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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: —7�31 t=c R�l t7�� <br /> PID: <br /> DESCRIPTION OF WORK: �o l-- <br /> ZO�TG REVIEW BY: DATE APPROVED: S•Z2,-c� <br /> BUILDING REVIEW BY: DATE APPROVED: S• • z z, - v� <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 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 Districc: <br /> r1° �, Fire Department: Post Office: School District: <br /> ��/ Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes No Date of Survey: �� <br /> Proposed Setbacks: <br /> Front(L-�ce): ��� t Righ[Side: 3v � � <br /> Reaz(�eeE}: �(?(� Left Side: /�D � f— <br /> Adjacent Structures: $� ' Wetland: <br /> Building Height: Def. Hgt. Peal:Hgt. <br /> Lot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resolu[ion Date: <br /> Shoreland District: y�� <br /> Avg. Setback: N r/�' Bluff Setback: �/� L,ot Coverage: �/� <br /> Ezisting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' Z 3.r� <br /> Hardcover Variance Required: Yes No_�C Date of Council Approval: <br /> REMARKS (in house): _ <br /> 7 <br />