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CHECg OFF LIST FOR ISSUANCE OF PERMITS <br /> � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: G�.��� P��C�, <br /> PID: <br /> DESCRIPTION OF WORK.• � �, - ( � /`�� �1 S/r h <br /> ZONING REVIEW BY.• S�(�-Y� <br /> '�� DATEAPPROT�ED: �Zf Q /le.�'�/il��.t, <br /> BUILDING REf�IEW BY.• DATEAPPROT�ED: <br /> �3 -zs� v� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER1l�lIT Yes ✓ No <br /> PLAN REVIEW Y�S�- Na SEWER CONNECTION <br /> STATE SURCHARGE Yes� No N�ATER CONNECTION <br /> INVESTIGATION FEE Yes No � p�g FEE -- <br /> SAC Yes No SITEWSPECTION <br /> Number-of SAC Units OTHER (spec�) <br /> ZONING CHECg LIST Zoning District: �� - i � <br /> Fire Department: Post Office: <br /> School District.• <br /> Lot Area; Sg.ft. • Acres Widih <br /> Depth <br /> Survey Submitted.• Yes� No Date of Survey: Z 5 �� <br /> Proposed Setbacks: �� ,f/_ � <br /> Front ake : �f�� <br /> (L ) PJD C'�t(f�/ �ight Side: L3� <br /> 5�,�� <br /> Rear(Street); ,/j0 C�►1L�r � .�t Side: /?U �,'�y/(�Q / . . <br /> Adjacent Structures: ��� Wetland: �I/�' - <br /> Building Height: Def. Hgi. PeQk H� � �� S �?G� <br /> Lot Coverage.• O C � /W�%�32� /�r y h� <br /> �� S/7'C/C�'�% <br /> Grading: Sta,f�'Approval Date: By: Counci!Approval Date; <br /> Septic: Staff�ipprovalDate: BY�`�.LIL_ <br /> Zoning File; # Resolution: #__ Resolution Date: <br /> Shoreland District: <br /> MCWD Permit: <br /> Avg. Setback: Q� BluffSetback: <br /> Lot Coverage: <br /> Hardcover: 0_7S� �'� �Pr� Pro osed <br /> 75-250' �'- � <br /> 7Z <br /> zso-soo, —�� � s �d �� � � i <br /> 500-1000' � <br /> Hardcove�• Varzance Reguired: 3'es�]�o Z7 2�0 � <br /> Date of Council flpproval; �� S <br /> REMARKS(in house �� <br /> )� �']� �X�S�-ivl � sZ �l�� �S , ;✓ CI�N'� — �} <br /> lS r,�r2 dGl�, ' G �s f,� <br /> �l ll U.�e h�►-e fc�.N� ; � e � <br /> ��cf c.u�( �� r c��ce <br /> 33 <br />