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CHECK OFF LIST k'OR ISSUANCE Ok' PER.il�1ITS <br /> � FOR OFFICE USE ONLY <br /> A.DDRESS OR LEGAL: Oc� PA Rt�c N w oob 20� � . <br /> PID: -- �l�S "�17 � � 3 � / �,�c% <br /> DESCRIPTIONOFWORK: 1�F� ic -� �NTtY�.��2 ��n-wbc�z . <br /> ZO�IiYG REVIE�� BY: W . Y_ DATE APPROVED: / r- S _5 �_ <br /> BUII.,D .�i tC REVIEti� BY:. DATE APPROVED: I (�- �t -�� <br /> ,�; FEES TO BE C�-IA.RGED: � � Misc. Fees Calculated By: � ~ <br /> �" PERMIT _ Yes vr No <br /> Q� PLAN REVIEW Yes __� No SEWEFZ COYNEC�TON <br /> STATE SUR`H1��Gr Yes � No �AT'ER CO�NECTION <br /> INVESTIGAZ'ION-FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZO�TING C�CK LIST zoni.n�Districc: � -/�r--�---------------- --�- � -�- <br /> 0 <br /> Fire Department: r Post Office: �,v� (,q-I� School District: p(Zp�D' <br /> Lot Area: Sq.ft._ /v c, C NFl�v6�Acres — �Vidth — Depth — <br /> Survey Submitted: Yes p� No Date of Surve <br /> y: / -ls-s� <br /> Proposed Setbacks: <br /> �est (La.�Ce): . 1 l3' t Right Side: `�5' +- . <br /> Resr(Street): ���j� ± Left Side: I Z t �� <br /> Adjacent Struc[ures: /a�-7-y�,G��L� �Vetland: /�/ �/a <br /> Buildino Height: Def. Hgt. _ N �/� Peak Hgt. — <br /> Lot Coverage• c� •(C <br /> Gradi.n�: Staff Approval Date: fV//� By: — Council Approval Date: �— <br /> Septic: Staff Approval Date: N �/�- By: --�' � . <br /> Zoning File: # - N (/k Resolution: # — Resolution Date:� — • <br /> Shoreland Dis�ict: U-e5 <br /> Avg. Setback /V(/a- Bluff Setback: /V //3 I.�ot Coveraae: � <br /> ' ' Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' 2 z• Sy � • Zz•�g � . <br /> 250-500' . • <br /> 500-1000' <br /> Hardcover Vuiance Required: Yes No Date of Council Approval: <br /> . � <br /> RE11�ZA.RKS ('in house): � <br /> � � � � • � <br /> : ��i � 26 <br /> , �t:� . . <br />