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, CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> . FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: t C�O O C.�x ���2 W�. �?.e� <br /> PID: <br /> DESCRIPTION OF WORK: �L�K <br /> ZOr�G REVIEW BY: DAT'E APPROVED: g�L�-o( <br /> BUII.DING REV�`V BY: DAT'E APPROVED: {� -L 3 - �r <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERi1�IIT Yes ✓ No <br /> PLAN REVIEW Yes � No SEWER CONNEC'I'ION <br /> STATE SURCHARGE Yes '� No WATERCONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CH�CK LIST Zoning District: 6lR•1� <br /> Fire Department: nr l.� Post O�ce: (if�t•G� School District: ��a <br /> Lot Area: Sq.ft. �Uo C ff►9v�- Acres Width — Depth —" <br /> � <br /> Survey Submitted: Yes_� No Date of Survey: ON �=�� <br /> Proposed Setbacks: <br /> Fron[ (�e): 1'ZS � t Right Side: �S � N <br /> Rear (Si�eet): �� ' � Left Side: J 00` 5 <br /> Adjacent Structures: ^! �/�' Wetland: �s •k. <br /> Building Hei�ht: Def. Hgt. — Peal:Hgt. `— <br /> Lot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Sep[ic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: y-2S <br /> Avg. Setbac� p c IL Bluff Setback: � /� L.ot Coverage: <br /> Ezisting Proposed <br /> Hardcover: 0-7�' <br /> 75-250' �` �- <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No�� Date of Council Approval: <br /> REl�1ARKS (in house): <br /> 7 <br />