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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> � FOR OFFICE USE ONLY <br /> � ADDRESS OR LEGAL: ) �4 5 F� � ,�,n 6 c czo,�a� <br /> PID: <br /> DESCRIP'I'ION OF WORK: A iJ✓J r r iv�-► f R,.�-n.�,���e� <br /> ---------- -_—__ <br /> ------ _____--------------------------------- --- - -- -- --- -- <br /> ZOrTvi G REVIE`V BY• �_ DATE APPROVED: s'-� t-o s <br /> BUILDING REVIE`V BY: DATE APPROVED: 5--i z-�� <br /> FEES TO BE CHA.RGED: Misc. Fees Calculated By: <br /> PERMIT Yes l/ No <br /> PLAN REVIEW Yes _� No SEWER CONNEC'TION <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 /> --------------------------------------------------------------------------------------------------------------------- <br /> ZO��tG CH�CK LIST Zoning District: <br /> Fire Deparcment: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Dep[h <br /> Survey Submitted: Yes ✓ I�10 Date of Survey: o i.r ��l,l <br /> •�� <br /> Proposed Setbacks: <br /> Froat (L�e�: �p o � Right Side: SS� <br /> Rear (Street): 95 � Left Side: �' <br /> Ad;acent Structures: N�A Wetland: N/A <br /> Buildin� Height: Def. Hgt. �, ,� Peal:Hgt. --- <br /> Lot Covera�e: O , (� <br /> Grading: Staff Approval Date: /�J (A By: Council Approval Date: <br /> Septic: Staff Approval Date: n/� � By: <br /> Zoning F:le: # — Resolution: # Resolution Date: <br /> Shoreland District: �V-o <br /> Av�. Setback: Bluff Setback: Lot Coverage: <br /> Ezisting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> RENLARKS (in house): <br /> 7 <br />