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� - <br /> . CHECK OFF LIST FOR ISSUAi�10E OF PERMITS <br /> � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: ���?,,�,/ --�; z���.t. ��2- PID: /U-�1� -�? 3 YZ G�r o�� <br /> DESCRIPTION OF WORK: U,� G�ti.-;� <br /> ------------------------------ <br /> ZONING REVIEW BY: � DATE APPROVED: ��-��-�r s <br /> BUILDING REVIEW BY: DATE APPROVED: t�- �3-5 s <br /> ---------- - <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes ✓' No SEWER CONNECTION <br /> STATE SURCHARGE Yes v No WATER CONNECT'ION <br /> INVESTIGATION FEE Yes No c� PARK FEE <br /> SAC Yes No �� SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: G2-�� Shoreland District : ya5 <br /> Fire Department: �uqT2. Post Office: w��2 School District: plL�N� <br /> Lot Area: Sq.ft. �Z,3b o Acres 1 •°t Width �27� �" Depth 7 od�� <br /> Survey Submitted: Yes �C _ No Date of Survey: �1• -� � <br /> Proposed Setbacks: <br /> Front (�ke): +� J� Right Side: S 3� � � <br /> Rear (Strcet): Z G'd f Left Side: �S� � �'`!� <br /> Adjacent Structures: Arr'►�1u+� Wetland: �u� <br /> Building Height: Def. Hgt. U' .� Peak Hgt. <br /> Avg. Setback: (9 , l� Bluff Setback: — Lot Coverage: — <br /> E�sting Proposed <br /> Hazdcover: 0-75' `l•`l S�`"� <br /> �s-2so° Z.K q. `� <br /> 250-500' �y•`1 '`•2' <br /> 500-1000' � n <br /> Hardcover Variance Required: Yes No �C Date of Council Approval: <br /> Grading: Staff Approval Date: N({4 By: Council Approval Date: <br /> Septic: Staff Approval Date: BY� <br /> Zoning File: # Resolution: # Resolution Date: <br /> REMARK,S (in house): <br /> 26 <br />