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' CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> . FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3�,`j t�• ('��`�Si �U� ;7�,,�v'a <br /> PID: <br /> DESCRIPTION OF WORK: (�,�,�v>��� <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING REVIEW BY: s;� . ;- i DATE APPROVED: "I i� -��i� <br /> BUILDING REVIEW BY: ' � ��,�. DATE APPROVED: '7- 1(; �=i7 <br /> -----------------------------------------------r. ---------------------------------------------------------------------- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes �;�- No SEWER CONNECTION <br /> STATE SUR:I�ARG� Yes �� No WATERCONNECTION <br /> INVESTIGAT'ION FEE Yes No PARK FEE <br /> SAC Ycs No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST Zoning District: t.f.'-i A <br /> Fire Department: („c.�rt;� �t-t' Post Office: C�.�•ti�7 ���= School District: C�y''.�Z- <br /> —� <br /> Lot Area: Sq.ft. I.�t� Acres �, t 2`� Width 3 �' Depth Z�� '�� <br /> Survey Submitted: Yes_� No Date of Survey: `�7 'Z(:� `1 I� <br /> Proposed Setbacks: � i <br /> Front (-�e): _ r1 Right Side: j b 5 + � <br /> Rear (�reet): ?3�7 � � Left Side: 1 3� � � W <br /> Adjacent Structures: 7 � � Wetland: /�' i 1/� <br /> Building Height: Def. Hgt. ��<<- Peak Hgt. � <br /> Lot Coverage: 1J ��' <br /> Grading: Staff Approval Date: %--f t� -`! 1 By: -f`C' Council Approval Date: .ti� i� <br /> Septic: Staff Approval Date: �'�' ( � By: <br /> Zoning File: # 2�'� L Resolution: # Resolution Date: Z-�1 �S � <br /> Shoreland DisL ict: ��-� <br /> Avg. Setback: `s'��- Bluff Setback: �rc�'�µ- Lot Coverage: U� (C <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' (rtJ� C �,f/�'.� <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> � 26 <br />