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� CHECIi OFF LTST FOR ISSUA.��'CE OF PERstiIXTS <br /> FOR OFFICE USE ONI.Y . � . <br /> ADDRESS OR LEGAL: z�.�-1 n N o 2-�1� 5 r�-o c� t�R <br /> PID: <br /> I��CRIP"I'IDNOF�ORK: N�c.� �3��/� �^�� <br /> . - <br /> ZO��'G REVIEti�+BY: ` D�.TE APPROVED: <br /> BUILD .I�'G REYIE'4'Y BY: ,i,,�..—:- . D�TE APPROYED: . . <br /> FEES TO BE CH.ARGED: Niisc. Fees Calculated By: <br /> pEgMI,'r Yes ,/'' No �� <br /> PLAN REVIEW Yes ✓ No SE�TER CONNECITON _ <br /> STATE SURCHARGE Yes � No �ATERCONNECTION <br /> Ii�,'VESTIGATION FEE Yes No � PA�K�E <br /> SAC Yes No SITEINSPEG"TION <br /> . , OTHER (spe�ify) <br /> Number of SAC�Units a�� . � <br /> _ <br /> � �(L C t �C. ,`tr_c.t ..7�� C���/�<��_�- li ri�i j� �r' 'f l C�-�-'-%�� —_. <br /> 1 --- <br /> ZO\Z�IG CH:ECK LIST zonin� Dis�icc: �.Q- I � _ . <br /> Fire Department: r� � Post.Ofuce: W iY�- Sc�ool District: •[�Fl.�N'� ' <br /> Lot Area: Sq.fr. /Vo C N�-,rc;,Q Acres � Width Depth <br /> Surve;� Sub:�.itted: Yes o� No Date of Survey: <br /> Proposed Setbacics: <br /> Front (L�ke): I c�o' Ri��-:Side: � I u o � <br /> Rear (Screet): 7p� Left Side: l I l� <br /> Adjacene Structures: N � � `Vetland: N �� • <br /> Buildin� Hei�ht: Def. H�t. Peak H�t. <br /> Loc Covera�e: N /�" <br /> Gradin�: Stafi Approval Date: �(- t'?- n i By: � `�` Council Approval Dace: <br /> Septic: Staff Approval Date: N /� BY� <br /> Zo�in�pile; R Resolution: � Resolution Date: _ � <br /> Shoreland District: <br /> Av�. Se[back: Blufi Setback: LotCocera�e: <br /> E���j Proposed <br /> Hardcover: 0-7�' <br /> 7�-250' — <br /> ti0-SQO' <br /> 500-IOQO' <br /> Hazdcover Variance Required: Yes No Dat� of Council Aoproval: ____ <br /> gEI�IA.R�;S (in house). <br /> 7 <br />