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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: <br /> PID: <br /> DESCRIP'T'ION OF WORK: Gu> <br /> -------------- <br /> ------------------------------ - <br /> ----- TG �tiY BY: -- DATE APPROVED: S Z`I O <br /> BUILDING REVIEW BY: DATEAPPROVED: s -0 7 <br /> ^ - Misc. Fees Calculated By: <br /> FEES TO BE CHARGED: <br /> PERMIT Yes No <br /> PLAN REVIEW Yes ✓ No SEWER COivNECTION <br /> STATE SURCHARGE Yes —� No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC-Undts - s- AnK�-A OTHER (specify) <br /> -----------------------------------------------------1--- <br /> ZOYLNG CHECK LIST Zoning District. <br /> Fire Department: <br /> Post Office: School District: <br /> 114- � De th �ZCbt <br /> Lot Area: Sq.ft. Acres hw Width - 7 P <br /> Survey Submitted:. Yes No Date of Survey: �2$ Q <br /> Proposed Setbacks: L- <br /> Front(4ake): 1A00ah Richt Side: 449 h <br /> Rear(meat): ZOfo L 6A Side. I7S. <br /> Adjacent Structures: <br /> hA Wetland: V1 <br /> 7 -2.+ bAstmc��" <br /> Building Height: Def. Hgt, z1.5 Peak Hgt. <br /> 24•Z S b1JA+ 5.5 Coll <br /> Lot Coverage: Y�L� <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: S-1)- 0-1 By: � <br /> Zoning File: " Resolution: # Resolution Date: <br /> Shoreland District: 11 G Lot Coverage: <br /> Avg. Setback: Bluff Setback: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' - a <br /> 250-500' <br /> 500-1000' <br /> Yes No Date of CoLmcil Approval: - <br /> liz.rdcever `ariance RegLired: <br /> F.E L�Rr�S (if ho-Ls e)' <br />