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, CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: q 6 U /V v R n�- Q/�w•v /I,t�A�-✓� <br /> PID: <br /> DESCRIPTION OF WORK: �1JEu1 /?,�5 . <br /> ZOr1NG REV�W BY: DATE APPROVED: 9• � t�-c�2. <br /> BUII..DING REV�W BY: DATE APPROVED: � -��e:�z. <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes � No <br /> PLAN REVIEW Yes �/ No SEWER CONNECTION 2 �,s�o <br /> STATE SURCHARGE Yes � No WATER CONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes � No STTEINSPECTION <br /> Number of SAC Units 1, OTHER (specify) <br /> ZONING CH�CK LIST Zoning District: <br /> Fire Departmenr. Post Office: School District: <br /> Lot Area: Sq.ft. �Sq,S?c�,��Acres 3•b b Width �/o Z Depth 3 9� <br /> Survey Submitted: Yes C�_ No Date of Survey: 7 - �- o Z <br /> Proposed Setbacks: <br /> Front(bake): ►� 1. I Right Side: ?�. 5 5 <br /> Rear(Sfreet): I�1-3 Left Side: 2Z„�i• �1 ^� <br /> Adjacent Structures: _ �/(/�- Wetland: /J//� <br /> Building Height: Def. Hgt. �o' Peal:Hgt. 39� <br /> Lot Coverage: N !/� <br /> Grading: Staff Approval Date: �y- 17-02 By: ��- Council Approval Date: <br /> Septic: Staff Approval Date: --- Se��-, By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: y�5 <br /> Avg. Setback: nr�,�-- Bluff Setback: N �� Lot Coverage: .��,� <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> soo-i000� �.r� ss�Yy �►�� <br /> Hardcover Variance Required: Yes No�_ Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />