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� CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z 5 o czv�,n,� �z.o rA� . <br /> PID: <br /> DESCRIPTION OF WORK: �v�,�,.s ��.S , <br /> ZO�TI�1G $EV�+W BY: DATE APPROVED: 2• �Z •o� <br /> BUII�DI1i IG REVIEW BY: DATE APPROVED; -2._ �-z,_o� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes � No <br /> PLAiY REVIEW Yes � No SEWER CONNECI'ION <br /> STATE SURCHARGE Yes � No WATF�t CONNECTION <br /> INVESTTGATION FEE � Yes No � PARK FEE <br /> SAC Yes No ri SIT`EINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CH�CK LIST Zoning District: LR•�� . <br /> Fire Department: Post Office: School District: • <br /> Lot Area: Sq.ft. (,5,3 Y�f Acres 1.5 � Width 2 9�•4`'( Depth Z�2•�� A� <br /> Survey Submitted: Yes_ c,� No Date of Survey: 1-2,�r-0 3 <br /> Proposed Setbacks: � <br /> Front(I.ake): _ 5'p` Right Side: 12S <br /> Rear(Street): 9 o Left Side: 17� '� <br /> Adjacent Structures: N(� Wetland: 35 <br /> Building Height: Def. Hgt. 2 t Peal:Hgt. 3� <br /> Lot Coverage: O•K <br /> Grading: Staff Approval Date: �-I Z-03 By: ��, Council Approval Date: -- <br /> Septic: Staff Approval Date: 2-�2-n 3 By: M•(.i. <br /> Zoning File: # /92—ZZ q 2 Resoludon: # y�2'] Resolution Date: �•z y�"j- <br /> Shoreland District: N fl <br /> Avg. Setback: Bluff Setback: Lot Coverage: � <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />