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CHECK OFF LIST FOR ISSUANCE OF PERwIITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 57.0 TbN"w A <br /> PID: <br /> DESCRIPTION OF WORK: <br /> ZONTi i G REVIEW BY: N DATE APPROVED: t 2-Z-+-g g <br /> DATE APPROVED: t i•'-g g <br /> BUILDLNG REVIEW BY: <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes No <br /> PLAN REVIEW Yes No SEWER CONNF:G"ITON <br /> STATE SURCHARGE Yes No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC-Units OTHER (specify) <br /> ZONE' G CHECK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> N° <br /> Lot Area: Sq.ft, Acres Width Depth <br /> Survey Submitted: Yes No cL Date of Survey: 5 n <br /> Proposed Setbacks: <br /> Front(I": 110 Right Side: 3 5-4' <br /> Rear(Street): Z Left Side: N <br /> Adjacent Structures: Wetland: 11,0 <br /> Building Height: Def. Hgt. LL" Peak Hgt. e ?— <br /> Lot <br /> ZLot Coverage: It/le- <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: 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 />