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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: � q Z, (o F AG(=RN t55 �P b�..�-r (�,o�-✓� <br /> PID: <br /> DESCRIPTION OF WORK: (�J L.W �Z�S <br /> -------------------------------------- ------- ------------------------------------------------------------------- <br /> ZONING REVIEW BY: DATE APPROVED: �/• 2 - d/ <br /> BUILDING REVIEW BY: DAT'E APPROVED: y - Z-0( <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIEW Yes � No SEWER CONNECTION <br /> STATE SURCHARGE Yes � No WATER CONNECTION <br /> INVESTIGATION FEE Yes No �/' PARK FEE <br /> SAC Yes No � SITEINSPECTION <br /> Number of SAC Units �yLq�sr� �'itc►•►-. �wt,sOTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST Zoning District: C K-1 � <br /> Fire Department: ��,.r� Post Office: �/�/1n,v,.,� School District: �,eSlvNYt-4 <br /> �(•51 <br /> Lot Area: Sq.ft. �,O�� Acres , l�j Width (l�o Depth � {C�tl.JQ <br /> Survey Submitted: Yes X No Date of Survey: oc..T" 5 �.o 0 0 <br /> Proposed Setbacks: , <br /> Front (�ej: �1 Right Side: llo- 2 <br /> Rear (S�e�i): Z�� Left Side: (b• � <br /> Adjacent Structures: N�I>- �Vetland: N�� <br /> Building Height: Def. Hgt. �Zi Peak Hgt. Z�.5 <br /> Lot Coverage: ��,�iv1 ✓�, <br /> Grading: Staff Approval Date: S ' 11 - � ` By� ��v- Council Approval Date: — <br /> Septic: Staff Approval Date: /U //�?' By: <br /> Zoning File: # Z b Z 3 Resolution: �#�f5 Z`� Resolution Date: / z • / r• ?�c�a� <br /> Shoreland District: �.R- �C. <br /> Avg. Setback: �•�c Bluff Setback: r.7 I/� Lot Coverage: �/h(L�,�.�� <br /> Existing Proposed <br /> Hardcover: 0-75' 29�/o Z lo�D <br /> 75-250' �_ <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes � No Date of Council Approval: /2- 1 1 -?�o� <br /> REMARKS (in house): <br /> 27 <br />