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: _ . <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> , FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �q �� �=�c,�;�,r.,-�-; �� <br /> PID: <br /> DESCRIPTION OF WORK: (ac.uc <br /> --------------------------------------------------------------------------------------------------------- <br /> ZO�TING REVIEW BY: �J U',i�.- DATE APPROVED: �,-S-0 3 <br /> BUII�DING REVIE`V BY: � �1.�:..._ DATE APPROVED: `_s-_ o� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERIVIIT Yes /' No <br /> pLAIv REVIEW Yes �✓' No SEWER CONNECTION <br /> STATE SURCHARGE Yes ✓ No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> --------------------------------------------------------------------------------------------------------------------- <br /> ZOrTvi G CHECK LIST Zoning District: L,�- �C. <br /> Fire Department: Post O�ce: School District: <br /> Lo[Area: Sq.ft. Acres �� Width Depth <br /> Survey Submitted: Yes p� No Date of Survey: Z- � � c��' <br /> Proposed Setbacks: <br /> F�et3t (La�ce): ii ?s Right Side: + 7 � <br /> �; ilt�u' <br /> ,]�g��eetj: 1�-t Z- Left Side: S� <br /> Adjacent Structures: 3 3� Wedand: �� �/� <br /> Building Hei�ht: Def. Hgt. — Pealc Hgt. — <br /> Lot Covera�e: -- <br /> Gradin�: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # v y- ��"y�� Resolution: # Resolution Date: �-?7-�.� <br /> Shoreland District: ��y <br /> Av�. Setback: C�.�� Bluff Setback: �f i/� L,o[Coverage: — <br /> Existing ,,,;/ ` Proposed�c,�, � <br /> Hardcover: 0-75' 'Ll 3� / y'. `� `�� 3' � `ry -�� <br /> 75-2�0' '��• q <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes ;x No Date of Council Approval: �-27-�� <br /> REMARKS (in house): <br /> 7 <br />