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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z-7 55 Go�rvT2y s� ,o� �2 <br /> PID: <br /> DESCRIPTION OF WORK: oc�� <br /> - -------------- ------- --------------------------------- . <br /> -------------------------------- — - <br /> ZOti11i 1G REVIEW BY: � DATE APPROVED. 6 � u z <br /> BUII..D�tG REVIEW BY: DATE APPROVED: � - 6 , �z <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER11i1IT Yes � No <br /> PLA��1 REVIEW Yes �' No SEWER CONNEC"ITON <br /> STATE SURCHARGE Yes � No WATERCONNEC'I'ION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZOivIi�1G CH�CK LIST Zoning District: /12• 1� <br /> Fire Department: �� (�4t�_ Post O�ce: T School District: Q/Gt�O <br /> .�— <br /> Lot Area: Sq.ft. Acres Z.(a�{ Width Dep[h <br /> Survey Submitted: Yes_ c� No Date of Survey: O�v �_��.1: <br /> Proposed Setbacks: <br /> Front (�aise): l 3y' � Right Side: �3.5' + n+ <br /> Rear (St�ee�t): Z oo' �= Left Side: ��` `� 5 <br /> Adjacent Structures: I 0 ` �Vetland: N/�i <br /> Building Height: Def. Hgt. — Peal:Hgt. — <br /> Lot Covera�e: — <br /> Grading: Staff Approval Date: G •G •�Z By: �� � Council Approval Date: �' <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # z.-�3�( Resolution: /# Resolution Date: 5 • 2 4�-d"L <br /> Shoreland District: Ill v <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />