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� CHECB OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS QR LEGAL: �3loc� 2�A�L�2,a,4� a v� <br /> PID: <br /> DESC ON OF WORK: rzc,�-t <br /> ZO�TING VIEW BY: DATE APPROVED: /d -z- n Z <br /> BUII.DING V�+W BY: DATE APPROVED•, ►o-z • o i <br /> ____ �_ _�______________ <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes _� No <br /> PLAN REVIEW Yes / No SEWER CONNECTTON <br /> STATE SURCHARGE Yes / No WATERCONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of�SAC�Units OTHER (specify) <br /> ZONING C CK LIST zoning Districc: C.�2-I/a . <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq.ft. 2�.�13'7 Acres .S 1 � Width Depth <br /> Survey Submitted: Yes�c No Date of Survey: 2•zg- c�� <br /> Proposed Setbacks: <br /> Front(�: `�l0 Right Side: �o� f <br /> Reaz(S�eei): 10 5 Left Side: fa0�-� <br /> Adjace�t Structures: _ �,�-r-�qc►�-�r� Wetland: N I J� <br /> Building Height: Def. Hgt. o.� Peal:Hgt. n,(� <br /> Lot Coverage: i o.� <br /> Grading: Staff Approval Date: iJ/►� By: Council Approval Date: <br /> Septic: Staff Approval Date: �J/�¢. By: <br /> Zoning File: f# 2 7ro Resolution: # Resolution Date: 9'•Z 3-uz <br /> Shoreland Distri�t: y�� <br /> Avg. Setback: �1��il Bluff Setback: iJ/� Lot Coverage: i�•� <br /> Existing Proposed <br /> HazdcoWer: 0-75' <br /> !, 75-250' <br /> 250-500' c� o <br /> 500-1000' 2�i.°1 31.2 <br /> Hardcover Variance Required: Yes No o�_ Date of Council Approval: <br /> REMARKS(�n house): <br /> � <br /> 7 <br />