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� CHECK OFF LIST FOR ISSUANCE OF PERitiiITS <br /> FOR OFFICE USE ONL <br /> ADDRESS OR LEGAL: ` � - 1 �- .�'v _ � � <br /> PID: ' <br /> DESCRIPTION OF WORK: " —�-- �z, ;� .,: �� �; -� ' <br /> ZOi�tING REV�W BY: �,� ,�wa�-- DATE APPROVED: I 0-�t- 41 <br /> BUII.DING REVIEti� BY: ) DATE APPROVED: ( o• 3t-4� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: . <br /> PERMIT Yes � No <br /> pLAN REVIEW Yes _� No SEWER CONNECTION <br /> STATE SUR�HARG�� Yes _�� No WATER CONNECTION <br /> INVESTIGAZ'ION-FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONIlVG CHECK LIST Zoning District: G.�L-�A . <br /> Fire Department: Post Office: School District: (7(1�N n <br /> Lot Area: Sq.ft. d�to c,ttRc.�(�� Acres Width Depth <br /> Survey Submitted: Yes�_ No Date of Survey: (�-�Z- �i'Z <br /> Proposed Setbacks: � <br /> Front (L-ako): �-{b5 �-+= Right Side: '�b }' <br /> Rear (&treet): �b0� -E- Left Side: Z,tS' �— <br /> Adjacent Structures: �--t-rv�c.H C.� Wetland: !�I iA <br /> Building Height: Def. Hgt. (9.K Peak Hgt. - <br /> Lot Coverage: /� �fA <br /> Grading: Staff Approval Date: N(� By: Council Approval Date: <br /> Septic: Staff Approval Date: /V �d�- By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland Dist:ict: . <br /> Avg. Setback: Bluff Setback: L.ot 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 /> . 26 <br />