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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 1-{(ag0 l3e-sT G c ..NNCl-k (2 <br /> PID: <br /> DESCRIPTION OF WORK: �p�=z <br /> ZONING REVIEW BY: 0_ DATE APPROVED: 10 - v <br /> Ct 0 - 3 <br /> BUILDENG REVIEW BY: 3 ca,—____ DATE APPROVED: ( o - 1 o -c`? <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes (/' No _ <br /> PLAN REVIEW Yes -' No SEWER CONNECTION <br /> STATE SURCHARGE Yes i/ No WATER CONNECTION <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. Acres Width Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: t <br /> Front(lie): S ° S- "=. Right Side: t 12 <br /> Rear(Suaet): I a't '± Left Side: I`f bi--i_ <br /> Adjacent Structures: A-7771c/fc=2O Wetland: N /A <br /> wilding Height: Def. Hgt. Peak Hgt. <br /> Lot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> N Pr" Shoreland District: <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: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />