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, <br /> ` � CHECK OFF LIST FOR ISSUANCE OF PERMITS � <br /> FOR OFFICE USE ONLY � <br /> l ADDRESS OR LEGAL: ��10 5��Z-�, Av-e <br /> r PID: <br /> DESCRIPTION OF WORK: ��c,�� <br /> ZONING REVIEW BY: DATE APPROVED: (,-2 Y• ot <br /> BUII.DING REVIEW BY: DATE APPROVED: � -L y-o Z <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes �/ No <br /> PLAN REVIEW Yes �/' No SEWER CONNECTTON <br /> STATE SURCHARGE Yes �� No WATER CONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTTON <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes � No Date of Survey: S-2�• 9 5 <br /> Proposed Setbacks: <br /> Front (�eke): �c9o` '` Right Side: b`1 � � <br /> Reaz(SEreet): 1 SaO� } Left Side: �„� � <br /> Adjacent Structures: /�7T��k�j Wetland: ,�///i <br /> Building Height: Def. Hgt. — Peak Hgt. — � <br /> Lot Coverage: � <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: � By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: N � <br /> Avg. Setback: Bluff Setback: LotCoverage: <br /> Eusting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />