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' CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z o S T o N is q Av C <br /> PID: <br /> DESCRIPTION OF WORK: w E w iZ-E S <br /> ZONING REVIEW BY: DATE APPROVED: 6- L6 0 3 <br /> BUILDING REVIEW BY: (QA, DATE APPROVED: 6 t✓6-d 9 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes No <br /> PLAN REVIEW Yes v No SEWER CONNECTION f D t'�` ►�,/b <br /> STATE SURCHARGE Yes ✓ No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units 1 OTHER (specify) <br /> ZOti'ING CHECK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres 1.*1 Width - Depth <br /> Survey Submitted: Yes x_ No Date of Survey: 103 <br /> Proposed Setbacks: <br /> Ffem-fEece): 4r= 161 .5 Right Side: /25'1 <br /> Rear (Street): 47.E Left Side: bit 2 <br /> Adjacent Structures: N 114 Wetland: N 1A <br /> Building Height: Def. Hgt. 2-W Peak Hgt. 34 S <br /> Lot Coverage: N 1 A <br /> Grading: Staff Approval Date: G 2c -o-3 By: oY,O Council Approval Date: <br /> Septic: Staff Approval Date: N /14 By: <br /> Zoning File: #_P3-21870 Resolution: # 14434 Resolution Date: 3r)o- Wl <br /> Shoreland District: /Nz> <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Existing 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 />