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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> F R OFFICE USE ON Y <br /> ADDRESS OR LEGAL: �C� "- �� �� . � �� � <br /> PID: ��� _ �-� �� , r' �` <br /> � ' ' �-�� �� � ; -� �,;r Y��� � ✓�� <br /> DESCRIPTIDN OF W RK �f--2-,� �;,� ,U ., �� ,�� �;',���- <br /> ZONING REVIEW BY.• ��1� �i �� Y� DATEAPPROVED: f/�� l-�f� <br /> B UILDING RET�IEW BY.• _ DATEAPPROVED: I -�t -o�3 <br /> FEES TO BE CHARGED: �/� Misc. Fees Calculated By: ������ y <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes-� No SEWER CONNECTIDN �'� <br /> STATE SURCHARGE Yes�- No WATER CONNECTION�_� <br /> INVESTIGATION FEE Yes No � PARK FEE ��/.} <br /> SAC Yes�- No SITEINSPECTION <br /> Number of SAC Units �_ OTHER (spec�) <br /> ZONING CHECK LIST Zoning District: ��r 1� �w� ��_�`��_��____ <br /> Fire Department: l-� Post O�ce: �-�— School District: G��''U�-� <br /> Lot Area: Sq.ft. yz�f%(� S�. („f 7 L�' � � ���� <br /> Acres • L�' Width � Depth <br /> Survey Submitted: Yes `° No Date of Survey: /�'Z �� n'� <br /> Proposed Setbacks: � <br /> F�ronl(�): �� � Right Side: � � U <br /> t / <br /> Rear�: �j � Z Left Side: ��y--l-j�,{-(�'� <br /> 1 <br /> Adjacent Structures: ,�rT�TI`��(,��;� Wetland: ��' <br /> i � <br /> Building Height: Def. Hgt. ��' Peak Hgt. l �� � <br /> Lot Coverage: � <br /> • � <br /> Grading: StaffApproval Date: � � � Lg�1 � <br /> Y Council Approval Date: <br /> Septic: StaffApproval Date: By. ��— <br /> Zoning File: # '� Resolution.• # Resolution Date: <br /> Shoreland District.• MCWD P �•mit: <br /> Avg. Setback. BluffSetba�� LotCoverage.• <br /> Existing/ Propose <br /> Hardcover: 0-75' <br /> ��'f�.�. — <br /> 250-500,- ' <br /> �00' <br /> Hardcover T�ariance Reguir-ed: I'"es No� Date of Council Approval: <br /> REMARKS(in house): <br /> 33 <br />