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� CHEC�i'. O�F LIST FOR ISSUA�.�TCE OF PERLtiIYTS <br /> _ � FOR OFFICE USE ONLY . ' . <br /> ADDRESS OR LEGAL: 1I 4 U (�c�a�VF C.I�v�i4 A-Jt, - <br /> PID: <br /> DES CRIP'I'ION OF�ORK: N C(.�I �2--� <br /> . <br /> ZO�'G REVIEti�BY: DATE APPROV�D: �2 5-o I <br /> BUILDItii'G REY��BY: � . DATE APPROYE'D: �- 2 5.-�( <br /> FEES TO BE C$ARGED: Niisc. Fees Calculated By: <br /> pEgMI'r Yes ,/ No �� <br /> PLAN REVIEW Yes _,� No SE�V'ER COVNECTION <br /> STATi� SURCHARGE Yes�_� No WATERCONNEC'TION <br /> IIti'�YE.iTIGATION FEE Yes No PARK FEE <br /> SAC Yes No oc SITEINSPECTION <br /> Nt.mber of SAC-Units _�--�,r- r,�,,�,,. �� OTHER (specify) <br /> Z(��1.,tG CH�CK LIST zoaiag Dis�icc: 111 -�� _ . <br /> �ire Department: jM r9��nr� Post Office: �nti•��..��� School Districr. �.;�PS�—e'vv�v! ' <br /> i��.� s <br /> � <br /> Lot Area: Sq.fc. 8,9 fl D t Acres .�3 � widc� S a Depth <br /> Surve; Subritted: Yes .c No Date of Survey: �''L 4 <br /> � DI <br /> Propvsed Setbacks` � <br /> � F�ect(La.ke): {� � Rioht Side: " I 0� <br /> i <br /> Rser(Screet): 3D � I.efr Side: I U <br /> Adjacent Structures: N (Iq tiVetlaad: — • <br /> Buildia�Hei�ht: Def. H�t. 23� Peak Hot. 2� � <br /> Lot Covera�e: m •(�- <br /> Grading: Stafi Approval Date: I- 25�- V 1 By: ��, Council Approval Date: <br /> Septic: Staff Approval Date: d (�{ By: <br /> Zonin,File: � 2 63 5 Resolution: � Resolutioa Date: /2 -I I. O v � . <br /> Shoreland District: � �{C S <br /> Av�. Setback: D•lL Btufi Setback: N A LotCo4•cra�e: <br /> Existina Proposed <br /> Hardcover: 0-75' p � <br /> 75-250' —�-- <br /> ti0-500' <br /> 500-1000' <br /> � Dace of Counci?Aoproval: <br /> Hazdcover Variaace Required: Yes oC No <br /> REtiiARbS(in hause): <br /> 7 <br />