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♦ <br /> , � � • CHECK OFF LIST FOR ISSUANCE OF PERz1�IITS <br /> FOR OFFICE USE ONLY • _ <br /> ADDRESS OR LEGAL: 3 l 3� N'o R�-t S l't-o� �2 <br /> PID: Rx P�,n u �x�Sirt N� a,.'► n�e� <br /> DESCRIPTIO�t OF WORK: P1�ba�= ove'�. 1=YlAnt r sr�o0 't4N0 [_�n7'L1r�v� �N�'jifi°y`s <br /> ._______________�________ - _-- <br /> ZO.�'G REVIEW BY: _ DATE APPROti�ED: � z- �t,�c-�`t <br /> � BUII.D�TG REVIEW BY: � DATE APPROVED; i Z-�� -� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes t/ No <br /> pI,AN REVIEW Yes r/ No SEWER CO�fNECTION _ <br /> STATE SURCHARGE Yes �/ No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTTON <br /> Number of SAC•Units OTHER(specify) <br /> �--------__---__ __--------- <br /> ZO�^L`�'G CH�CS LIST Zoning District: �tZ.-1r3 . <br /> Fire Department: tA�t.�: Post OfFce: C� School District: o�•�o� <br /> Lot Area: Sq.ft. Y4,39 o Acres /.o r � Width r itit�'.6��'�- Depth <br /> Survey Submitted: Yes �C No Date of Survey: '1`l�$'�5 <br /> EN'rN�t �.�'N�uco . <br /> Proposed Setbacks: �r ✓wa�►uw�ut-s � K � � <br /> Front�bake�: 'N' Right Side: � 1 0 . <br /> Reaz(St�eet}: � � 5� Left Side: n � � <br /> Adjacent Suuctures: — �•�� Wetland: -- _ <br /> �gr dWOr+�w+wf'S <br /> Buildin�Heighr. Def. Hgt. y.� ' Peak Hgt. — <br /> Lot Coverage: �,�� ' <br /> Gradin�: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: —' By: <br /> Zoning File: # "'— Resolution: # Resoludon Date: <br /> Shoreland District: y-P 9 <br /> Avg. Setback: �J(�f- Bluff Setback: i✓ ��' Loc Co��erage: <br /> . Eustmg Proposed <br /> Hardcover: 0-75' <br /> 75-250' /�'d G H'�4�v� <br /> 250-500' _----- <br /> 500-1000' <br /> Hardcover Variance Required: Yes No�,� Date of Council Approval: <br /> REMARKS('in house): <br /> 7 <br />