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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY • <br /> ADDRESS OR LEGAL: 21�� 5 c�6blL�."o on OR � <br /> PID: <br /> DESCRIPTION OF WORK: I�fC-,w t2�5 <br /> --- ------------------- -------------------_------------------------____----_-----^------ <br /> ZO�TING REV�W BY: c� DATE APPROVED• I cr ZS 9� <br /> BUILDIITG REVIEW BY: � DATE APPROVED: t o�2 5-S 9 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓' No <br /> PLAN REVIEW Yes � No SEWER CONNEG"fION <br /> STATE SURCHARGE Yes r/ No WATERCONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes r/ No� STTEINSPECTION <br /> Number of SAC�Units _� OTHER (specify) <br /> ZONING CIi�CK LIST Zoning District: ��� � <br /> Fire Department: (..oN� (A�. Post O�ce:�Q�« School District: dit.or� <br /> Lot Area: Sq.ft. 3�,��`t -} Acres . 8 3 � Width f S S• 2-3 Depth Z35-SS <br /> Survey Submitted: Yes_� No Date of Survey: �3 5°i <br /> Proposed Setbacks: � <br /> Front(Lalce): St�•S� Right Side: (0 5 � � <br /> Rear(Sueet): l($ � � Left Side: 3�- 5 <br /> Adjacent Structures: N �fA Wetland: i1/ (�'4 <br /> Building Height: Def. Hgt. 30 + Peak Hgt. 3 6` <br /> Lot Coverage: 0•l� ' <br /> Grading: Staff Approval Date: �o• 2 s-°i� By: � Council Approval Date: --- <br /> Septic: Staff Approval Date: �//f By: <br /> Zoning File: �i — Resolution: # Resoludon Date: <br /> Shoreland District: �J <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Eusting Proposed <br /> Hazdcover: 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 />