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. CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> � ADDRESS OR LEGAL: S Z�S (3�w �i �L, 2�►.✓� <br /> PID: = <br /> DESCRIPTION OF WORK: •:.o� <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING REVIEW BY: DATE APPROVED: '1-�(� -�� <br /> BUILDING REVIEW BY: DATE APPROVED: �� -r�: ��� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes c,/ No <br /> PLAN REVIEW Yes �/ No SEWER CONNEC'TION <br /> STATE SURCHARGE Yes �/ No WATERCONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> --------------------------------------------------------------------�-�--------------------------------------------------- i <br /> ZOI�TIl�1G CHECK LIST Zoning District: ��--f <br /> Fire Department: ��: " (�lGt= Post Office: (it..' � ��'. School District: C�/��� <br /> Lot Area: Sq.ft. N� ��t�H'v c" Acres — Width ` Depth � <br /> Survey Submitted: Yes �- No Date of Survey: ��s i=�l�L:, <br /> Proposed Setbacks: <br /> Front (I�3: L z� � � Right Side: I�G�� � <br /> Rear (Street): 7�� Left Side: 5�� � <br /> Adjacent Structures: ���� Wetland: N "� <br /> Building Height: Def. Hgt. ✓V ( 0� Peal:Hgt. <br /> � Lot Coverage: <br /> � Grading: Staff Approval Date: By: Council Approval Date: <br /> f <br /> Septic: Staff Approval Date: By: • - <br /> �, Zoning File: # Resolution: # Resolution Date: <br /> � � <br /> � Shoreland District: <br /> � Avg. Setback: Bluff Setback: L.ot Coverage: <br /> I 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 />