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CHECg OFF LIST FOR ISSUANCE OF PERMITS <br /> ' FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: j�� �� � ��r�� �G✓ �.� <br /> PID: <br /> DESCRIPTION OF Yi'ORK.• � ,���;;� � <br /> - Ir r c < c�.-� ik , �c ��l c.�,-,�c �'/ <br /> ZONINGREijIEWBY.• �' DATEAPPROT�ED: G, �i �;C� <br /> BUILDING RET�IEW BY.• DATEAPPROVED: S�-z� -v c� <br /> FEES TO BE CHARGED: / Misc. Fees Calculated By: <br /> PERMIT Yes r/ No <br /> PLAN REVIEW Yes �/ No SEWER CONNECTION <br /> STATE SURCHARGE Yes ✓ No N�ATER CONNECTION <br /> IIVVESTIGATION FEE Yes No � PARK FEE <br /> SAC Yes No� SITEINSPECTION <br /> 1Vumber of SAC Units OTHER (spec�) <br /> ZONING CHECg LIST Zoning District: (_ � -. � ' <br /> Fire Department: Post Office: <br /> School District.• <br /> Lot Area; Sq.ft. • Acres ., l l7 Width <br /> Depth <br /> Survey Submitted: YeS_� No ���'�� <br /> Date of Survey: � <br /> Proposed Setbacks: f�;G C�1�-1'G'��U (b C v v� �rCf S���l C� <br /> Front(L�ef• ('�' �G�� Right Side: <br /> Rear(Street): Left Side: <br /> Adjacent Structures: Wetland: <br /> i % <br /> Building Height.� Def. Hgt. ;� peQk H� z ��} r <br /> Lot Coverage: <br /> Grading: Staff Approval Date: a�=��1!�- By. Counci!Approval Date: <br /> Septic: Staff,4pproval Date: � J� By. ��- <br /> Zoning File: # � � �'��'C Resolution: # ' c <br /> 1� � Resolution Date: Z � Cj <br /> iC� �/�ftrrc'1 .� i��Gl�� -t�c.-,a�; �c��i��i�� � � <br /> Shoreland District: � ~�`�"��z"� �� �G 5��� �ri /'7�ti';c �Z/r-f-,�, �;/��p��� <br /> MCNrD Permit.• i�� <br /> Avg. Setback: BluffSetback. — <br /> Lot Coverage.• <br /> Fxisting Pro osed <br /> Hardcover: 0-75' p <br /> �?C� �;����(� �s-zso� <br /> 2so-soo� <br /> �00-1000' <br /> Hardcover Variance Reguired.� 3es No <br /> Date of Council.4pproval: <br /> REMARKS(in house): <br /> 33 <br />