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� CHECK OFF LIST FOR ISSUANCE OF PERA�IITS <br /> FOR OFFICE USE ONLY <br /> � ADDRESS OR LEGAL: Z S6C� �v,vw���� <br /> PID: <br /> DESCRIPTION OF WORK: �C�t� <br /> Z0�11i tG REV�W BY: DATE APPROVED: b -��- �i g <br /> BUILDING REV�`V BY: DATE APPROVED: l� •�� -�� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓' No <br /> PLAN REVIE`V _ Yes � No SEWER CONNECTION <br /> STATE SURCHARGE Yes ✓ No WATERCONNECTION <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: G.2-l C- <br /> Fire Deparcment: �v.M/J Post Office: Vyt1� -vt�T1�1 School District: f�J�PSTtanlit�f- <br /> Lot Area: Sq.ft. M� G��►o�ni�c Acres — Width -- Depth — <br /> Survey Submitted: Yes �. No Date of Survey: b-f3 �q�''1 <br /> Proposed Setbacks: � <br /> Front(�): �� Right Side: 2g,4 <br /> Rear (Street): r 5� ` Left Side: 37 ' <br /> Adjacent Structures: r4-T7''►ac,.i-r`.M Wetland: /�1 I� <br /> Building Hei�ht: Def. Hgt. — Peal:Hg[. — <br /> Lot CoveraJe: c�•(Z <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: �,-t S <br /> Avg. Setback iv/�- Bluff Setback: N/�- Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' ' <br /> 75-250' O.�� <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No oL Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />