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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z CD 6 v"loc>4 Ili r" <br /> PID: ++ <br /> DESCRIPTION OF WORK: Actck RkY,5 {o ax sh c pc/rc <br /> ZONING REVIEW BY: DATEAPPROVED: gioet <br /> BUILDING REVIEW BY: c-Xe • DATE APPROVED: 6 •/D - 07 <br /> FEES TO BE CHARGED: �� `` Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes • No SEWER CONNECTION <br /> STATE SURCHARGE Yes No . WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District. k R-1 (3 <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq..ft. Acres Width Depth <br /> Survey Submitted: Yes No V. Date of Survey: i9 S 3 <br /> Proposed Setbacks: i <br /> Frontt <br /> ( : h l�. Right Side: S 0 <br /> / * l <br /> Rear(Street-: Left Side: I CO <br /> Adjacent Structures: {')4 Wetland: Vl A- <br /> Building Height: Def. Hgt. h/ . Peak Hgt. <br /> Lot Coverage: G1C__ <br /> Grading: StaffApproval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: 6 --5- 0 ek. By. .„,)(�- <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: AQ MCWD Permit: <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 /> 33 <br />