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.� f R <br />� � CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 2s 5 �-}-o���,�,,�e� ((,�,an <br /> PID: <br /> DESCRIPTION OF WORK: GRlL��� A�o�na� <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING REVIEW BY: DATE APPROVED: g-S�z <br /> BUILDING REVIEW B : ._ DATE APPROVED: S•�-n Z <br /> ------------------------------------------------------------------------------------------------------------------------ <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 WATER CONNECTTON <br /> INVESTIGATION FEE Yes No ✓- PARK FEE <br /> SAC Yes No !i SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes_� No Date of Survey: /D•23-0 ! <br /> Proposed Setbacks: <br /> Front(�al�e�: (31' t Right Side: (2 5' <br /> Rear(r�reet}� �70' Left Side: / �'-I•�� <br /> Adjacent Structures: q-T-���`r� Wetland: it! /r9 <br /> Building Height: Def. Hgt. U.1,c. Peal:Hgt. " <br /> Lot Coverage: ^//A� <br /> Grading: Staff Approval Date: " By: Council Approvai Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # -" Resolution: # Resolution Date: <br /> Shoreland District: /J o <br /> Avg. Setback: Bluff Setback: L.ot Coverage: <br /> Existing Proposed <br /> Hardcover: 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 />