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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 10 e toR• <br /> PID: <br /> DESCRIPTION OF WORK: Po a t <br /> ZONING REVIEW BY: c DATE APPROVED: Y-O-aY <br /> BUILDING REVIEW BY: DATE APPROVED: <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes f No <br /> PLAN REVIEW Yes No SEWER CONNECTION <br /> STATE SURCHARGE Yes t- No WATER CONNECTION <br /> INVESTIGATION FEE Yes No v- PARK FEE <br /> SAC Yes No G--' SHE INSPECTION <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 g No Date of Survey: 0-L`(- 00 <br /> Proposed Setbacks: <br /> Front (hake): I Qt Right Side: S o' <br /> Rear (Street): Go ' Left Side: i <br /> Adjacent Structures: 3S Wetland: — <br /> Building 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 /> Shoreland District: <br /> Avg.Setback: Fluff Setback: Lot Coverage: <br /> tsting 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 /> 32 <br />