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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z c�� o f��.C1z r2�� -r�z�►L <br /> PID: <br /> DESCRIPTION OF WORK: N L w �Z�. S <br /> - -- =------------------------------------------------------=------------ <br /> ZOrT�ti G REv�W BY�— DATE APPROVED• Z � -o z <br /> BUILDI�i 1G REVIEW BY: DATE APPROVED: 2 • u�- �Z. <br /> — --- -- -----------------------------------__=-�:_--------------------- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes �/' No <br /> PLA��1 REVIEW Yes ,� No SEWER CONNE�"ITON <br /> STATE SURCHARGE Yes �/ No WATERCONNECITON <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 Districr. 22- � � <br /> Fire Depar[ment: Post Office: School District: <br /> Lot Area: Sq.ft. Z + '—�" Acres Width �R�-T6Jth/l. Depch <br /> Survey Submitted: Yes < No Date of Survey: Z-► � - 0 2 <br /> Proposed Setbacks: <br /> Fron[ (�: � �Z Right Side: ��•S � <br /> Rear (Street): 1 �0 Left Side: 1 Z�I � <br /> Adjacent Structures: /�J //�. Wetland: �u � '+' <br /> Building Height: Def. Hgt. 3�' Peak Hgt. ,35� <br /> Lot Coverage: N 1� <br /> Grading: Staff Approval Date: 2_ � . o Z By: �� • Council Approval Date: N��o <br /> Septic: Staff Approval Date: 2, �y� -v L gy; M.(�i. <br /> Zoning FIle: # — Resolution: # �' Resolution Date: <br /> Shoreland District: N(� <br /> Avg. Setback: Bluff Setback: L.ot Coverage: <br /> Existing 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 /> REMARKS (in house): <br /> 7 <br />