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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> ' FOR FFICE USE ONLY <br /> , ADDRESS OR LEGAL: � �� � ,� 2� <br /> PID: <br /> DESCRIPTION OF WORK `J e,�� l��c.�;,� <br /> ZONING REi/1'EW BY.• .(i�" DATEAPPROVED: /c� (,� <br /> BUILDING REi�IEW BY.• DATEAPPROVED: <br /> -- `'�-�o . oc� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By.• <br /> PERMIT Yes ✓� No <br /> PLAN REVIEW Y�S—�� No SEWER CONNECTION <br /> STATE SURCHARGE Yes—� No WATER CONNECTION <br /> INVESTIGATION FEE Yes No ✓ PARK FEE -- <br /> SAC Yes No ,i SITEINSPECTION <br /> Number of SAC Units T,� �,2�,� OTHER (spec�) <br /> ZONING CHECg LIST Zoning District: -- � <br /> Fire Department: Post Offzce: <br /> School District: <br /> �j 7 irCi�cL.�i c:x_1 z�-,�� �. <br /> Lot Area: Sg.ft. • Acres 7 � Width ' Depth ��C� <br /> Survey Submitted: Yes� �7o Date of Survey.� �f G� <br /> --�.� <br /> Proposed Setbacks: �� �/2�C�g <br /> � �lu� <br /> �xl(��� 2`�S �= � <br /> �t Side: �� <br /> �e���,�. s ��^ ��-s� i . . <br /> �eftSide: Z.�d <br /> Adjacent Structures: /�� Wetland: � <br /> � /�� <br /> Building Height: Def.Hgt. Peak Hgt. `�y', <br /> , <br /> Lot Coverage:_ ►'� � <br /> cl2.c°r2v� 2�m��lse�-, <br /> Grading: StaffApproval Date: _ �7� ��(� By: �jC�sh�c<> <br /> Counci!Approval Date: <br /> Septic: StaffApprovalDate: -� By, f 1�. <br /> y,�_ <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District.• ✓ MCWD Pe�-mit: <br /> Avg. Setback. BZuffSetback.• <br /> Lot Coverage: <br /> Existing Propo ed <br /> Hardcover: p_75� �. O G <br /> 75-250' <br /> 250-500' I 3�L `y (� v�-fp <br /> 500-1 D00' <br /> Hardcover Variance Required.� Yes No � <br /> Date of Council.Approval: <br /> REMARKS(in house): <br /> 33 <br />