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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �,3C�9 c,qsG., G,�,.c�(.�. <br /> PID: ' <br /> DESCRIPTION OF WORK Sttt�� — i O�c�v ` <br /> -------------------------------------------------------------------------�---------------------------------------------- <br /> ZONINGREVIEWBY: w.. DATE A.PPROVED: y- �•oy <br /> B UILDING REVIEW BY: DATE APPROVED: y-LL •o y <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes �/ No <br /> PLANREVIEW Yes �/ No SEWER CONNECTION <br /> STATE SURCHARGE Yes ✓ No WATER CONNEC770N <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes � No Date of Survey: Z•L�.•7 v ��+ r^�uG� <br /> Proposed Setbacks: <br /> Front (I,ak�}: (ZO� '� Right Side: �p�� * <br /> � � <br /> Rear (St�e�t): � ± Left Side: ZS' <br /> Adjacent Structures: 2 3' Wetland: /v!i� <br /> Ba�ilding Height: Def. Hgt. C9 •(L Peak Hgt. <br /> Lot Coverage: 12�0 �. <br /> Grading: Staff Approval Date: —'— By: Cot�ncil Approval Date: <br /> Septic: Staff Approval Date: � By: <br /> Zoning File: # --' Resolc�tion: # Resolc�tion Date: <br /> Shoreland District: y�5 <br /> Avg.Setback T �q- Bluff Setback: nJ�/a-- Lot Coverage: / 2."Td a" <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' � g�� - <br /> Hardcover Variance Required.• Yes No_� Date of Council Approval: <br /> REMARKS(in house): <br /> 32 <br />