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� •►, r.. J <br /> � CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 1�Z.S 5 H-o�'�:fi�/�� lJ� <br /> PID: <br /> DESCRIPTION OF WORK: (.��TAc�-c=-� G/��G C: <br /> ZOi�TING REVIEW BY: DATE APPROVED: �o•a�- 03 <br /> BUILDING REV�W BY: DATE APPROVED• �0 2 q►- 3 <br /> __________- _____ �-�-_____--------------------__________________ � <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> pLAN REVIEW Yes v No SEWER CONNECTION <br /> STATE SURCHARGE Yes v No WATERCONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZOti�TG CHECK LIST zoning Districc: <br /> Fire Department: Post Office: School District:_ <br /> Lot Area: Sq.ft. Acres Width Depih <br /> Survey Submitted: Yes�t_ No Date of Survey: S-6 •�3 <br /> Proposed Setbacks: , <br /> Fret��(Lake): Z"d`� � Right Side: tO � � <br /> R�ear(Sueet): ��O� ''�- Left Side: 1 5 S�� � <br /> Adjacent Structures: �3{ � Wetland: <br /> Building Heiaht: Def. Hgt. 0.Ic Peak Hgt. <br /> Lot Covera�e: it! (/a. <br /> Grading: Staff Approval Date: � By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: f� — Resolution: # Resolution Date: . <br /> Shoreland Disuict: /'�.1-PS <br /> Av�. Setback: ,�v� � Bluff Setback: �v /� Lot Coverage: <br /> Existing Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' " <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REVIARKS(in house): _ <br /> 7 <br />