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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESSOR LEGAL: Z 95y S W A-MV-1-OW u 2z00 <br /> PID: <br /> DESCRIPTION OF WORK: Wt_,L ) k?,BS <br /> ZO. L G REVIEW BY: ,Q DATE APPROVED: S-3i-ol- <br /> BUILDING REVIEW BY: DATE APPROVED: S-3i <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes No <br /> PLAN REVIEW Yes No SEWER CONNECTION <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 /> ZONING CHECK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. I 06,-1 22 Acres 2, L(!;' Width 2,3 j Depth <br /> Survey Submitted: Yes W_ No Date of Survey: S• 3��� <br /> Proposed Setbacks: <br /> Front(L-alae): 10`{ Right Side: SI.2 <br /> Rear (Street): 22.3 A Left Side: 16 <br /> Adjacent Structures: IV I od Wetland: -26 .-5 <br /> Building Height: Def. Hgt. 30 Peak Hgt. 3Y� <br /> Lot Coverage: N <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: 7• Zg -011 By: Kis . <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: M6 <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: YeDate of Council Approval: <br /> REMARKS (in house): <br />