradin�: Staff Approval Date: � By: Council Approval Date: <br /> Septic: S�aff Approval Date: — By: <br /> �.�� Zonin; File: n Resolution: # Resolution Date: <br /> Shoreland District: <br /> Av;. Setback: Bluff Setback: I.ot�overa�e: <br /> Ezistin� Proposed <br /> Hardcover: 0-7�' <br /> 75-2�0' <br /> 2�0-500' <br /> 500-1Q00' <br /> Hardcover Variance Required: Yes \o Date of Council Approval: <br /> REl�1ARKS (in house): <br /> 7 <br />