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CHECKOFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: <br /> PID: <br /> DESCRIPTION OF WORK: C VY1 e-c 1 s-1vic i 3 -5 c - ,n r r + <br /> -----------------------------------------------------------------------------------------------------------------------���� <br /> ZONING REVIEW BY: DATEAPPROVED: j j- ?_- 6 !o <br /> BUILDING REVIEW BY.• DATEAPPROVED: /t• ) • d 6 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By.- <br /> PERMIT <br /> y.PERMIT Yes No <br /> PLAN REVIEW Yes No SEWER CONNECTION <br /> STATE SURCHARGE Yes No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No _ SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------- ----—------------------------------------------------------ <br /> ZONING CHECKLIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres /µ,3!�;- Width 371 -5 " Depth 53(,-.7-5 <br /> Survey Submitted: Yes_�/ No Date of Survey: <br /> l.-, ta3b.�`�� <br /> Proposed Setbacks: *Side: <br /> Front qaka): Nq Z <br /> Rear(&wet): Z(O-F Left Side: y)A <br /> Adjacent Structures: n A Wetland: M"e- <br /> Building Height: Def Hgt. VI& Peak Hgt. <br /> Lot Coverage: n R <br /> Grading: Staff Approval Date: /V t9,--J By: Council Approval Date: <br /> Septic: Staff Approval Date: J (7�� By: (,J 5r <br /> Zoning File: # r Resolution: # Resolution Date: <br /> Shoreland District: SWO` G" C '(a- \k J V[CWD Permit: <br /> Avg. Setback: Bla ff Setback Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' O r4p <br /> 250-500' n)n h COAY <br /> .i 00-1000' P eopeo-cj <br /> Hardcover Variance Required: )es Aro Date of Council Approval: <br /> REMARKS(in/rouse):Bw ., dries heft' 'M%G Gu(" wi wA b Ai. reQtArtwtm� <br /> IUp 1',:5'-(r6- �G7 <br /> 33 <br />