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' ' CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> AD�DRESS OR LEGAL: � (os C �sT�C- Glt�Z:K <br /> ' PID: <br /> '� <br /> DESCRIPTION OF WORK: N Ew t2�5 <br /> - - ---- -------------------------------------------------------- ----- <br /> ZOrTvi G REVIEW BY: � DATE APPROVED: /-!b � Z <br /> BUII.DING REVIEW BY: � DATE APPROVED: /- 1� •o Z <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER�I�IIT Yes ✓' No <br /> PLAN REVIEW Yes � � No SE`VER CONNE�"ITON <br /> STATE SURCHARGE Yes t/ No WATERCONNECTION <br /> INVESTIGATION FEE Yes No �G PARK FEE <br /> SAC Yes No _� SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> Z01�1I�tG CH�CK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Dep[h <br /> Survey Submitted: Yes x No Date of Survey: �2-1'� -�1 <br /> Proposed Se[backs: <br /> Front (L-e�e): S(9•`-I Right Side: '-� �•3 <br /> Rear (Sucet): 2�15� t Left Side: �7•�7 <br /> Adjacent Structures: /J /�/�- Wetland: 2 1 � � <br /> Building Height: Def. Hgt. Z y Peal:Hgt. Z S�.� <br /> Lo[Coverage: N�/�- <br /> Grading: Staff Approval Date: 1 - i to - �2 By: ��. Council Approval Date: — <br /> Septic: Staff Approval Date: 1 -l fU il�� By: 1'� <br /> Zoning File: # Resolution: # -- Resolution Date: <br /> Shoreland Dis[rict: /v V <br /> Avg. Setback: Bluff Setback: Lot Covera;e: <br /> Existin; Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> RENIARKS (in house): <br /> 7 <br />