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' CHECK OFF LIST FOR ISSUANCE OF PERIVIITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �'���-{�j ��I"\���C F' I ��'��� l.�i't ��. .� <br /> PID: ���;. � �.-1 _ .� �; -,:�i - r'�C��`� <br /> DESCRIPTION OF WORK: F� y `�ttc ,Zci� i ti{ `�� rc�. ti ti <br /> ZO�'G REV�W BY: L���C 11��-�t l��`I��`1�'����« DATE APPROVED: <� -,�?_(`?C;' <br /> BUILDING REVIEW BY: � DATE APPROVED: <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes No <br /> PLAN REVIEW Yes No ,,r SEWER CONNEC'I'ION <br /> STATE SURCHARGE Yes No WATERCONNECITON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> -----__--- ------------------------------------------- <br /> ZONING CH�CK LIST Zoning District: L�.- �L'- <br /> Fire Department: �"�,�j1,�.,i1C� Post O�ce: 'V� l,(..- ��- School District: ��(,�,t..u'�C� I 1,1-����'l.� <br /> Lot Area: Sq.ft. ��IGi 5(o�� Acres �{ . � Width ,���C'� Depth �].�_`�� � <br /> Survey Submitted: Yes_� No Date of Survey: =' i ;"�� <br /> Proposed Setbacks: <br /> Front(I�c): � 0� Righ[Side: <br /> Rear(Street): Left Side: <br /> Adjacent Structures: Wetland: <br /> Building Height: Def. Hgt. ` Peal:Hgt. — <br /> Lot Covera�e: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # — Resolution: # — Resolution Date: <br /> Shoreland District: <br /> Avg. Setback: Bluff Setback: L.ot Coverage: <br /> Ezisting 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 />