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' CHECK OFF LIST FOR ISSUANCE OF PER.�I�IITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: ���s c-c>x 1=A Z� R-o�A� <br /> PID: <br /> DESCRIPTION OF WORK: (�o(Lu� ,� nv� � r� o� <br /> ------------_______________------------------------- <br /> ZO�TING REVIEW BY: DATE APPROVED: �/-/� �0 3 <br /> BUILDING REVIEW BY: ,,,� DATE APPROVED: y-r�t `a�2 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes _� No <br /> pL� g��EW Yes � No SEWER CONNECTION <br /> STATE SURCHARGE Yes c/ No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZO�'Il�1G 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: 9•Z-g -'� 5 <br /> Proposed Setbacks: � <br /> Front (v�< �to' r Right Side: �Yo� <br /> Rear (��): `l�`� Left Side: 135' � <br /> Adjacent Structures: h�'��v.� Wetland: ill�- <br /> Building Hei�ht: Def. Hgt. �- Peal:Hgt. --- <br /> Lot Covera�e: � <br /> Grading: Staff Approval Date: _ By: Council Approval Date: <br /> Septic: Staff Approval Date: -- BY� <br /> Zoning File: # — Resolution: # Resolution Date: . . <br /> Shoreland District: /U� <br /> Av�. Setback: Bluff Setback: L.ot Coverage: <br /> ExistinQ Proposed <br /> a <br /> H ardcove r: 0-75' <br /> 75-2�0' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />