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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FQR/,OFFICE LIS 1 S NLY <br /> ADDRESS OR LEGAL: /� /JJ jJ,4//,/ /.5 lot <br /> DESCRIPTION OF WORK: AOC('n of <br /> ZONING REVIEW BY: �� ($ --��--_--�--- DATE APPROVED: - <br /> BUILDING REVIEW BY: 11,4��Q __ DATE APPROVED: i_zs-Ss <br /> FEES TO BE CHARGED: QQ Misc. Fees Calculated By: <br /> PERMIT Yes No <br /> PLAN REVIEW Yes — No SEWER CONNECTION <br /> STATE SURCHARGE Yes ' No WAL'ER CONNECTION <br /> INVESTIGATION FEE Yes No '-- PARK FEE <br /> SAC Yes No v Sl•1'h INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: (ZQ-1(3 Shoreland District : NIA <br /> Fire Department: WA1/4?-24iv Post Office: tjuA rr} School District: O - ' t <br /> Lot Area: Sq.ft. No c ety+/..J Acres -- Width Depth <br /> Survey Submitted: Yes 7(.. No Date of Survey: t 2-Z3- 9`{ <br /> Proposed Setbacks: <br /> Front (hake): 52-2— Right Side: 53! �� <br /> Rear (SrrPet): l`{•'L Left Side: A% 6) <br /> Adjacent Structures: /21-77-77c4ssep Wetland: /V/,9 <br /> Building Height: Def. Hgt. O. Peak Hgt. O./ <br /> Avg. Setback: Bluff Setback: Lot ' o erage: <br /> Existing P opose• <br /> Hardcover: 0-75' <br /> 75-2.0' <br /> 250 500' <br /> 511-1000' <br /> Hardcover Varianc; Required: -s o D. e of Council Ap•r oval: <br /> Grading: Staff A•proval Date: By: Council App oval Date: <br /> Septic: Staff A,,proval Date: -_ 'y: <br /> Zoning File: • Re • .tion: # Resolution Date. <br /> RE (in house): <br /> 26 <br />