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CHECK OFF LIST �'OR TSSUANCE OF PERII�IITS <br /> � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: _. 3 S S� No 2i��1 ��/� �/���...Q - <br /> PID: <br /> DES CRIPTION OF VYORK: �i� � � <br /> ZO\"�iYG REVIEti� BY: � � DATE APPROVED: �/ - Z.3� 5� <br /> BUII.,D .l�i IG REVIEti'V BY: � Nl/�- . DATE APPROVED: -- . <br /> �EES TO BE CHARGED: • l=��� � Misc. Fees Calculated By: ~ <br /> PERZvIIT _Yes �/ No . <br /> PLAN REV�W Yes No � SEW�t COI�TNECTION <br /> STATE SUR`H�RCr�, Yes • No ��ATER COI�INECITON <br /> TiYVESTIGA'ITON-�EE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units ��OTHER (specify) <br /> ZONI�V'G C�CK LIST Zoni.ng Districc: C..2 -�� �' � � <br /> Fire Departmeat: �yl�r� Posc Ofrice: School District: c,v�es,t9�.i�� <br /> L.ot Area: Sq.fr._ Ni� G-t�ire:L Acres �Vidth Depch <br /> Survey Submitted: Yes No_� Date of Survey: <br /> Proposed Setbacks: <br /> - - FIOII[ (La.�Ce): - . =-=�ig�S�de• _ � . -: <br /> � c�� �� - <br /> Rear (S[reet): Left Side: <br /> Adjacent Structures: tiVetland: <br /> Building Height: Def. Hgt. Pea.ti Hgt. <br /> Lot Coverage: <br /> Gradin�: Staf2 Approval Date: I 1 -Z� - ��. gy; � Council Approval Date: <br /> (a-�. C�� _ <br /> Septic: Staff Approval Dace: gy; • � . <br /> Zonino File: # � Resolution: � Resolution Date: • <br /> Shoreland Dis[.-ict: <br /> Avg. Setback: Bluff Setback: L,otCoverage: � . <br /> ' ' Exiscin� Proposed <br /> Hardcover: 0-75' <br /> 75-2�0' . . . <br /> 250-500' . • <br /> 500-1000' <br /> Hardcover Variaace Required: Yes Iv'o Date of Council Approval: <br /> � <br /> RE1�L4RKS ('Ln house): � <br /> � `_ . - . <br /> • ''' 26 <br /> , ���. . . <br />