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CHECK OFF LIST FOR ISSUAI�ICE OF PERMITS <br /> ' � FOR OFFICE USE ONLY <br /> 'ADDRESS OR LEGAL: 3y5� Gi?�Sil�c- �cs��-c: <br /> • PID: <br /> DESCRIPTION OF WORK: ,(��a,� <br /> ZO��T�1i G REV��V BY: DATE APPROVED: l 1-z�• n S <br /> BUILD�G REVIE�V BY: DATE APPROVED: � i. z,-o� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes c/ No <br /> PLAN REVIEW Yes �' No SEWER CO1�iVECTION <br /> STATE SURCHARGE Yes _�/ No `VATERCONIVECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> --------------------------------------------------------------------------------------------------------------------- <br /> ZOi�1I�1G CH�CK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Se.ft. (,�57.3`� Acres . I5� Width � Depth / 35./ S �e <br /> Survey Submitted: Yes �_ No Date of Survey: Il-ib-bs <br /> Proposed Setbacks: <br /> Front (�ej: _ 3�' Right Side: i 3� <br /> Rear (�rcetj: �� � Left Side: Ib� <br /> Adjacent Structures: q-�-�qec�ti� Wetland: /v"1� <br /> Building Height: Def. H�t. � (A-- Peal:Hgt. — <br /> Lo[ Covera�e: (_,ESs �-{�lArc ►�o�s� -�r <br /> Grading: Staff Approval Date: �J I�P By: Council Approval Date: <br /> Septic: Staff Approval Date: nl(F�- By: <br /> Zoning File: #_ — Resolution: f# — Resolution Da�e: <br /> Shoreland District: �o.�s <br /> Avg. Setbac� �r ig- Bluff�ecback: �/� �ot Covera�e: <br /> ��5��� Proposed <br /> Hardcover: 0-7�' <br /> 7�-2�0' . <br /> 2�0-500' <br /> �00-1000' ��3•�( �� <br /> Hardcover Variance Required: Yes No�_ Dace of Council Approval: <br /> ���.��2�� (an�ouse): <br /> 7 <br />