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, `� CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 1(��' ��,�N (J(a v� <br /> PID: <br /> DESCRIPTION OF WORK: o o l <br /> ZO.�i 1G REVIEW BY: DATE APPROVED: �(- 3 � - �2 <br /> BUII.,D�1G REVIEW BY: � DATE APPROVED; y - 3 � -U'L <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER�l�1IT Yes � No <br /> PLAi�1 REVIEW Yes � No SEWER CONNECTION <br /> STATE SURCHARGE Yes c� No WATER CONNECTTON <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: <br /> Fire Department: Post Office: School District: <br /> L,ot Area: Sq.fr. Acres Width Depth <br /> Survey Submitted: Yes oc No Date of Survey: e�r.r ��c� <br /> Proposed Setbacks: <br /> Front (L-e�ce): (9 U Right Side: �f j + <br /> Rear (St�eet): (,S Left Side: Z 5� � ±' <br /> Adjacent Structures: ti 6 � Wetland: N �� <br /> Building Height: Def. Hgt. — Peal:Hgt. '— <br /> Lot Coverage: — <br /> Grading: Staff Approval Date: ^ By: Council Approval Date: <br /> Septic: Staff Approval Date: �l ' �v • D Z- By:�� . <br /> Zoning File: # — Resolution: # � Resolution Date: <br /> Shoreland District: �v <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hazdcover: 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 />