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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 1.40 CSUEA42 LANE <br /> PID: <br /> DESCRIPTION OF WORK: rV LW ( .- • _. <br /> ,Q S- <br /> ZONING REVIEW BY: S� DATE APPROVED:DATE APPROVED: 5-- <br /> ZY 5 <br /> BUILDING <br /> REVIEW BY: <br /> BEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes No <br /> PLAN REVIEW Yes c/ No SEWER CONNECTION <br /> No WATER CONNEC1"ION <br /> STATE SURCHARGE Yes No •/-1 PARK FEE <br /> Y <br /> SAC Yes <br /> INVESTIGATION FEE Yes No (/"..- srrh, INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CtiECK LIST Zoning District: 12...R-\ (2 Shoreiand District : IUO <br /> s Post Office: (dot UY4�-e- School District: 0 to J O <br /> Fire Department: (�b�v� l�i�- <br /> Acres Z•( Width 3t?,2.t I Depth ZS I•`I t( WN•Q <br /> Lot Area: Sq.ft. °f 1�ct.� � 1 <br /> Survey Submitted: Yes _J No Date of Survey: N'ZV-9(o <br /> Proposed Setbacks: <br /> Front (1:781(4): —1(. Right Side: t`1$•1L3 <br /> Rear (St•Feet): l0 g.(o Left Side: 1541 <br /> Adjacent Structures: /J ttet- Wetland: ►J (A <br /> Building Height: Def. Hgt. ZS — Peak Hgt. 2ct <br /> vg. Setback: <br /> Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> �1 ek 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No <br /> Date of Council Approval: <br /> 2 °P.() Council Approval Date: <br /> Grading: Staff Approval Date: SH" `Lb By: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> WS S (in house): <br />