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� CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �0 �S�ssccX c,r4,v� <br /> PID: <br /> DESCRIPTION OF WORK: oo / <br /> ZOtiTvi G REV�W BY: DATE APPROVED: �!-ZK-o z <br /> BUILDING REVIEW BY: — DATE APPROVED: <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAi�t REVIEW Yes _� No SEWER CONNECTION <br /> STATE SURCHARGE Yes v No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTTON <br /> Number of SAC�Units OTHER (specify) <br /> ZOIVI�`G 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: lo•L� • O� <br /> Proposed Setbacks: <br /> Front(Laicc�: (6�� � Right Side: SO� t <br /> Rear (St�aet): 250' t Left Side: L6v � = <br /> Adjacent Structures: 3c�' Wetiand: ��� '+' <br /> Building Height: Def. Hgt. — Peal: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: �U <br /> Avg. Setback: Bluff Setback: LotCoverage: <br /> Eusting 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 /> REMARKS (in house): <br /> 7 <br />