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, • <br /> CHECK OFF LIST FOR ISS UANCE OF PERMITS <br /> FOR OFFICE USE ONL Y � <br /> ADDRESS OR LEGAL: � �� � }�'�X ��, � S� �� <br /> PID: ' <br /> DESCRIPTIDNOFWO/R.,�K: � �-� ��c:�✓ �'�'�f��cz"�`�Iiv'�' C�%h' r� /.� �iCa <br /> �_ :.. �.!'f(��I�,G.(�/�C7C;�_'L���_�1�11XlL��'1�C��.L�t�LL��"IsC_��_�����������_��_ <br /> ZOliTING REi�IEW BY.• DATEAPPROTIED: � -�j <br /> BUILDING REVIEW BY: DATEAPPROijED: ��Q - S -0 7 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By�W ��____�_�M__ <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 OTHER (specify) <br /> -----------------------------------------------------� ---------------------------------___---------------- <br /> ZONING CHECK LIST Zoning District: /� �� <br /> Fire Department: Post Office: School District: <br /> i <br /> Lot Area: Sq.ft. Acres Width ��.��� Depth ��Q ,, <br /> Survey Submitled: Yes ,,� No Date of Survey: 3 - ��� — 7�C��eju���J <br /> Proposed Setbacks: ����h <br /> Front fb�elr�: �b Side: ��� � /U� <br /> Rear S� �, � , <br /> (��� ,� C'���-/�r �'Side: �.���9'<� �C�r�'�'/Y//l'l�"P!/Y�OS.t'S' <br /> Adjacen!Structures: �� Wetland: �-� 1�r(�F�7 lC G/� <br /> Building Neight: Def. Hgt. ��� Peak Hgt. <br /> Lot Coverage: <br /> Gruding: Staf{,4pproval Date: _ By: Council Approval Date: <br /> Septic: StaffApproval Dale: By: �i'� <br /> Zoning File: # Resolution. # Resolution Date: <br /> /� � /S Er��l�� 1� �cr;' �rer� C�.�� C_K. C/�. <br /> Shoreland Disti-ict.� � MCWD Permit: � <br /> Avg. Setback: BluffSetback: LotCoverage: <br /> F�isting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-.i 00' <br /> 500-1000' <br /> Ha��dcover Variance Required: Yes No Date of Council Approval. <br /> REMARKS(in house): <br /> 33 <br />