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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: l ��S �',R,o�N �� S � <br /> PID: <br /> DESCRIPTION OF WORK: ��w �2,�—S � <br /> - -------------------------------------:------- _� <br /> ZO.�tI�i 1G $EVIEW BY: � DATE APPROVED• C Z �.�,� cL <br /> BUII.D�1G REV�`V BY: DAT'E APPROVED: �z-��, � � <br /> FEES TO BE CHARGED: �''�isc. Fees Calculated By: <br /> PERNIIT Yes � No <br /> PLAl�i REVIEW Yes ✓' No SEWER CONNECITON <br /> STATE SURCHARGE Yes ✓ No WATER CONNECITON <br /> INVESTIGATION FEE � Yes No ✓ PARK FEE <br /> SAC Yes No � SITEINSPECTION <br /> Number of SAC�Units � OTHER (specify) <br /> _-------_______ _ _ ��,�------------------------------------------------------- <br /> ZONING CHE.CK LIST Zoning District: ��- >� . <br /> Fire Department: Post Office: School Districr. � <br /> Lot Area: Sq.fc. '�)�y3'8�y Acres I•b'�l Width �!U?�;U�,2, Depch <br /> Survey Submitted: Yes x No Date of Survey: t Z-- �� ' �'Z- <br /> Proposed Setbacks: <br /> Front(L-tdEe): l b 5•3 Right Side: 3 v-� <br /> Rear(St�eet): �Z�Q� Left Side: 3`'(•5 <br /> Adjacent Structures: Iv(/� �Vetland: ti(/k <br /> Building Height: Def. Hgt. Z7' Peal:Hgt. 33-S <br /> Lot Coverage: S"70 <br /> Grading: Staff Approval Date: � �_ �2 _ u 2 By: �- Council Approval Date: ��/� <br /> Septic: Sc;.ff Approval Date: I - 2- 0 3 By: !1'1•6 <br /> Zoning File: # 2�8 Z`1 Resolution: # M'0b� Resolution Date: 9• Z 3-�z— <br /> Shoreland District: N� <br /> Avg. Setback: Bluff Setback: L,ot Coverage: <br /> Ezistino 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 /> < <br /> REMARKS (in house): 1�5� s �S I 6 N L� v <br /> 7 <br />